Aims. The primary aims of this study were to determine the time to sonographic correction of decentred hips during treatment with Pavlik harness for developmental dysplasia of the hip (DDH) and investigate potential risk factors for a delayed response to treatment. Methods. This was a retrospective cohort study of infants with decentred hips who underwent a comprehensive management protocol with Pavlik harness between 2012 and 2016. Ultrasound assessments were performed at standardized intervals and time to correction from centring of the femoral head was quantified. Hips with < 40% femoral head coverage (FHC) were considered decentred, and hips with > 50% FHC and α angles > 60° were considered corrected. Survival analyses using log-rank tests and Cox regression were performed to investigate potential risk factors for delayed time to correction. Results. A total of 108 infants (158 hips) successfully completed the bracing protocol and were included in the study. Mean age at treatment initiation was 6.9 weeks (SD 3.8). All included hips centred within two weeks of treatment initiation. At two, five, eight, and 12 weeks following centring of the femoral head, 13% (95% CI 8 to 19), 67% (95% CI 60 to 74), 98% (95% CI 95 to 99), and 99% (95% CI 98 to 100) of hips had cumulatively achieved sonographic correction, respectively. Low α angles at presentation were found to be a risk factor for delayed time to correction (hazard ratio per 1° decrease in α angle 1.04 (95% CI 1.01 to 1.06); p = 0.006). Conclusion. The majority of decentred hips undergoing Pavlik treatment achieved sonographic correction within eight weeks of centring and radiological severity at presentation was a predictor for slower recovery. These findings provide valuable insights into hip development during Pavlik treatment and will inform the design of future prospective studies investigating the optimal time required in harness. Cite this article: Bone Joint J 2025;107-B(1):118–123

Pre-operative anaemia can present in up to 30% of elective arthroplasty patients. The presence of anaemia increases the risk of requiring blood transfusion post-operatively as well as acts as an independent risk factor for poor outcome such as prosthetic joint infection. Recent international consensus on this topic has recommended a specific care pathway for screening patients with pre-operative anaemia using a simple bedside Heaemacue finger-prick test to detect in a simple and cost-effective manner, and then allow treatment of preoperative anaemia. This pathway was therefore incorporated in our trust. This was a retrospective study done at a single tertiary-referral arthroplasty centre. Our data collection included the Heamacue test results and formal haemoglobin levels if they were performed as well as compliance and costs of each of the tests for patients listed for an elective shoulder, hip and knee arthroplasty between September and December 2018. Medical records and demographics were also collected for these patients for subgroup analysis. Our exclusion criteria comprised patients listed for revision arthroplasty surgery. 87 patients were included in this study. Our compliance rate was 15%. The mean difference between a Haemacue test and a formal FBC result was only 17.6g/L suggesting that it has a reasonably high accuracy. With regards to costs, we found that a Haemacue test costs £2, compared to £7.50 for a full blood count and Haematinics combined. This gave an overall cost saving of £5.50 per patient. Extrapolation of this date locally for 2017 at our hospital, where 1575 primary joint arthroplasties were done, a cost saving of £8,662.5 could have been achieved. Within the UK using data extrapolated from the National Joint Registry a total of £1,102,205.5 (1,221,894 Euros) could have been saved. The use of a single, Haemacue test to screen for pre-operative anaemia in elective arthroplasty patients is more cost effective compared to a formal full count and haematinics tests. However, we found that compliance with the care pathway is variable due to system limitations. This may be addressed through implementing changes to our electronic system in which patients are booked for surgery. We also noted a significant cost reduction if this pathway were to be used Nation-wide. Thus, we encourage other centres to consider the use of the Haemacue test pre-operatively in elective arthroplasty instead of formal full blood counts at the time of decision to treat with arthroplasty; this allows sufficient time for correction of pre-operative anaemia thus improving patient outcomes from arthroplasty

Aims

The metabolic variations between the cartilage of osteoarthritis (OA) and Kashin-Beck disease (KBD) remain largely unknown. Our study aimed to address this by conducting a comparative analysis of the metabolic profiles present in the cartilage of KBD and OA.

Aims

Temporary hemiepiphysiodesis (HED) is applied to children and adolescents to correct angular deformities (ADs) in long bones through guided growth. Traditional Blount staples or two-hole plates are mainly used for this indication. Despite precise surgical techniques and attentive postoperative follow-up, implant-associated complications are frequently described. To address these pitfalls, a flexible staple was developed to combine the advantages of the established implants. This study provides the first results of guided growth using the new implant and compares these with the established two-hole plates and Blount staples.

