The purpose of this study is to classify the pitfalls, obstacles and complications that occur during distraction histogenesis and also to evaluate the risk factors likely to lead to these problems.

In this study we have retrospectively and prospectively studied the difficulties occurring during distraction histogenesis since 2003. We studied 74 patients (mean age 19,2 years, age range 11–60 yrs) whose 97 limbs segments were lengthened. 21 patients underwent angular correction, 42 patients limb lengthening, 17 patients both angular correction and limb lengthening and 14 non-union correction. In 46 cases, we used the Ilizarov fixator, in 38 the Taylor Spatial Frame and in 10 cases the monolateral external fix-ator Orthofix LRS. Difficulties that occured during limb lengthening were subclassified into pitfalls, obstacles, and complications. For all cases we have recorded the time of appearance of all these difficulties and have associated them with the severity of the initial deformity.

The total number of difficulties in distraction histogenesis was 20%. The number of presenting problems was estimated 5.4% and involved knee subluxation, pin breakage and malalignments. Obstacles presented in 9.5% and included cases with poor bone regeneration, peroneal nerve palsy, premature consolidation and heel cord lengthening. Finally complications were noted in 5.4% of the cases. These consisted of infection, fracture, non-union and loss of range of knee motion.

The problems, obstacles and complications that occur during distraction histogenesis can all impact on the optimal therapeutic target. Extensive surgical experience, and optimal pre-operative planning in conjunction with the type of the original deformity may all contribute in minimising these difficulties

To evaluate the operative treatment of Blount disease using the TSF external fixator and to evaluate the system.

During January 2004 and August 2008, 8 males and 2 females with Blount disease (16 limbs) were treated using TSF system. For the radiological assessment we obtained standard long-leg standing radiographs and we measured the anatomic medial proximal tibial angle (aMPTA), the diaphyseal-metaphyseal tibial angle (Drennan), and the femoro-tibial angle.

The mean follow-up was 29 months (15 to 45). No patient had pain around the knee, medial or lateral instability. The range motion of the knee immediately after frame removal was 10° to 90° of flexion in two patients while in the other it was from 0° to 110°. The mean leg-length discrepancy was reduced postoperatively from mean 1,9 cm (1,7–3,2) to 0,9 cm (0− +1,5). The aMPTA angle increased from mean 73° (59°– 83°) to 94° (107°–90°), Drennan angle from 17° (14°–22°) to 3° (0°–7°), and femoro-tibial angle from 17° (10°–30°) varus to 7° (2°–10°) valgus. The frame was removed at mean 9 weeks (7–14). Two patients had delayed union, two presented with loss of correction (due to dissociation of struts and secondary to medial physeal bar), two patients had pin track infection. No neurologic complications were referred.

Accurate corrections of multiplanar deformities as varus, internal rotation and shortening of the limb that coexist in Blount disease may be accomplished using TSF system

To study the use of TSF system in treating trauma and bone deformities in children. To determine the difficulties of this process and the risk factors that lead to complications.

From January 2004, in 61 children (37 male and 24 female), 67 extremities, with a mean age 8.9 years children a TSF external fixator was applied for the treatment of trauma or bone deformities. 21 children were operated for angular deformity, 19 for bone lengthening, 10 for rotational deformity, 6 for combined angular deformity and lengthening and 11 for pseudoarthrosis. Intra and postoperative difficulties were classified using the Palay method in problems, obstacles and complications.

The rate of difficulties was 22.2 %. Problems were presented in 5.9% (4/67) consisting of 2 non-axial deformities, 1 pin fracture and 1 subluxation of the knee. Obstacles were presented in 10.4% (9/67) including 3 cases with delayed bone healing that needed infusion DBM, 1 peroneal nerve palsy due to hematoma formation treated with decompression of the region, 1 early bone fusion that needed re-operation and 2 cases of percutaneous achilles lengthening. Complications presented in 5.9% of (4/67) the cases including 1 fracture, 1 pseudoarthrosis, 1 peroneal nerve palsy and 1 limitation of range of motion in the knee (0–45 0).

The problems, obstacles and complications that presented during treatment influenced the final therapeutic objective. Initial deformity, preoperative planning and surgeon’s experience are associated with reducing the rate of all difficulties

Between 1999 and 2002 14 children with femoral shaft fractures were treated with closed, locked intramedullary nailing. There were 11 male and 3 female patients, aged 11–16 years (mean 14.4 years). All fractures were closed. There were 9 transverse, 1 pathologic, 1 bipolar, 1 malunited and 2 spiral fractures. The fractures occurred following MVA or falls from height. All fractures were reduced and closed locked intramedullary nailing was performed using small diameter titanium nails without reaming. The entrance of point of the nail was created at the tip of the greater trochanter and no traction was used intraoperatively. The mean hospital stay was 2 days and immediate partial weight-bearing was permitted.

