Aim

External fixator knee arthrodesis is a salvage procedure mainly used in cases of end-stage infected total knee replacement (iTKR). A stable fixation combined with bone-ends compression is basic to achieve knee fusion in such a scenario but providing enough stability can be challenging in the presence of severe bone loss after multiple previous procedures. Compared with monoplanar configuration, a biplanar frame achieves improved coronal stiffness, while providing the advantages of good access to the wound and allowance of early ambulation. Our primary hypothesis stated that a biplanar frame would achieve higher and quicker fusion rate than a monolateral configuration.

Aim. This study assessed quality of life (QoL) in patients having external fixation for treatment of osteomyelitis and fracture-related infection (OM/FRI). Method. Patients who had surgery for OM/FRI and who completed the EuroQoL EQ-5D-5L or EQ-5D- 3L questionnaires, were identified between 2010 and 2020. Patients were followed-up for 2 years after surgery. QoL was compared between patients who had either an Ilizarov frame or a monolateral external fixator with those who did not receive external fixation. Results. 165 patients were included. Of these, 37 (22.4%) underwent application of external fixation which included 23 circular frames and 14 monolateral external fixators. Patients in the frame group had more BACH ‘Complex’ infections (34/37; 91.9%), compared to non-frame patients (57/81; 70.3%). Pre-operatively, the mean EQ-index score for patients planned to receive a frame (0.278 SD 0.427) was worse compared to other treatments (0.453 SD 0.338, p=0.083). At 6 weeks after surgery, the EQ-index score remained significantly lower in frame patients compared to non-frame patients (frame: 0.379 SD 0.363; no frame: 0.608 SD 0.326, p=0.016). By 6 months, 26/37 patients had undergone frame removal. The patients who had frames in situ at 6 months had lower EQ-index scores when compared to patients who had their frames removed (frame in situ: 0.187 SD 0.213; frame removed 0.674 SD 0.206, p=0.076). At one year, 36/37 (97.3%) patients had their frame removed. QoL had greatly improved, to levels similar to non-frame patients (no frame: 0.652 SD 0.357; frame removed: 0.657 SD 0.247, p=0.949). Conclusions. Frame treatment leads to significant improvement in Quality of Life in patients suffering from osteomyelitis, with similar results in EQ5D scores after 1 year compared to patients who did not need an external fixator. These effects cannot be felt until after the frame has been removed with impaired QoL during frame treatment, especially in those patients with frames in situ for more than 6 months. This underlines the need for close and professional patient support during frame treatment for bone infection

BACKGROUND. Most closed tibial fractures in children can be treated conservatively. On the occasions that surgical intervention is required, there are various options available to stabilise the fracture. We would like to present our experience of using monolateral external fixators in the management of closed tibial fractures. Aim. We sought to assess the time to healing, limb alignment, and complications observed in a cohort of tibial fractures treated with external fixation. METHODS. Our limb reconstruction database was used to identify patients who underwent monolateral external fixation for a closed tibial fracture between January 2008 and December 2016. Radiographs of all patients were assessed to determine the original fracture pattern. Time to union was assessed as the time when the fixator was removed and the patient allowed to mobilise independently without any further support of the limb. The presence or absence of residual deformity was assessed on final follow-up radiographs. RESULTS. 22 patients fulfilled the inclusion criteria. 78% of patients had both tibial and fibular fracture. The mean age at injury was 12 years. The mean time taken for the fracture to heal was 18 weeks. The total duration of follow-up averaged 9 months. The mean Valgus deformity at the final follow up was 4 degrees and the mean Varus deformity was 4 degrees. The mean procurvatum was 4.2 degrees and the mean recurvatum was 6 degrees. 50% of patients had pin site infection. Two patients had tibio fibular synostosis. None of them had leg length discrepancy or refractures. There were no episodes of osteomyelitis. CONCLUSIONS. Five degree of coronal plane deformity and ten degree of sagittal deformity were considered as acceptable in children due to their potential for remodeling. All our patients had acceptable levels of residual deformity. In our opinion monolateral external fixation represents a safe and effective option