A total of 25 children (37 legs and 51 segments) with coronal plane deformities around the knee were treated with the extraperiosteal application of a flexible two-hole plate and screws. The mean age was 11.6 years (5.5 to 14.9), the median angle of deformity treated was 8.3° and mean time for correction was 16.1 months (7 to 37.3). There was a mean rate of correction of 0.7° per month in the femur (0.3° to 1.5°), 0.5° per month in the tibia (0.1° to 0.9°) and 1.2° per month (0.1° to 2.2°) if femur and tibia were treated concurrently. Correction was faster if the child was under 10 years of age (p = 0.05). The patients were reviewed between six and 32 months after plate removal. One child had a rebound deformity but no permanent physeal tethers were encountered. The guided growth technique, as performed using a flexible titanium plate, is simple and safe for treating periarticular deformities of the leg

Treatments of complex foot deformities often need use of special external fixators to treat various deformities of multiplaner directions and contractures of ankle and foot joints. In severe cases the best choice is use external hinge distraction system to restore function of joints, treat short foot, and correct deformity. Simple, small, mobile hinges/SLDF 2/was modified for the treatment. From 1995 to 2007 we treated 160 cases to severe foot deformities with congenital clubfoot, neuromuscular deformities and posttraumatic deformities age between 3 to 60 years with the new modified system. In some cases the treatment was combined with lengthening and axial correction of the lower leg if needed. The average time for correction is 4 to 6 week’s followings by 1–3 months of fixation to keep the final correction. A special orthosis is needed after removal of the fixation devices for another 6 months. Complications were mostly superficial Pin infection, loosening of wires, no nerve or vascular damage and no thrombosis was seen. In all cases a plantigrade foot was achieved with some stiffness of the joints in neuromuscular diseases. The walking ability was in most cases much better due to plantigrade correction; enable the patient to walk without any aid accept orthopedic shoes. The satisfaction rate of all patients was very good; some of the patients were abele to wake first time due to the correction. The use of external fixation is an ideal treatment in complex congenital or posttraumatic foot deformities to achieve good correction, good functional and cosmetic result with a tolerable system

A case is reported of an 18-year-old man with a post-traumatic radial shortening of about 10 cm with 40° of radial deviation as a consequence of an epiphyseal arrest that occurred when the patient was 8 years old. In the past the patient and his parents had refused all corrective treatment which would result in a permanent shortening; then a treatment by the Ilizarov external fixator was proposed. The forearm assembly was made by two fixed rings (one proximal and one medial) and one hinged distal ring. A closed corticotomy was performed parallel to the distal ring, whose fulcrum was at the ulnar styloid. Correction and lengthening were obtained by elongating two opposite threaded bars about 0.5 mm per day. Minor revisions were made on an out-patient basis. Time of correction and lengthening was 113 days, followed by 70 days in the fixator and a further 44 days of plaster cast after fixator removal. The complete correction of deformity and concurrent lengthening showed that Ilizarov‘s method is a definite but very demanding option in the treatment of severe deformities of the upper limb

The Ilizarov apparatus was used to carry out opening-wedge callotasis of the proximal tibia in ten patients who had suffered premature asymmetrical closure of the proximal tibial physis and subsequent genu recurvatum. In four knees, the genu recurvatum was entirely due to osseous deformity, whereas in six it was associated with capsuloligamentous abnormality. Preoperatively, the angle of recurvatum averaged 19.6° (15 to 26), the angle of tilt of the tibial plateau, 76.6° (62 to 90), and the ipsilateral limb shortening, 2.7 cm (0.5 to 8.7). The average time for correction was 49 days (23 to 85). The average duration of external fixation was 150 days (88 to 210). Three patients suffered complications including patella infera, pin-track infection and transient peroneal nerve palsy. At a mean follow-up of 4.4 years, all patients, except one, had achieved an excellent or good radiological and functional outcome

