Introduction. It is recommended that the ankle be held in dorsiflexion at the time of placement of syndesmosis screw. We assessed the validity of this recommendation. Materials and methods. A two-part roentgenographic and computerised analysis of distal tibiofibular syndesmosis. The first part involved recruitment of 30 healthy adult volunteers. The second part involved 15 ankle fractures with syndesmotic injury requiring syndesmosis screw placement. In the first part individuals maximally dorsiflexed and plantarflexed their ankles in a specialised jig for standardisation. Mortice views were taken and intermalleolar distance measured. In the second part mortice views were taken in plantarflexion and dorsiflexion before and after the placement of syndesmosis screw in theatre. The intermalleolar distance was then measured. Results. In both parts of the study we found the change in intermalleolar distance between the positions of plantarflexion and dorsiflexion was not more than 0.9 mm. This change is significantly less than the calculated difference between the anterior and posterior talar body width of 3-5 mm. Conclusion. This study shows that the width of ankle mortice is independent of the position of the talus occupying it and hence dorsiflexion of the ankle at the time of syndesmosis screw placement is totally unwarranted

Osteoarticular infections in paediatric population are primarily hematogenous in origin, although cases secondary to penetrating trauma, surgery or contiguous site are also reported. Despite being rare, numerous studies report infection relapse rates around 5 %. Osteomyelitis complications in children include septic arthritis, osteonecrosis of the bone segment, impaired growth. 7 years old male patient presented with history of traffic injury in January 2004. He sustained closed diaphyseal fracture of the right femur initially treated by elastic osteosynthesis. Four years after traffic injury he was diagnosed at our Institution of chronic femoral Osteomyelitis with positive cultures for methicillin sensible Staphylococcus aureus, requiring multiple surgical debridements and systemic antibiotic therapy. Five years follow- up the patient developed valgus deformity of his right knee (mechanical axis 11° genu valgum) with limb length discrepancy of 15 mm, intermalleolar distance of 15 cm and bone edema in external compartment of the knee (MRI). At this time the patient did not present any recurrence of septic process with normalization of laboratory parameters (ESR and CRP) and clinically asymptomatic. In February 2014, at the end of growth, a distal femoral varus osteotomy was used to treat valgus knee malalignment. Medial closing wedge osteotomy was performed satisfactorily using Tomofix® Osteotomy System (DePuySynthes). 18 months follow- up after varus osteotomy the patient progressed satisfactorily without pain and a normal function of his right knee. Correction limb length discrepancy was achieved (5 mm) with a normal alignment of his right limb (mechanical axis 3° genu valgum). Although Osteomyelitis is not very frequent in children population, its treatment requires not only prolonged antibiotic therapy but also multiple surgical debridements. We recommend monitoring over a long period of time children affected with Osteomyelitis in order to prevent and treat correctly impaired growth