Fractures of the distal metaphysis of the tibia represent 7–10% of tibial fractures and less than 1% of the lower limb fractures. Their treatment is difficult and presents a high percentage of bad results because of comminution of the metaphyseal bone fragments, articular involvement, poor circulation in the distal third of the leg. Until few years ago, in presence of a comminuted fracture, the only surgical possibility was the use of plate and screws. The external fixation represented a temporaneous treatment in case of open fracture or severe soft tissue damage. The recent technology applicated to external fixation has transformed the external fixator in synthesis device less uncomfortable, to increase the compliance of the patient, and more stable, to be used in the definitive treatment of this fractures. Recently we change the external fixator with double ring in a monolateral external fixator with single ring, in the “hybrid frame”

Background. Although minimally invasive plate osteosynthesis (MIPO) has become popular option for humeral shaft fractures, indirect reduction and its maintenance are technically challenging. The purpose of this study is to describe a reproducible technique utilizing an external fixator during MIPO and to assess its outcomes. Methods. Twenty-nine cases with a mean age of 37.1 years were included. There were 7 simple (type A) and 22 comminuted (type B or C) fractures. Indirect reduction was achieved and maintained by a monolateral external fixator on the lateral aspect of humeral shaft, and MIPO was performed on the anterior surface. Union, alignment, complications, and functional results of the shoulder and elbow were assessed. Results. Twenty-eight of 29 fractures were united with a mean of 19.1 weeks including 3 delayed unions. The mean follow-up period was 20.8 months. There was one hypertrophic nonunion, which was healed after fixing two additional screws. None had angulation greater than 10 degrees in the coronal and sagittal planes. Mean constant shoulder score and mean Mayo elbow performance score were 89.1 and 95.5, respectively. There was no direct damage to nerves related to the pin of external fixator, while two cases of radial neuropraxia developed, which recovered within 2 months after operation. Conclusion. Assisted by the preliminary external fixation, MIPO may achieve successful outcomes for humeral shaft fractures

The aim of this paper is to describe the technique and evaluate the effectiveness of the RIA system in the first cases of bone loss treated by the authors with this technique. Between January 2010 and January 2011, ten patients were treated with an average age of fourty six years, with infected bone loss as a result of open fractures in various bone segments, with multiple failed treatment attempts, including three humeri, four femurs and three tibiae. The average size of the initial bone loss was 4 cm, varying from 1 to 8 cm. In 4 patients it was used simultaneously a Ilizarov apparatus with acute compression of the focus, in two patients a Ender pin and monolateral external fixator, three other cases with a SAFE nail with core with antibiotics and in one case an osteosynthesis with a plate and screws. The RIA was introduced with a percutaneous technique with a one pass drilling. The graft thus collected was mixed with appropriate antibiotics and aplied at the defect. The volume of the harvested graft, complications of the donor and recipient and the final results was recorded. The review showed that the average volume of graft was 60 cc, from 20 to 90 cc. In two female patients older than 70 years with osteoporosis, insufficient bone of poor quality was obtained. Problems included a case of iatrogenic fracture of the donor site, due to poor surgical technique and a case of relapse of the nonunion. Regarding the effectiveness of grafts extracted with the RIA system, 90% of the cases achieved consolidation in average of 5 months after grafting, range 3–9 months. This short experience with the RIA system showed that it is an attractive method allowing a rapid removal of a large volume of bone graft with a minimally invasive approach and a short learning curve. It is not indicated in elderly patients with osteoporosis and those with a narrow medullar canal less than 11 mm. Special attention must be done to the need to choose a drill no larger than 1 mm of the diameter of the isthmus, to do a single entry point and with only one drill passage to prevent the weakening of the donor site