Aim: To review our experience with hemi-epiphysiodesis using different methods for the correction of angular deformity about the knee. Method: This was a retrospective review of 73 patients (101 knees) who underwent hemi-epiphysiodesis from 1999 to 2008. Assessment looked at the type and degree of deformity, implants used, average operating time and hospital stay, complications, degree of correction and the average time to correction. Results: There were 50 boys and 23 girls with bilateral deformity in 28 cases. There were 88 valgus and 13 varus knees. Average follow-up was 17 months. Staples were used in 28 cases, “8” Plates in 24, Screws in 16 and Drilling in 5 cases. The distal femoral physis was involved in 46 knees, the proximal tibial physis in 21 and both physes in 34 knees (total 135 physes). Average operation time and hospital stay were similar for all methods. There were 6 minor and 3 major complications with staples with an average correction time of 14 months, 3 minor complications with an average correction time of 11 months with “8” plates, 3 minor and 1 major complication with an average correction time of 14 months with screws and 1 minor complication with drilling with an average correction time of 13 months. The outcome was considered as resolved in 47 and pending in 26 cases, with all showing progressive correction of deformity. Conclusions: Hemi-epiphysiodesis by any method is an effective way to correct angular deformities about the knee in skeletally immature individuals within a reasonable time limit and with minimal morbidity when compared to a corrective osteotomy. Our experience suggests that “8” plates achieve faster correction with the least complications when compared to other methods. Valgus knee deformities corrected faster than varus ones

The aim of our study was to assess the efficacy and complications of treatment of limb deformities using six axes deformity analysis and the Taylor TM Spatial Frame [TSF]. Between January 1997 and March 2000, we treated 75 lower limbs in 66 patients with deformities. Patients were divided into four groups. The groups were Blount’s disease, congenital deformities, traumatic deformities, and a miscellaneous group. The data was prospectively collected. This was a consecutive series of the first 66 patients treated at our institution with the TSF. Deformity correction using the TSF is done with the aid of computer software. The mean age of the 66 patients was 18.7 years (range 0.5 to 72 years). The average frame time was 18.6 weeks (range 9 to 49 weeks). There was shortening present in 31 limbs with a mean of 18.6 mm (range 5 to 50 mm). Deformity correction with distraction osteogenesis was begun 7 days after the osteotomy. The mean length of time until correction was 6.7 weeks (range 3 to 13 weeks). There were a total of 10 complications (13.3%) in the series. 27 tibiae in 23 patients underwent correction with the TSF for Blount’s disease. There were 11 infantile and 16 adolescent forms. Correction of congenital deformity was performed in 20 tibiae and 8 femurs in 18 patients. There were 9 males and 9 females. There were 13 male and 8 female patients with traumatic lower limb injuries. There were 11 malunions and 10 nonunions (including 2 infected nonunions) that were corrected with the TSF. The TaylorTM Spatial Frame is an effective technique in treating deformity. Angulation, translation, shortening and rotation can be corrected simultaneously. Based on our results, we conclude that the TSF allows safe, gradual correction that is accurate and well tolerated

Background. Temporary hemiepiphysiodesis using 8 plate guided growth has gained widespread acceptance for the treatment of paediatric angular deformities. This study aims to look at outcomes of coronal lower limb deformities corrected using temporary hemiepiphysiodesis over an extended period of follow up. Methods. A retrospective analysis was undertaken of 56 children (92 legs) with coronal plane deformities around the knee which were treated with an extraperiosteal 2 holed titanium plate and screws between 2007 and 2015. Pre and post-op long leg radiographs and clinic letters were reviewed. Results. The mean age was 11.9 years (range 3 to 16) with a mean angular deformity of 12.3 degrees (5.1 to 33.5). The mean rate of correction was 0.8 degrees per month. Isolated distal femur correction occurred at a mean rate of 0.6 degrees per month (0.2 to 1.4) and isolated tibia at a rate of 0.5 degrees per month (0.0 to 1.7). Children treated with concurrent treatment of both femur and tibia corrected at a rate of 1.4 degrees per month (0.1 to 2.7). Similar rates of correction occur in children aged 10 and over compared to those younger than 10 (0.8 degrees per month compared to 0.7). We also saw similar rates of correction with extended follow up. The average rate of correction over the first 9 months post op was 0.8 degrees compared to 0.6 degrees over the following 10 months. Conclusion. This study is the largest long term follow up of 8 plate hemiepiphysiodesis which highlights the rate of correction in all age groups. Implications. With this knowledge surgeons can make a more informed decision regarding placement of hemiepiphysiodesis plates and length of time required for correction of angular deformities. It may also lead to consideration of alternative, more powerful techniques if the rate of correction is insufficient. Conflict of Interest: None declared

