Purpose: Surgical treatment with circular external fixation of forearm deformities and shorthening in patients with congenital and posttraumatic pathologies remains controversial. The purpose of the present study was to determine the reasonable indications for operative treatment and to evaluate long-term results of forearm surgery in these patients. We review the results of correction of deformities and length discrepancies of the forearm using circular external fixator.

Methods and Materials: We evaluated the results of distraction lengthening in 25 forearms of 24 patients with forearm shortening and deformity. The mean age at the time of surgery was 18.2 years (range 6 to 55 years). Etiologies were: congenital radioulnar synostosis and deformity of the forearm (2), multiple hereditary exostoses (3), distal radial physeal arrest (2), Madelung’s deformity (5), congenital shortening of both bones (1), radial clubhand with Bayne type I deficiency (2), pseudoartrosis (6), malunion correction (3), Forearm Elongation After Hand Replantation (1). The ulna was involved in 14 cases and the radius in 11. The lengthening technique consisted in a subperiosteal osteotomy and progressive distraction after 5 days of waiting period. In majority of cases the deformity and shortening of ulna and radius were different, for this reason we use separate system for lengthening and correction for each bone. That permits to correct wrist deformity and restore normal relationships in the distal radioulnal syndesmosis.

Results: All 25 forearms were reviewed at a mean 28,6 months. Mean lengthening was 31.2 mm (range 10 – 68 mm). One patient that in the pass was treated with monolateral fixator, had other two subsequent lengthening and obtains normal length of forearm. One patient has radial nerve palsy after 21 days of distraction. Reducible claw fingers completely regressed after interruption of the lengthening were observed in 4 cases. There were 2 cases with an axial deviation at the end of lengthening and 2 cases of late healing resolving without a secondary bone graft. The healing index was 49.8 days per cm gained length.

Conclusion: Lengthening of the forearm was found to improve upper extremity function and appearance of the arm with satisfaction of all patients.

Introduction: Tibial pilon acquired deformities are often a combination of axial deviation, translation, rotational defects and leg length discrepancy. Correction of deformity pattern with a percutaneous rectilinear supramalleolar osteotomy and an external fixation by Ilizarov apparatus aims to reduce misalignment progressively, simultaneously and mini-invasively.

Method: From 1994 to 2004, 29 patients have been treated for pilon tri-planar deformity of the leg. The mean age was 26 years (range 16 to 49 years), 15 were males and 14 females. Type and level of the deformity were determined by preoperational X-ray pictures. Two rings of Ilizarov apparatus are positioned in the segment of the limb proximal to the osteotomy: one at the level of the proximal tibial metaphysis and the other 3–4 cm further the osteotomy. A third ring is positioned at the level of the tibial pilon, parallel to the articular edge of the ankle. In order to maintain stability of the ankle, a half ring or horseshoe-shaped component should be placed on the calcaneus and metatarsals with opposing olive wires. The positions of the mobile joints between the rings will depend on the location of the correction axis. The closed metaphiseal osteotomy is performed in order to correct triplanar deformities in a progressive way, through angulations and translation in an oblique plane. The half ring on the foot allows maintaining the ankle distracted, which is necessary to reduce articular compression and to avoid soft tissue damages and muscular contractures in this region. Correction of translational deformities, axial deviation, and rotational deformities we performed in two stages. The axial deviation and translational deformity should be corrected in the first stage, and the rotational deformity is corrected during the second stage.

Results: In all cases we achieved correction of the angular or rotational deformities. Bleeding was never over 100 ml. We have not observed any soft tissue damages. Controlled weight-bearing was practiced in first day postoperatively, and the mean hospitalization time was 4 days. Time required to reach the correction was in a range of 3–6 weeks. In 20 patients the entire of the leg discrepancy was in a range of 1,5–6 cm. We reported no case of infection or non union. The devices have been removed after a mean time of 11 weeks (range 8–15 weeks).

Conclusion: Corrections of triplanar deformity of the pilon by the Ilizarov apparatus are progressive and mini–invasive. Also, it allows treating misalignment and lengthening by a single operation. The apparatus layout combining foot fixation and ankle distraction permits to correct soft tissues, secondary deformities, and finally a rapid weight bearing recovery.

Acquired pilon deformities are often a combination of axial deviation, translation, rotational defects and leg length discrepancy. Correction of a deformity pattern with a percutaneous rectilinear supramalleolar osteotomy and an external fixation by Ilizarov apparatus aims to reduce misalignment progressively, simultaneously and minimally invasively.

From 1994 to 2004, 27 patients were treated for pilon tri-planar deformity of the leg. The mean age was 27 years (range 16 to 49 years); 15 were males and 12 females. Type and level of the deformity were determined by preoperative X-rays. For the procedure, two rings of Ilizarov apparatus are positioned in the segment of the limb proximal to the osteotomy: one at the level of the proximal tibial metaphysis and the other 3–4 cm beyond the osteotomy. A third ring is positioned at the level of the tibial pilon, parallel to the articular edge of the ankle. In order to maintain stability of the ankle, a half ring or horseshoeshaped component should be placed on the calcaneus and metatarsals with opposing olive wires. The positions of the mobile joints between the rings depend on the location of the correction axis. Closed metaphyseal osteotomy is performed in order to correct tri-planar deformities in a progressive way, through angulations and translation in an oblique plane. The half ring on the foot maintains distraction in the ankle, which is necessary to reduce articular compression and to avoid soft tissue damage and muscular contractures in this region.