Malformation and hypoplasia of the clavicle can result in pain, impaired function, restricted shoulder movement, subjective feeling of instability and cosmetic deformity. There are no reports of clavicle lengthening by osteotomy and distraction osteogenesis (DO). This is a retrospective review of 5 patients (7 clavicles) who underwent clavicle lengthening by DO using a monolateral external fixator for clavicular hypoplasia. There were 3 males and 2 females with mean age 15 years (9 to 23) and mean follow-up 21 months (8 to 51). Preoperative diagnoses included Klippel-Feil syndrome, cleidocranial dysplasia with torticollis, congenital myopathy and Noonans syndrome and obstetric brachial plexus injury. Mean length gained was 31 mm (15 to 41) which represens an average of 24.7% of overall bone length. Mean time in fixator was 174 days (161 to 263) and mean external fixation index was 56 days/cm. Two patients required internal fixation following fixator removal to consolidate union and one required additional internal fixation for atrophic regenerate. Mean preoperative oxford shoulder score improved from 28.5 to 41 and all patients were extremely satisfied with their result. Two patients developed pin site infections. Clavicular lengthening by distraction osteogenesis for congenital clavicular hypoplasia is a previously unreported technique that enables gradual correction of deformity without risking brachial plexus traction injury following acute correction. It has the potential to improve shoulder pain, function, range of movement and cosmesis. Distraction ≥25% of overall bone length may require additional plate fixation to consolidate union

Objective: To compare the mechanical stability of fixation of bicondylar tibial plateau fractures using available internal and external fixation techniques. Method: A bicondylar tibial plateau fracture was simulated on a uniform synthetic bone and tested with loading to failure. Following power calculations, seven tibias were used for each fixation method; five types of fixation were tested: 1) Dual plating. 2) Ring Fixator with inter-fragmentary screws. 3) Hybrid fixator (Ring-Bar) with interfragmentary screws. 4) Lateral plate and medial monolateral external fixator. 5) Lateral plate and medial interfragmentary screws. The specimens were tested in compression to failure. The vertical subsidence in either medial or lateral plateau was measured using an electrical transducer. Results: In all cases the mode of failure was consistent with collapse occurring in the medial plateau. There was no significant difference in the ultimate strength between dual plating and the ring fixator [4218N, 4184N respectively; P=0.28, t test]. Failure was seen at lower loads with the other fixation systems (Table). Conclusion: The Ring Fixator and dual plating demonstrated a greater strength and the most stable fixation, choice may depend on tissue viability and surgeon preference. Furthermore mobilisation of the patient may be undertaken earlier with more confidence using these two methods rather than less stable techniques

The correction of axial deviation of the lower limbs in paediatric patients requires complete patient history and clinical examination. The correct approach to the deformity must consider:radiology,evolution,associated joint damage, neurologic diseases and surgical planning. Timing and choice of operation (osteotomy, assimetric epiphyseal distraction, hemiepiphysodesis, epiphysiodesis) are critical. Thirty-four paediatric patients with an average age of 10 years (range 2–18) were treated with a monolateral external fixator: 16 femoral osteotomies (nine post-traumatic, four congenital, one after radiotherapy for neoplastic diesease, one Ollier’s disease, one multiple exostosis) and 18 tibial osteotomies (eight congential, four post-traumatic, two multiple exostosis, two osteogenesis imperfecta, one neoplasm, one Ollier’s disease) were performed. The knowledge of normal physiologic values, angles and anatomical and mechanical axes are fundamentally important. In choosing which operation to perfom in patients with post-traumatic deviation, the controlateral limb, functional necessity, symptoms and possible compensation must be considered. External fixation appears to be necessary in the correction of lower limb deformities because of patient comfort in the femur, because it allows osteotomy in the apex of the deformity and because it is possible to perform lengthening and correction when necessary. We suggest performing lengthening and correction osteotomy at the same level when it is possible, whereas it is dangerous to perform it at the distal metaphyseal femur and distal third of the tibia