Introduction: Even most severe foot deformities can be treated with the Ilizarov method (IM). In the last 17 years the IM was used in more than 200 feet. 11 of these feet had a severe chronic Osteomyelitis of the foot. In one case the osteomyelitis lasted more than 21 years. With traditional methods these feet cannot be healed, but often must be amputated. Material and method: AH 11 feet had a type 4 classification according to Dimeglio. All feet have been treated unsuccessfully up to ten times and more before. In one foot necrotic bone was sequestrated regularly. Our operation consisted in all cases in one step only: the Ilizarov ring fixator was put to the foot and the lower leg according to the deformity. No necrectomy was done. An open wedge osteotomy was done if necessary. Postoperatively the feet were gradually distracted and kept in orthograde position. Antibiotics were given as a single shot intraoperatively only. Results: During the time of correction in all cases secernation stopped without any further treatment. In all cases the osteomyelitis became clinically inapparent. Even serology became normal. The feet could be kept in normal position. The patients were able to walk even longer distances. All became pain free. Mean follow-up is 3 years and 7 months (6 months-15 years). Complications: In 4 feet a 2nd procedure with resection of subcutaneous bone spurs was necessary. Not a single case became worse or developed a sepsis. Discussion: We could show that even long lasting cases of severe osteomyelitis of the foot can be treated successfully with the IM. It is most important to correct the deformity. No skin flap or muscle transfer is necessary to improve the condition. The IM should be the treatment of choice in severely involved cases with osteomyelitis and chronic ulceration, especially in patients with neuropathic osteomyelitis, e.g. spina bifida

To evaluate the correction of complex congenital deformities of the lower limb by six axes deformity analyses and computer assisted correction using the Taylor TM Spatial Frame (TSF), from 1998 to 2000, the authors performed corrections of multiple congenital deformities in 24 lower limbs in 18 patients. There were 9 males and 9 females. There were a total of 29 bone segments, (8 femurs, 21 tibiae) in the 24 lower limbs that were corrected with application of the TSF. Our series included the following diagnoses and deformities: unknown skeletal dysplasia (2), achondroplasia (3), pseudoa-chondroplasia (1), multiple epiphyseal dysplasia (2), spondyloepiphyseal dysplasia (2), fibular hemimelia (3) tibia hemimelia (1), hypophosphatemic rickets (3), and posteromedial bowed tibia (1). The mean age of the patients was 15.4 years (range 0.5 to 35 years). The mean frame time until correction was 20.1 weeks (range 9 to 49 weeks). The mean follow up was 2.4 years (range 2 to 3.4 years). The apex of the deformity was directed posteromedial in 7, anterolateral in 6, medial in 5 and anteromedial in 5 patients. The mean coronal and sagittal plane deformities were 14.60 (range −230 to 400) and 70 (range, −400 to 280), respectively. The average magnitude of the deformity was 21.70 (range 90 to 470), and the plane of the deformity to the coronal plane was −23.30 (range −800 to 400). Eight patients had a mean lower extremity shortening of 12.3 mm (range 5 to 50 mm). One patient had 15° of internal rotation. With application of the TSF and the principles of distraction osteogenesis, we were able to reduce the coronal and sagittal plane deformities to 3.10 and 1.40 respectively. The overall mean magnitude of the deformity was decreased to 3.40. Shortening was corrected to an average of 3 mm. We experienced only 4 complications in the 24 limbs (16.7%). Complications in this patient group included one female patient with hypophosphatemic rickets who had residual deformity with significant lateral mechanical axis deviation due to inadequate translation. In addition, there were two superficial pin tract infections and one delayed union. Computer-assisted six axes deformity planning and TaylorTM Spatial Frame application effectively and safely correct complex congenital and developmental limb deformities and offer significant advantages over the well-established Ilizarov technique

Aims

The use of technology to assess balance and alignment during total knee surgery can provide an overload of numerical data to the surgeon. Meanwhile, this quantification holds the potential to clarify and guide the surgeon through the surgical decision process when selecting the appropriate bone recut or soft tissue adjustment when balancing a total knee. Therefore, this paper evaluates the potential of deploying supervised machine learning (ML) models to select a surgical correction based on patient-specific intra-operative assessments.

