Purpose: The Ponseti method of clubfoot treatment has revolutionised the management of this condition. Prior to the introduction of the Ponseti regime to the UK in the late 1990’s children were frequently treated by open surgical releases. The aim of our study is to compare the patient’s perspective of outcome following Ilizarov treatment against the long-term outcome generated by the formal scoring systems.

Method: We identified nine patients and 14 feet from the theatre logbooks, treated by the senior author (CB), with recurrent deformity of idiopathic clubfeet, using an ilizarov external fixator between 1994 and 1996. A variety of objective and subjective scoring systems were used to compare the results following Ilizarov treatment.

Results: International Clubfoot Study Group (ICFSG) scores on six patients gave two excellent feet, one good foot, four fair feet and one poor foot. Giving an excellent/ good rate of only 37.5% with a mean follow up of 13.5 years. The Reinker & Carpenter scoring system resulted in five feet graded as excellent, one as good and two were rated poor. Giving an excellent/good rate of 75%. Functional questioning was also undertaken, six of seven (85%) patients deemed their treatment a success and were glad to have undergone treatment with an ilizarov frame. All but one patient is in higher education pursuing a vocational career or are in full time employment.

Conclusion: Our results show that 85% of our patients who were treated with an Ilizarov frame for correction of a relapsed clubfoot were happy with their long term outcome. Thus the patient’s perspective of the long term results of Ilizarov treatment for relapsed club foot are very encouraging. These results do not appear to correlate well with the International Clubfoot Study Group scores.

Introduction: Unstable fractures of the distal tibia that are not suitable for intramedullary nailing are commonly treated by open reduction and internal þxation and/or external þxation techniques. Treatment of these injuries using minimally invasive plate osteosynthesis (MIPO) techniques may offer the advantage of achieving adequate þxation whilst minimising soft tissue injury and damage to the vascular integrity of the fracture fragments. Purpose: We report our experience using MIPO techniques for the treatment of unstable fractures of the distal tibia. Method: A review of all patients who sustained an unstable fracture of the distal tibia treated by MIPO between 1998 and 2001 was undertaken. Twenty patients were identiþed. The mean age was 38.3 years (17 Ð 71). All fractures were closed, and were classiþed according to the AO system. Intra-articular fracture extensions were classiþed according to RŸedi and Allgšwer. Results: Sixty percent of patients achieved callus by 8 weeks. All patients achieved callus by 3 months. The mean time to full weight bearing was 12 weeks (8 Ð 17). By 6 months 18/20 patients had achieved union. The two remaining patients achieved union by 7 months without further surgery. There were no deep infections and only one malunion. There were no cases of failure of þxation. Conclusion: MIPO appears to offer a reliable method of þxation of fractures of the distal tibia that are unsuitable for intramedullary nailing. Our results suggest that this technique is associated with a lower risk of signiþcant complications than encountered with more traditional methods of þxation of such fractures.

INTRODUCTION: Unstable distal and proximal tibial fractures that are not suitable for intramedullary nailing are often treated by open reduction and internal fixation (ORIF) and/or external fixation techniques. Discuss the treatment of these injuries with Percutaneous Plating technique which offers advantages over standard external fixation and/or ORIF as it minimises soft tissue trauma and does not disturb the osteogenic fracture haematoma.

PURPOSE: We report on the experience using percutaneous plating of unstable distal fractures in a district General Hospital setting and discuss the technique used and the applicability of this method to military personnel with high functional demands.

METHOD: a retrospective review of all patients treated with percutaneous plating technique for an unstable distal tibial fracture between 1998 and 2001 was undertaken. Fractures were classified to the AO system Reudi and Allgower. Indications for use of the percutaneous plate technique were distal tibial fractures which were initially managed in plaster until definitive fixation. No external fixation was used. The operation consisted of supine position on a radiolucent table. The fracture was reduced by closed methods and a DCP was shaped to fit the tibia. This was then positioned on the medial tibia in an extraperiosteal, subcutaneous tunnel. 4.5mm screws were fitted via stab incisions as appropriate to hold the plate in position. No splinting was used other than the plaster itself unless the patient was felt to be unable to comply with a touch weight bearing regime. Clinical and radiological follow up was 6–8 weeks, 3 months and 6 months post injury.

RESULT: 22 patients were identified, 20 of whom were available to follow up. Mean age was 38.3 years (range 17–71). There were 18 males and 4 females. Mechanism of injury was a fall in 12, motorcycle RTA in 6, and rugby/ football injury in 4. Most fractures were 42-A1/42-B1. 4 fractures had distal intra-articular fracture extensions. All were closed injuries. Over 50% of patients underwent fixation within 24 hours of the injury. Mean hospital stay was 6.5 days (2–31). There were no deep infections (one superficial infection which resolved with oral antibiotic treatment). Most patients achieved callus by 8 weeks, all by 3 months. Mean time to full weight bearing was 12 weeks (8–17). By 6 months only 2 fractures had not united. These united at 7 months. There were no non-unions and only one mal-union. There were no cases of failure of fixation.