Introduction and Aims: The hypothesis that ‘utilisation of gradual distraction and soft tissue correction by external fixation improves outcomes in hand and wrist deformity’ was analysed in 29 extremities in 24 patients, to define the indications for gradual soft tissue correction of congenital and acquired deformity and distraction osteogenesis in hypoplastic digits. Method: This retrospective review of 29 extremities in 24 patients evaluated the role of monolateral external fixators with uniplanar (n=20) and multiplanar (n=9) correction capability (Orthofix, International). Evaluation included an assessment of complications, patient satisfaction, functional outcome, and impact on health-related quality of life. Results: The devices were successfully used to correct radial longitudinal deficiency of the radius (radial club hand) (n=9); digital hypoplasia (n=15) and wrist flexion contracture secondary to spasticity (n=5). There were no significant complications related to the devices. Pin track irritation and drainage occurred in two of 108 pins. One pin became loose and needed to be replaced, and one fixator required two intraoperative adjustments. Multiplanar fixators used for correction of radial club hands and wrist flexion contracture improved soft tissue position in allowing secondary bony procedures and/or tendon transfers. Distraction osteogenesis of metacarpals and phalanges (included seven previously transferred extraperiostial toe phalanges) was successful with an average lengthening of 2.1 centimetres. Conclusion: Gradual distraction and soft tissue correction improves outcomes in congential and acquired hand and wrist deformity in children and adolescents. Mono-lateral fixation devices allow correction with hinges or gears, enhance correction of complex deformity, and is well tolerated by patients and caregivers

Aim: Adequate length is an important prerequisite for a functional digit. Over the last 20 years small external fixators have been developed allowing the principles of distraction osteogenesis to be applied to the small bones of the hand. We present our experience in digital lengthening with the contemporary designs of external fixators. Methods: From 1998 to 2001, 14 patients (15 rays) were treated with metacarpal or phalangeal lengthening through distraction osteogenesis using a monolateral frame with two half-pins on each site of the osteotomy. The mean age of the patients was 21 years (7–48) and the indications were traumatic amputation in 8 and congenital amputation (transverse deficiency, brachydactyly, constriction band syndrome) in 6. The mean distraction period was 3 weeks and the mean consolidation period 7 weeks. No protective splinting or additional bone grafting was necessary. Results: The distraction callus consolidated in all patients. The mean total length gained was 17, 5 mm (68% of the original length). The mean treatment time was 2, 8 days for every mm of length gained. One patient suffered angulation at the distraction site due to hardware failure and the fixator had to be revised and in another bony prominence was noted necessitating trimming. No infection, fracture or half pin loosening were observed. Conclusions: Callotasis using contemporary monolateral external fixators is a reliable technique for digital ray lengthening. Meticulous preoperative planning and surgical technique and close observation of the patient during the distraction phase are necessary in order to avoid complications. Over 2 cm of lengthening can be achieved without bone grafting

Introduction: We present preliminary short term results of medial opening wedge high tibial osteotomy with hemicallotasis using a monolateral external fixator, combined with microfracturing, in younger active patients with established Grade IV medial compartment osteoarthritis. Methods: Prospectively collected data was analysed for 28 consecutive knees in 27 patients undergoing this procedure. Mean age was 47 years (range 28 to 64), follow up was 23 months (range 7 to 61). Results: Mean Lysholm scores improved from 63.6 before surgery (range 42 to 85) to 81.6 at latest follow-up (range 46.5–100) (p< 0.001). Similarly, the mean Tegner activity scale improved from 1.7 (range 1 – 4) to 3.3 (range 1 – 6) (p< 0.001). Average IKDC score at last follow-up was 68 (range 35.6 – 100). Mean pain score (visual analogue scale 0 to 10) improved from 5.5 pre-operatively (range 1 – 9), to 3.5 at latest follow-up (range 0 – 8) (p< 0.001). All but 4 patients reported improved pain scores. Superficial pin site infection occurred in 6 patients (21.4%) and settled with oral antiobiotics in all cases. One patient had persistent patellofemoral (PF) pain. Discussion: The use of hemicallotasis for high tibial osteotomy (HTO) in association with extensive microfracturing of the medial compartment provides a viable, minimally invasive method for management of the young active patient with medial compartment osteoarthritis, without the risk of serious complications. In the short term even with advanced full thickness cartilage damage, this provides effective pain relief, helps put off more major arthroplasty alternatives and improves activity levels