Cubitus varus is the most frequent complication following the treatment of supracondylar humeral fractures in children. We investigated data from publications reporting on the surgical management of cubitus varus found in electronic searches of Ovid/MEDLINE and Cochrane Library databases. In 894 children from 40 included studies, the mean age at initial injury was 5.7 years (3 to 8.6) and 9.8 years (4 to 15.7) at the time of secondary correction. The four osteotomy techniques were classified as lateral closing wedge, dome, complex (multiplanar) and distraction osteogenesis. A mean angular correction of 27.6º (18.5° to 37.0°) was achieved across all classes of osteotomy. The meta-analytical summary estimate for overall rate of good to excellent results was 87.8% (95% CI 84.4 to 91.2). No technique was shown to significantly affect the surgical outcome, and the risk of complications across all osteotomy classes was 14.5% (95% CI 10.6 to 18.5). Nerve palsies occurred in 2.53% of cases (95% CI 1.4 to 3.6), although 78.4% were transient. No one technique was found to be statistically safer or more effective than any other. Cite this article: Bone Joint J 2014;96-B:691–700

Contracture of the anterior musculature causes posterior humeral head subluxation and results in a posterior load concentration on the glenoid. This reduced contact area causes glenoid wear, humeral medialisation and eventually posterior instability. After arthroplasty that does not correct for this, posterior wear stress increases in the implant, across the cement mantle and bone thus increasing the risk of aseptic loosening over time. Correction of the posterior wear pattern at the time of arthroplasty of the shoulder is recommended. Asymmetric reaming of the glenoid has been recommended as a means to correct this deformity but leads to producing a smaller glenoid which is medialised. This shortening of the glenoid causes the stabilising muscle envelope to shorten and the glenoid vault to become much smaller in volume. These potential changes may have a destabilising effect on the implant leading to early loosening and secondary failure of the prosthetic implant. Other options include using an implant to make the correction of the deformity such as augmented glenoid components. Early uses of these implants were not successful mainly due to the design flaws of the early implants. Newer implants have made design changes to overcome these early failures. CT scan evaluation is important to determine the degree of correction that is needed to balance the glenohumeral joint. Correcting the deformity and keeping the muscle envelope at the appropriate tension may lead to better long term outcomes. These implants are currently in use but long term outcome studies are not yet available to determine their ultimate values to the patients

Vertebral compression fractures are very common. 250,000 are diagnosed annually in the United States with 80% due to osteoporosis. 1. Symptomatic relief with conservative therapy is often difficult to achieve. The consequence of significant pain is deterioration in quality of life and often in level of function. They independently increase mortality rate. 1. . Balloon kyphoplasty is a relatively new technique which stabilises the vertebral body and restores saggital spinal alignment. Excellent pain relief and improved functional outcome is reported. 2,3. We aim to confirm this. All patients receiving balloon kyphoplasty treatment at Derby Hospitals NHS Trust from April 2006 to August 2010 were entered prospectively onto a database. Visual Analogue Score (VAS) for pain and Oswestry Disability Index (ODI) for function were recorded. Technical data including number of levels, cement volume, screening time and kyphosis correction was recorded. 198 patients underwent balloon kyphoplasty between April 2006 and August 2010. Some data was incomplete. 105 patients had sufficient data for meaningful analysis. 170 levels were operated on in 105 patients. 65% (n=68) of patients were female and the average age was 74. The average pre-operative visual analogue score (VAS) was 8.2. This decreased to 4.0 in the immediate postoperative period. This dramatic improvement remained and was 4.1 at 6 weeks, 3.3 at 6 months and 3.6 at 1 year. The average pre-operative Oswestry disability index (ODI) was 58. This improved to 47 in the immediate post-operative period. At 6 weeks this had improved further to 40 and further improvements were seen at 6 months (ODI 37) and 1 year (ODI 38). Balloon kyphoplasty should be considered in all patients with ongoing pain following an acute vertebral compression fracture that doesn't respond to conservative treatment

Children who present late with hip dislocation may require femoral osteotomy after reduction, to correct valgus and anteversion deformity of the femoral neck. After these procedures proximal femoral growth is unpredictable. We have studied proximal femoral growth in 40 children who had been treated by femoral osteotomy. Preoperatively, the mean femoral neck-shaft angle was 5° greater on the affected side than on the contralateral side. Postoperatively, it was 28° less. There was progressive recorrection; after five years the angle was not significantly different from that on the contralateral side. In our series 70% of the capital epiphyses became abnormally shaped, taking the appearance of a ‘jockey’s cap’. All the growth plates became angulated but this corrected with time. Correction of the neck-shaft angle probably results from the more normal mechanical environment provided by reduction. The abnormal radiographic appearance of the epiphysis and growth plate is probably due to the rotation produced by the osteotomy