Gradual fibular transfer by Ilizarov external fixator is a reliable technique in management of post-traumatic and post-infection large tibial bone defects with good clinical outcome, and with few complications.

Background: Capitate shortening is the best decompression procedure in the management of Kienböck’s disease in patients with ulnar neutral or positive variance, although carpal collapse develops inevitably. The current study was to report our experience in partial capitate shortening osteotomy as an alternative procedure. Methods: This was a prospective study of 20 patients with Lichtman stage II and IIIa Kienböck’s disease managed by partial capitate shortening osteotomy. Results: At final follow-up (average 36.5 mo), visual analog pain scores improved significantly postoperatively to 3.3. Flexion and extension improved from 62% (±17%) and 52% (±21%) preoperatively to 63% (±13%) and 68% (±13) postoperatively, respectively. The power grip improved significantly from 49% (±16%) to 63% (±12%) postoperatively. The average quick Disability of the Arm Shoulder and Hand Score improved from 60.8(±13.8) to 38.3(±13.9) postoperatively. Conclusions: Partial capitate shortening is a simple and effective procedure for the management of ulnar neutral or ulnar positive Kienböck’s disease before the onset of radiocarpal arthrosis without violation of scaphocapitate joint thus avoiding carpal collapse that follows complete capitate shortening. Type of Study/Level of Evidence: Therapeutic IV.

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Background:Although the incidence of rotational lower-limb deformity caused by malunited femoral fractures is low, it can alter the force transition across lower limb joints. The aim of the current study was to evaluate the effectiveness of the Taylor Spatial Frame (TSF) in the treatment of severe rotational lower-limb deformities that were caused by neglected malunited femoral fractures in pediatric and adolescent patients. Methods:Fifteen skeletally immature patients, six boys and nine girls with mean age of 10.17 yr (range: 7 to 14 yr), who had rotational deformities of the lower limbs and had osteotomies and application of TSF from March 2012 to February 2016 underwent clinical and radiographic assessments. Results:The osteotomy site was at the middle third of the femur in 12 patients and at the supracondylar region in three patients. The mean correction time for the femoral rotational deformity was 19.6 days (range: 15 to 28 days). The mean time for fixator removal after full correction of rotational deformity and lengthening was 172.67 days (range: 150 to 180 days). The mean preoperative leg-length discrepancy (LLD) was 4.31 cm (range: 2 to 10 cm), and the mean postoperative LLD was 0.27 cm (range: 0 to 2 cm; P < 0.001). Femoral torsion was internal in 10 patients and external in five patients. The mean preoperative rotational deformity was 81 degrees (range: 60 to 180 degrees); the mean postoperative rotational deformity decreased significantly to 3.53 degrees (range: 0 to 7 degrees; P < 0.001). Conclusions:TSF was effective in treating severe rotational deformities of the lower limbs that were caused by neglected malunited femoral fractures in pediatric and adolescent patients.