Introduction: We present preliminary short term results of medial opening wedge high tibial osteotomy with hemicallotasis using a monolateral external fixator, combined with microfracturing, in younger active patients with established Grade IV medial compartment osteoarthritis. Methods: Prospectively collected data was analysed for 28 consecutive knees in 27 patients undergoing this procedure. Mean age was 47 years (range 28 to 64); follow up was 23 months (range 7 to 61). Results: Mean Lysholm scores improved from 63.6 before surgery (range 42 to 85) to 81.6 at latest follow-up (range 46.5–100) (p< 0.001). Similarly, the mean Tegner activity scale improved from 1.7 (range 1–4) to 3.3 (range 1–6) (p< 0.001). Average IKDC score at last follow-up was 68 (range 35.6–100). Mean pain score (visual analogue scale 0 to 10) improved from 5.5 pre-operatively (range 1–9), to 3.5 at latest follow-up (range 0–8) (p< 0.001). All but 4 patients reported improved pain scores, one of whom had patellofemoral pain. Superficial pin site infection occurred in 6 patients (21.4%) and settled with oral antibiotics in all cases. Discussion: The use of hemicallotasis for high tibial osteotomy in association with extensive microfracturing of medial compartment provides a viable, minimally invasive method for management of the young active patient with medial compartment osteoarthritis, without the risk of serious complications. In the short term even with advanced full thickness damage, this provides effective pain relief, helps put off more major arthroplasty alternatives and allows patients an improved activity level. The external fixator provides a very stable functional stabilization, superior to other available methods of internal fixation

Numerous growth factors, together with bone morphogenetic proteins (BMP), are involved in the biological mechanism of bone induction. BMP 7 combined with collagen type 1 has shown to be effective in triggering the osteoinductive mechanism in the presence of bone defects as an alternative to bone graft. The aim of the present study is to present the experience gained at the Orthopaedic Clinic of Catania with BMP in lower limb non-union or pseudoarthrosis with bone defect after skeletal stabilisation. From December 2003 to May 2004 at the Orthopaedic Clinic Of Catania four patients were treated using OP 1. The study group comprised three women and one man with a mean age at the time of operation of 27 years (range 23– 32 years). One subject presented with non-union, two patients with normotrophic pseudoarthrosis and one with atrophic pseudoarthrosis. In all cases the bone defect was localised at the tibia. All patients were treated surgically with skeletal stabilisation (one with a monolateral external fixator, one with a T2 intramedullary nail and two with a Gross-Kempf nail) always after decortication of Judet. Three patients healed with a mean follow-up of 5 months. One subject is still under treatment. None of the patients have any pain and demonstrate complete weight bearing and functional capacity. X-rays showed good consolidation of bone defect. Clinical and radiographic results obtained at this point are more than fair. Healing time was short without any side effects. It is important to verify whether, in the treatment of lower limb non-union and or pseudoarthrosis, the osteoinductive capacity of the OP 1 could provide the same valid results without good reduction and skeletal stabilisation. The use of OP 1 is extremely interesting for many reasons. However, it would be extremely important to test whether the biological effect is not exclusively related to an optimal mechanical stability

Introduction. Knee arthrodesis is a limb salvage procedure considered as an alternative to an amputation in case of severely infected total knee arthroplasties, associated with large damage of the extensor mechanism. The techniques are various and the series in the literature not always homogenous. In this study we assessed the results of knee arthrodesis performed with two monolateral external fixators in two perpendicular planes . Material and methods . This retrospective series of 19 knee arthrodeses was done in 18 patients, which were 65 years old on average. All patients had severe damage on their extensor mechanism associated with an infection of their implant. In all cases the infection was documented and patients were treated by antibiotics during on average 9 months. The first surgical step consisted in a debridement of the knee which was provisionally fixated with the lateral external fixator. The second step consisted in the removal of the infected implant or of the spacer . The bony surfaces were freshened and the anterior external fixator was applied with a compressive effect on the fusion site . Full weight bearing was allowed 45 days after surgery. Results. Radiological fusion was observed in 17 cases after 4,6 months on average and the external fixators were removed after 8 months on average. Two patients experienced wound healings problems that required additional plastic surgery. Two cases were revised and bone grafting was performed. One patient suffered from malunion at the last follow up ( 7 years in this study). Discussion. This type of fixation avoids internal fixation in septic conditions. The transquadricipital pins of the anterior fixator are well tolerated. The rigidity of the combination of two monolateral fixators in two perpendicular planes allows quick reloading , which is essential in old patients, often debilitated by numerous procedures. Conclusion. Arthrodesis is functionally an acceptable alternative to an amputation in these patients. This technique is reliable, has the advantage of avoiding an internal device in an infected knee, of stabilizing the fusion site thanks to the biplanar fixation and of allowing quick weight bearing,