In all cases we achieved correction of the angular or rotational deformities. Bleeding was never over 100 ml. We have not observed any soft tissue damage. Controlled weight-bearing was practised on the first day postoperatively, and the mean hospitalisation time was 4 days. Time required to reach the correction was in a range of 3–6 weeks. In 20 patients the total leg discrepancy was in a range of 1.5–6 cm. We reported no case of infection nor union. The devices were removed after a mean time of 11 weeks (range 8–15 weeks). Corrections of tri-planar deformity of the pilon by the Ilizarov apparatus are progressive and minimally invasive. In addition, it is possible to treat misalignment and lengthening by a single operation. With the apparatus layout combining foot fixation and ankle distraction soft tissue and secondary deformities can be corrected and finally a rapid recovery of weight bearing is possible.

Aims: The þeld of External Fixation devices and methods is lacking uniform, comprehensive terminology and description. The aim of our work is to introduce ÒMethod of Uniþed Designation of External FixationÒ(MUDEF), which will allow simple and systematic communication, documentation and approach to this widely-used treatment modality. Methods: Developed and applied in the research lab and clinical practice MUDEF is based on 8 standard and 6 additional (elaborating) symbols (http:// www.aotrf.org, the ÒFor the orthopedic surgeonsÒ chapter). Results: Use of MUDEF providing comprehensive objective information on the External Fixation system: accurate location of the elements of external þxation device on the extremity; type and orientation of the pins or wires as well as order and direction of their placement; visual imagination of the geometry and dimension of the external þxation device. This method allows to accurately documenting any external þxation device, facilitate study of different aspects of external þxation technique and interpretation of the results based on universal and clear information of comparable data. This method will facilitate analysis of complications of external þxation technique, provide basis for clear communication in the þeld of research and publications and assisting improving existing technique and technology. Conclusions: We are suggesting and hopeful that MUDEF will have appropriate role and place in documentation in the þeld of orthopaedic practice, research and literature supplementing other existing classiþcation systems.

Introduction. Congenital deficiency of the fibula frequently presents as spectrum of musculoskeletal anomalies involving the ipsilateral hip, femur, knee, tibia/fibula, ankle and foot. Until recently the treatment of choice for sever type-II fibular hemimelia has been Syme’s or Boyd’s amputation. The present technique of limb lengthening with distraction osteogenesis have proved to be a valid alternative. The study shows that simultaneous treatment of tibial and foot deformities allows the patient to obtain a plantigrade foot and to avoid the prosthetic choice of treatment.

Materials and methods. 12 patients with 15 involved extremities underwent tibial lengthening and correction of the foot deformities for congenital tipe II fibular hemimelia with Ilizarov apparatus. There were 10 boys and 2 girls, range 7 years 3 month to 16 years 2 month (mean 10 years 7 month). The mean follow up time was 28 months ( range 15–63 month). Most of the patients had hypoplasia of the lateral femoral condyle and femoral shortening and simultaneous lengthening of femur in 9 cases was performed. Valgus-procurvatum deformity of tibia was present in all cases, absent lateral rays were present in 8 feet, foot coalition in 5 feet.

Results. Lengthening of the tibia was performed at one level in 4 cases In the other 11 it was performed simultaneously with a proximal osteotomy of tibia to correct thevalgus and with a supramalleolar osteotomy to obtain axial realignment of ankle. Correction of the foot deformities was performed by closed method in 5 cases with overcorrecton in varus-adduction and plaster cast. Subtalar osteotomy in the presence of coalition was performed in 5 cases, osteotomy of calcaneus for equinus in3, and in 2 cases osteotomy through rigid subtalar joint. Osteotomy of midfoot for abducted and equines forefoot was performed in 3 cases. In two difficult rigid cases ankle arthrodesis was needed to stabilise the foot. Prophylactic anlage excision with soft tissue release and Achilles-tendon lengthening in 13 cases. Good results were achieved in 12 cases. 2 were successful and one poor because the patient refused continuing treatment with external fixator. There were 5 major and 16 minor complications. Complications involving delayed consolidation, bending or deformation of regenerated bone, early consolidation were observed in 4 cases. Complications involving soft tissue were observed in 9 cases, There were no permanent neurological and vascular injures.

Conclusions. The Ilizarov technique provides a means of achieving simultaneous lengthening of the femur and tibia, angular and rotational deformities correction in children with congenital type II fibular hemimelia. This method should be combined with simultaneous ankle and foot reconstruction for correction of eqininovalgus deformity associated instability and subluxation of ankle. This method should be combined with simultaneous ankle and foot reconstruction for correction of eqininovalgus deformity associated instability and subluxation of ankle. Various types of osteotomy of the hind and mid food give the possibility to achieve the stable result of correction.