Guided growth is commonly performed by placing an extra-periosteal two-hole plate across the growth plate with one epiphyseal and one metaphyseal screw. Recent work by Keshet et al. (2019) investigated the efficacy of the removal of the metaphyseal screw only (“sleeper plate”) after correction. They concluded the practice to be unnecessary as only 19% of patient show recurrence of deformity. The aim of this study is to examine the incidence of rebound and undesired bony in-growth of the plate (“tethering”) after metaphyseal screw removal only. In this retrospective case series, patient data on 144 plates inserted around the knee was obtained. Plates still in situ (n=69) at time of study and full hardware removal (n=50) were excluded. The remaining 25 plates had a metaphyseal screw only removed after deformity correction. We analyzed the rate of re-bound, tethering and maintenance of correction in two age groups at latest follow-up for a mean of 3.5 years (1.25 to five). Fisher's exact test with Freeman-Halton extension was used to analyze the two by three contingency table. Twenty-five plates were identified as “sleeper plates” in our series. 13 plates (52%) maintained the achieved correction after a mean of 21 months (four to 39), nine plates (36%) required screw re-insertion due to rebound after a mean of 22 months (12-48) from screw removal, and four plates (16%) showed tethering with undesired continuation of guided growth after a mean of 14 months (seven to 22) from screw removal. Younger patients (years at time of plate insertion) had higher rates of rebound and tethering (p=.0112, Fisher's exact test). All Tethering occurred in titanium plates, none occurred in steel plates. The sleeper plate is an acceptable treatment strategy for coronal deformities around the knee. Rebounding and tethering are potential outcomes that occur in younger patients and should be disclosed to patients; titanium plates may increase the risk of tethering, however further long-term follow-up is needed. We stress the importance of close post-operative follow up to identify tethering early and prevent over correction. The sleeper plate technique is a viable option in younger children with congenital abnormalities, however, continued monitoring of alignment is necessary after screw removal to check for rebound and tethering

Complex congenital foot deformities pose a challenge to the surgeon due to poor results after extensive surgery. We report the clinical outcomes of children with complex congenital foot deformities treated with UMEX® (Universal mini-external fixator System) frames. This is a prospective review of our experience in patients treated in this way, from 2004 to 2011. The indications for treatment included resistant/recurrent Congenital Talipes Equino Varus (CTEV), cavo-varus deformity secondary to Charcot-Marie-Tooth disease, arthrogryposis, fibular hemimelia and other congenital abnormalities. A total of 32 children (35 feet) have been treated, out of which 22 were male and 10 were female patients. Age at surgery ranged from 3 to 15 years (median age – 7 years). Three patients underwent bilateral procedures; the reminder (29 patients) underwent unilateral foot operations. Twenty-eight patients had undergone previous surgery including soft-tissue and/or bony corrective procedures. The frames were removed at an average of 69 days after application, and the patients spent a further 6 weeks in a walking cast. Good functional outcomes were noted in 26 patients in the first postoperative year and in 19 patients in the fifth postoperative year. Further operations were needed in 10 patients. Complications occurred in 10 patients, predominantly pin-site infections and 1 case of bony overgrowth at pin-site and 1 of proximal tibio-fibular diastasis. This is a simple fixator to use with a short learning curve. In groups of patients with complex congenital abnormalities, we achieved good functional outcome with low-complication rates

We report the clinical outcomes of children with complex congenital foot deformities treated with UMEX® mini-external fixators. This is a prospective review of our experience in patients treated in this way, from 2004. The indications for treatment were resistant/recurrent Congenital Talus Equina Varus(CTEV), cavo-varus deformity secondary to Charcot-Marie-Tooth disease, arthrogryposis, fibular hemimelia and other congenital abnormalities. In addition, one patient underwent this treatment since he was allergic to casting material. A total of 32 children (35 feet) have been treated, with a male to female ratio of 22:10 respectively. The patient-age at operation ranged between 3 and 15 years (median age −7 years). Three patients underwent bilateral procedures and 29 patients underwent unilateral foot operations. Twenty-eight patients underwent previous soft-tissue and bony corrective operations with serial casting. The frames were removed at an average of 69 days after application with a further 6 weeks in a walking cast. Seventy-nine percent of the patients had good functional outcome. Further operations were needed in 10 patients. Complications occurred in 10 patients, including pin-site infections, bony overgrowth at pin-site and proximal tibio-fibular diastasis. In conclusion, this is a simple fixator to use with a small learning curve. In groups of patients with complex congenital abnormalities, we achieved good functional outcome with low-complication rates