A prospective study of 196 closed tibial diaphyseal fractures treated by a monolateral external fixator is presented. The patients were managed by a group of Surgeons including the senior author (PBMT), a definitive fixator being used in 34 patients, and a fracture reduction device in 162 patients. All the patients were followed up in an external fixator clinic by the senior author, and follow up continued for 1 year after the fractures had healed. Fracture healing was determined clinically. There were 196 tibial fractures, with an average age of 29 years (range 12–80 years). 111 Fractures involved the right tibia, and 85 the left. There were 166 males and 30 females. 116 Fractures were deemed due to a low energy accident, and 80 due to a high energy injury. The most common mechanism of injury was football (75), a fall (52), a road vehicle accident (49), direct trauma (7), assault (4), and rugby (3). According to the AO classification system 33 were A1 fractures, 47 A2, 42 A3, 15 B1, 46 B2, and 7 B3. Time to fracture healing was 19 weeks on average (with a range from 9–87 weeks). 15 Fractures united with a deformity of more than 5. 0. in the coronal plane. One patient required a corrective osteotomy for a mal-united fracture. There were 279 pin track infections that required antibiotic treatment in 85 patients. 33 Pins had to be removed due to persistent infection. Of these patients 15 developed 32 ring sequestrae, but infection was settled by debridement under GA. 7 External fixators had to be removed early because of pin site infection. One patient developed a full blown osteomyelitis, which was treated with the Lautenbach irrigation and settled. There were 7 re-fractures, but all healed after further treatment. 5 Were treated in a POP cast and 2 were re-treated with another external fixator. There were 7 non-unions, but all eventually healed with further treatment with an external fixator. The authors conclude that treating a closed tibial fracture with an external fixator is a viable alternative method of treatment

Introduction: Fusion of the knee joint should be the last option for salvage of infected total knee arthroplasty (TKA). Although knee arthrodesis implies lost of function, it is a successful treatment in eradicating the infection and in decreasing pain. External fixation compression devices have been an excellent method for gaining fusion but, there is no documentation about its ability for obtaining adequate limb alignment with a stable fusion of the knee joint. Material and Methods: We have retrospectively reviewed the results of knee arthrodesis after infection of TKA using an anteriorly placed unilateral external fixator. In addition, we have assessed patient self-satisfaction. Postoperative radiographs have been evaluated to digitally measure loss of femoral and tibial bone stock using Engh radiological classification. Moreover, we have quantified tibiofemoral alignment and the section of bony fusion. Fusion of the knee joint was assessed with CT. Patients were interviewed and pain was graded using a Visual Analog Scale (VAS) and self-satisfaction as well as current health status using the 12-item social function survey form (SF12). Results: From 1992 to 2003, 52 arthrodeses were done for treatment of infected TKA. The average age was 71 years (range, 37–83 years). Type III bone defect according with Engh classification, in femur and/or in tibia, was present in 50% of the patients. The average postoperative tibiofemoral alignment was 1.2° (SD 3.79). The mean time to fusion was 11.26 months (range, 3–30 months). Time to fusion was statistical related with severe bone loss and with the tibiofemoral contact section. The average score according VAS was 1.6 (SD 2.60). Conclusions: Knee arthrodesis using a monolateral external fixator for infected TKA is an effective method to control infection as well as to obtain knee fusion and pain relief. Severe bone loss, frequently present in infected TKA, was found to be the most relevant factor in achieving tibiofemoral union. The individual clinical result according to SF12 shows a lower quality of life both for physical and mental components compare with general population

