Back ground: Complex gap nonunion of tibia following open fractures and osteomyelitis with pathological fractures in children is a treatment challenge with unpredictable outcome. Treatment options available are bone transport, bone grafting, induced membrane technique, allograft reconstruction and Huntington procedure (ipsilateral transposition of vascularized fibula). There is no consensus in the literature about which technique is optimal in the given situation. The purpose of the present study is to evaluate the role of Huntington procedure in the management of complex gap nonunion of tibia in paediatric patients. Material and method: Eighteen patients (11 males and 7 females) with a mean age of 8.4 years (range 3 e12 years) having complex gap nonunion of tibia with an average bone defect of 6.6 cm (range 5e17 cm) were treated with Huntington procedure between June 2008 to December 2016. The mean follow-up was 4.3years (range 3.5e6 years). Result: Union was seen in all except one, with an average time to union being 11.5 weeks and13.8 weeks at proximal and distal tibio-fibular synostosis respectively. Revision plating was done in one patient with nonunion. Hypertrophy of fibula was seen in all patients. One patient developed 15 ankle varus and required corrective osteotomy. Ankle was fixed in equinus in three patients with a mean value of 13.3 (range 5 e25 ). Lambrinaudi procedure was done to correct 25 fixed ankle equinus in one patient. Fixed flexion deformity of knee was seen in nine patients with a mean value of 9.7 (range 5 e20 ). Two patients had iatrogenic foot drop; one recovered completely and one had only partial recovery. Shortening was seen in eight patients with a mean value of 3.5 cm (range 1e5 cm). At final evaluation 9 patients were very satisfied, 8 satisfied and 1 was dissatisfied. Conclusion: Huntington procedure is a useful limb salvage surgery for complex gap nonunion of tibia in children. However; further improvements in the surgical technique are needed to increase the patient satisfaction by reducing the risk of complications.
Epiphyseal injuries of distal femur are rare with an incidence of 1%–6% among all physeal injuries. Prompt diagnosis and appropriate surgical treatment is crucial to achieve satisfactory functional outcomes. A conjoint bicondylar coronal split (Hoffa) fracture with complete transaction of ipsilateral patellar tendon has been reported in a 12 year old child. The injury was managed by open reduction and internal fixation and bone to tendon repair. This case emphasizes the need of accurate intraepiphyseal fixation for the management of these fractures in skeletally immature patients.
Giant cell tumor (GCT) is a benign locally aggressive tumor with a tendency for local recurrence. GCT of metatarsal is of rare occurrence with very few cases reported so far. GCT in this location is rare and should be considered in the differential diagnosis of a destructive bony lesion in both skeletally immature and mature patients. We report the case of GCT of 1 st metatarsal in a 28-year-old female and discuss the difficult aspects of diagnosis.
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