Incidence of Congenital talipes equino varus [CTEV] is 1 to 2 per 1000 birth, Out of all cases 20% cases are Non-idiopathic. The management of non-idiopathic CTEV, however, continues to be challenging due to Rigidity, Poor skin condition, Bony changes, Vascularity and Associated congenital abnormalities. In recent literature, short term results of Ponseti method for correction of non-idiopathic CTEV have been encouraging. As Ponseti method decreases the severity of deformity and hence decreases the need for extensive surgery. The aim of current study is to evaluate the results of Ponseti method in Non-idiopathic CTEV. Total 7 children below the age of one year with Non idiopathic clubfoot presented to us in the duration of 2013 to 2015 who were treated by us. The cases included are Streeters Dysplasia with congenital constriction rings 3, Arthrogryposis multiplex congenita with Developmental dysplasia of hip 2, Arthrogryposis multiple congenita spina Bifida 1, Pierre Robinson Syndrome with Ichthiosis 1. Initially all the patients treated with Ponseti casting technique and scoring was done using modified pirani scoring. At an average we could correct the foot from Pirani 7 to 2.5 with a relapse in 4 patients. 2 patients were treated again by Ponseti's method with success while treatment was discontinued in 2 feet. We recommended Ponseti's technique in Syndromic clubfoot as an non-surgical initial modality with good results given. The final outcome may depend more on the underlying condition than the CTEV

Background. The incidence of scoliosis is 2/1000 population in the UK with 80% being idiopathic. In the Royal Victoria Hospital, Belfast there are approximately 25 scoliosis operations per year, the majority are for idiopathic causes and are limited to posterior instrumentation and fusion. It is current practice in this hospital to use a cell salvage machine for every case managed by nursing staff. Objective. To ascertain the requirement for and the economical viability of cell salvage during posterior instrumented scoliosis surgery. Method. Retrospective study looking at 35 charts of patients who had undergone scoliosis surgery (4 were excluded – 3 fracture patients and 1 patient aged 59). We looked at pre-operative haemoglobin, intra-operative blood loss and the need for post-operative transfusion. Results. Average age of patient 15.4 years; 28/31 causes were idiopathic; average blood loss 1282 mls (only 11 charts had it recorded); average pre-operative Hb 13.9; 7 patients required transfusion, 3 of which received cell salvaged blood only (average volume of cell salvaged blood was 148mls) and 2 out of 3 patients with neuromuscular disorders required blood transfusion. To make cell salvage economically viable it has been calculated that approximately 400 cases need to be performed– in our unit this would equate to 16 years assuming each patient yielded 1 unit of blood. Conclusion. This study does not support the routine use of a Cell Saver in posterior instrumented fusion scoliosis surgery in the population group. However, in patient with underlying neuromuscular and congenital abnormalities it may be viable

Introduction. Corrective femoral osteotomy in adults, as a closed procedure with the use of an intramedullary saw, is an elegant, minimally invasive technique for the correction of lower limb length inequalities or problems of torsion. Stabilisation following the osteotomy was achieved with a cephalo-medullary nail. We report the indications, results and complications following use of this technique. Aim. The aim of the study was to review consecutive patients who underwent closed femoral rotational or shortening osteotomy using an intramedullary saw over a ten-year period. Material & Methods. Forty femoral rotational and/or shortening osteotomies using an intramedullary saw were performed on thirty-six patients, between January 2001 and June 2011. The main indications were post-traumatic leg length discrepancies and congenital rotational abnormalities. Clinical & radiological follow up mean was 16.3 months. Results. Twenty one osteotomies were performed for femoral shortening with the mean correction of 3.5 cm. Nineteen osteotomies were performed for correction of torsion; there was a mean correction of 28.64 degrees with Internal rotation and 35 degrees with external rotation osteotomies. Fourteen patients required removal of locking screws. There were two patients with heterotrophic ossification, two patients with wound infection (one deep infection). One patient had a materiovigilance incidence and one patient had vascular complication requiring embolisation. The subjective results showed 37 osteotomies were satisfied with their operation, functional recovery and aesthetic appearance of the scars. Conclusion. Closed osteotomy of femur for correction of LLD and torsion using an intramedullary saw represents a reliable and effective procedure. Despite the complications, the original goal of the surgery was achieved in 37 of the 40 limbs treated. Patient satisfaction was achieved in 92.5 % of 40 osteotomies

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.

Adult presentation of neglected congenital muscular torticollis is rare. We report 12 patients with this condition who underwent a modified Ferkel’s release comprising a bipolar release of sternocleidomastoid with Z-lengthening. They had a mean age of 24 years (17 to 31) and were followed up for a minimum of two years. Post-operatively a cervical collar was applied for three weeks with intermittent supervised active assisted exercises for six weeks. Outcome was assessed using a modified Lee score and a Cheng and Tang score. The mean pre-operative rotational deficit was 8.25° (0° to 15°) and mean lateral flexion deficit was 20.42° (15° to 30°), which improved after treatment to a mean of 1.67° (0° to 5°) and 7.0° (4° to 14°) after treatment, respectively. According to the modified Lee scoring system, six patients had excellent results, two had good results and four had fair results, and using the Cheng and Tang score, eight patients had excellent results and four had good results.

Surgical management of adult patients with neglected congenital muscular torticollis using a modified Ferkel’s bipolar release gives excellent results. The range of neck movement and head tilt improved in all 12 patients and cosmesis improved in 11, despite the long-standing nature of the deformity.