Increased incidence of complications has been reported when lengthening limbs with underlying bone disorders such as dysplasias and metabolic bone diseases. There is a paucity of literature on limb lengthening in Osteogenesis Imperfecta (OI), probably due to the concern that the bone containing abnormal collagen may not tolerate the external fixators for a long term and there may not be adequate regenerate formation from this abnormal bone. We performed limb lengthening and deformity correction of nine lower limb long bones in six children with OI. Four children were type I and two were type IV OI as per Sillence classification. The mean age was 14.7 years. All six children had lengthening for femoral shortening and three of them also had lengthening for tibial shortening on the same side. Angular deformities were corrected during lengthening. Five limb segments were treated using a monolateral external fixator and four limb segments were treated using an Ilizarov external fixator. In three children, previously inserted femoral intramedullary nails were left in situ during the course of femoral lengthening. The average lengthening achieved was 6.26 cm. Limb length discrepancies were corrected to within 1.5 cm of the length of the contralateral limb in five children. In one child with fixed pelvic obliquity and spinal scoliosis, functional leg length was achieved. The mean healing index was 33.25 days/cm of lengthening. Among the complications significant ones included, one deep infection, one fracture through the midshaft of the femur, and development of anterior angulation deformity after the removal of the fixator in one tibia. Abnormal bone of OI tolerated the external fixator throughout the period of lengthening without any incidence of migration of wires and screws through the soft bone when distraction forces were applied. The regenerate bone formed within the time that is normally expected in limb lengthening procedures performed for other conditions. We conclude that despite abnormal bone characteristics, limb reconstruction to correct limb length discrepancy and angular deformity can be done safely in children with OI

Introduction: Achondroplasia is a form of rhizomelic dwarfism. Even if patients can compensate for their short arms through the mobility in their spine during the childhood, the flexibility in their spine becomes less with aging. Because of that, as they get older they experience problems in maintaining personal hygiene especially in reaching the back. In addition putting on socks and tying their own shoes might become difficult. Methods: Inclusion criteria included any patient with a history of achondroplasia who had undergone humeral lengthening in the proximal part of the humerus (just distal to deltoid muscle insertion). Patients who had distal humeral (supracondylar) osteotomy and/or who received other than monolateral external fixator were excluded from the study. 50 humeri of 25 patients with achondroplasia were lengthened using Orthofix mono-lateral external fixator utilizing proximal humeral osteotomy. Sixteen patients were female and nine were male. Mean age was 15.4 months (range, 9.6 – 21.8). Lengthening was started at 7th day. Patients were lengthened at 1/4 turn four times a day reaching 1 mm/day. Physical therapy was performed 3 times a week. Goal of lengthening was around 10 cm or whatever length the patient could tolerate. Patients wore Sarmiento type fracture brace 4–6 weeks after the fixator was removed. Results: Mean follow-up time from surgery was 51.5 months (range, 6 – 143 months). Mean follow-up time from removal of external fixator was 44.7 months (range, 0 – 135 months). Average external fixation time was 7.3 months. In 20 humeri it was noted that the average duration of lengthening was 4.2 months (range, 3 – 5.8 months). A mean lengthening of 9.3 cm was obtained (range, 4.3 – 12.8 cm). At latest follow-up range of motion was not compromised due to lengthening. All patients had similar ROM before and after the surgery. Complications included radial nerve palsy in 8, pin tract infection in 7, fracture through regenerate in 3, premature consolidation in 1, nonunion in 1, delayed healing in 1. Radial nerve palsy recovered without intervention in one case. In others it recovered uneventfully after successful decompression. No complications at all occurred in 30 cases. Discussion: Fifty humeri of 25 patients with achondroplasia received successful humerus lengthening as part of extensive limb lengthening offered in our center. None of the patients had long term sequela, and all radial nerve palsies recovered. Patients were satisfied with the lengthening and found it easier to undergo through humerus lengthening compared to lower limb lengthening. After a mean follow-up time of almost 4 years, these patients returned back to their normal lives with optimum upper limb function with no hindrance in maintaining personal hygiene, putting on socks or tying their own shoes

Aims

To investigate the risk factors for unsuccessful radial head reduction (RHR) in children with chronic Monteggia fractures (CMFs) treated surgically.