All fractures united according to clinical and radiological criteria within 9 weeks. The maximum patient follow-up was 24 months (mean 17 months). Hip and knee mobility was full and no case of femoral head osteonecrosis, infection or malunion was ascertained.

Closed, locked intramedullary nailing in adolescent patients provides immediate fracture immobilization combining safety and limited morbidity. Meticulous adherence to the surgical technique is necessary respecting the developing upper part of the femur.

Aim: To assess the efþcacy of percutaneous reaming of simple bone cysts followed by administration of a mixture of autologous bone marrow combined with demineralized bone matrix. Material-methods: 10 patients (7 boys aged 10 years on average and 3 girls aged 12 years on average) with a bone cyst (3 patients at the femur, and 7 at the humerus), were treated with the same surgical technique. The diagnosis was based exclusively on imaging methods (X-ray, CT, MRI) and no biopsy was performed. Under general analgesia and image intensi-þer control the cystic cavity was aspirated. Should ßuid was encountered then a mixture of bone marrow and demineralized bone matrix (DBM) was injected after thorough reaming of the canal proximally and distally. None of the patients required overnight hospital stay. The limb was protected till the patient became asymptomatic. Results: The average follow-up time was 24 months (9–29 months). No perioperative complications were noted. All patients were asymptomatic at the last examination, with normal limb movement. All bone cysts were classiþed from an independent observer, according to the Neer classiþcation, as type I and II. Conclusion: Percutaneous administration of DBM combined with autologous bone marrow after restoring the continuity of the medullary canal with reaming is a simple surgical technique requiring no hospitalization and a short period of immobilization while the clinical and radiological outcome is excellent.

Aim: To assess functional outcome after calcaneal neck lengthening osteotomy in cerebral palsy patients with severe pes planus-valgus deformity.

Methods: During the period 1999–2002, 17 cerebral palsy patients (12 males and 5 females), aged 3 to 16 years, with flexible pes planus-valgus deformity, were treated in our department. Patients underwent calcaneal neck lengthening osteotomy using allograft bone. A below knee plaster was applied to all patients while weight-bearing was avoided for 6 weeks before partial to full weight-bearing commenced for the following 2 months.

Results: Patients were followed-up postoperatively for 3–28 months (mean 17 months) and the clinical and radiological findings were evaluated. The mean correction of the talo-navicular angle on the antero-posterior view was found to be 34°. All patients were radiologically healed at 7.5 weeks in average. 10% mean improvement was observed in the Gross Motor Performance Measure. There were no complications such as pseudarthrosis or infection.

Conclusion: Calcaneal neck lengthening osteotomy using allograft bone for the surgical treatment of severe pes planus-valgus deformity in cerebral palsy children yields satisfactory radiological and functional results.

Aim: To assess outcome in adolescent periarticular fractures treated with cannulated Herbert screws. Patients and methods: During the period November 99–March 02, twenty nine adolescent patients were admitted to our department with the diagnosis of a periarticular fracture. All patients were male, 12–17 years old (average 15 years). All fractures were treated with cannulated Herbert screws. Twelve of these were fractures of the elbow, 6 of the knee and 11 of the ankle. All the fractures were treated with internal fixation. All patients underwent preoperative CT scan with 2-D reconstruction.

In all the cases the anatomical reduction was achieved and cannulated Herbert screws were applied with respect to the epiphyseal plate through minimal surgical incision..

The follow up period varied from one to six months, while all patients followed a rehabilitation program.

Results: All fractures healed well, without any reduction of the joint mobility or other postoperative complications.

Conclusions: Internal fixation of adolescent periarticular fractures with cannulated Herbert screws, can be considered as a useful method of treatment, since the anatomical reduction obtained, can be held with a very small operative incision, while the epiphyseal plate is respected.

Introduction: The growth plate almost always is involved in periarticular fractures in children. Treatment and prognosis of these fractures depends on the extend of the injury. Reduction has to itle and anatomical while fixation has to be secure and minimal secondary to the small size of epiphysis. The K-wires do not cause so much tissue damage but there is the possibility of sliding suiting in loss of fixation. On the other hand they offer no fracture compression. The use of screws may result in bone collapse. It is also inappropriate for small fragments.

Patients and Methods: From November 1999 untill December of 2001 17 patients with a diagnosis of a periarticular fracture were admitted to the pediatric orthopaedic department of KAT Hospital. There were 9 fractures of the elbow and 8 ankle fractures. Mean age was 12 years (6–14) (11 boys and 6 girls). Plain radiographs and CT were obtained before surgery to evaluate the kind and extend of the fracture. After limited arthrotomy percutaneous fixation was obtained with the use of at least wires 2 FFS wires and then a splint or cast was applied.

Results: FFS screws were removed in 3–6 weeks without anesthesia. In all of the patients the fracture was healed and there was not any infection or loss of reduction. Screws breakage was seen in Datient with no any functional consequences.

Conclusion: The use of FFS allows compressive fixation in periarticular fractures in children. It can be used percutaneously and it can be removed without need for another surgery.