A 51 years old female who experienced difficulty in gait ambulation due to secondary osteoarthritis of knee showed knee instability caused by paralysis associated with poliomyelitis and scoliosis. At the first medical examination, right knee range of motion was 0° to 90°, and spino malleolar distance (SMD) showed 72cm for the right leg, 78cm for the left leg, and the bilateral comparison of SMD indicated the leg length discrepancy of 6cm. The patient has a history of surgeries with an anterior – posterior instrument for the treatment of scoliosis, and with Langenskiöld method for the paralyzed right knee at the age of seventeen. The patient also experienced varus degeneration at the age of twenty seven, which was surgically treated with high tibial osteotomy. In this case, a reoperation of her right knee was performed due to the reoccurrence of the knee pain. Preoperative planning was performed using Patient-matched instrument (Signature; Biomet) which was created based on computed tomography data. Each part of osteotomy followed the resection guide by Signature, and a total knee arthroplasty was carried out using the Rotating Hinge Knee System (Zimmer, warsaw. Inc). Two week after the operation, the patient showed the ability to walk without any assistance, and has been in a good condition.

Introduction. Taylor Spatial Frame (TSF) has been designed to treat complex tibial, foot and ankle deformities using computer software. We have performed various osteotomies in combination with different soft tissue procedures, with the use of TSF. Material and Methods. A retrospective study of 20 consecutive patients operated by, senior author SSM, from 2004 onwards who underwent surgical correction of tibia, ankle, midfoot and hind foot including lateral column lengthening, calcaneal and midfoot osteotomies. Demographic details, diagnosis, procedures (including previous operations), length of follow-up, outcome and complications were recorded. Of the 20 patients, 13 were men and 7 women. The mean age was 39 years (range 18 to 70). 5 patients had TSF for malunion or non-union of ankle fractures, malunion of tibia (5), congenital talipes equino-varus(3), acute fracture of ankle (2), one patient each for spina bifida, Poliomyelitis, Charcot-Marie-Tooth disease, equino-varus due to periventricular leuco-encephalopathy and avascular necrosis of the talus. Bilateral TSF for torsional malalignment of tibia (1). Results. Follow up 6 to 54 months (mean 19.4). Patient based foot and ankle outcome criteria were used. Of the 20 patients, 16 had no pain and satisfactory range of movement and function at the last follow up. Post-operative complications included pin site infection(2) and frame hardware malfunction (2)patients, residual deformity requiring surgical correction at 22 months, (1) delayed union, neuropathic pain in (1), residual equinus deformity requiring Botox injections(1) and osteomyelitis requiring debridement(1). Conclusion. We present this series of complex congenital and acquired conditions of the foot and ankle treated with corrective osteotomies and Taylor Spatial Frame with good results

Limb lengthening by callus distraction and external fixation has a high rate of complications. We describe our experience using an intramedullary nail (Fitbone) which contains a motorised and programmable sliding mechanism for limb lengthening and bone transport. Between 2001 and 2004 we lengthened 13 femora and 11 tibiae in ten patients (seven men and three women) with a mean age of 32 years (21 to 47) using this nail. The indications for operation were short stature in six patients and developmental or acquired disorders in the rest.

The mean lengthening achieved was 40 mm (27 to 60). The mean length of stay in hospital was seven days (5 to 9). The mean healing index was 35 days/cm (18.8 to 70.9). There were no cases of implant-related infection or malunion.