PURPOSE: This study was designed to evaluate the mid-term results and efficacy of subtalar distraction double bone-block arthrodesis for calcaneal malunion. MATERIALS AND METHODS: From January 2004 to June 2007, we operated on 6 patients (10 cases). There were 5 males (9 cases) and 1 female (1 case), four of which presented with bilateral calcaneal malunion. Seven cases were operated on initially. The period between initial injury and arthrodesis was 23 months, and the average follow up period was 58 months. In operation, we applied an extensile lateral approach and arthrodesis was performed through a tricortical double bone-block and cannulated screws. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT were examined to assess union and various parameters. RESULTS: The mean age of the patients was 41 years. All cases achieved radiologic union at the final follow-up. The mean AOFAS Ankle-Hindfoot scale (maximum of 94 points) increased from 43.3 points preoperatively to 85.4 points at the final follow-up. The radiologic analysis of the pre- and postoperative standing lateral radiographs showed improvements of 5.6 mm in talo-calcaneal height, 1.8degrees in talocalcaneal angle, 5.1degrees in talar declination angle and 5.3degrees in talo-first metatarsal angle. CONCLUSION: Subtalar distraction two bone-block arthrodesis provides overall good results not only in the short term but also the mid-term with significant improvement in clinical and radiologic outcomes. This procedure warrants consideration for managing calcaneal malunion with loss of height and subtalar arthritis.
Adult ; Arthrodesis/methods ; Calcaneus/*injuries/surgery ; Female ; Fractures, Malunited/*surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Regardless of the method of treatment, as many as 5% of all pelvic fractures result in malunion or nonunion of the pelvis. However, there is not much information in the literature on the management of these late complications. Because they cause disabling symptoms and socioeconomic problems, some patients with malunion or nonunion of pelvic fractures need to undergo surgery. We report our experience with satisfactory results of surgery for pelvic malunion and nonunion in four patients. The key to successful reconstruction is thorough preoperative planning and methodical surgical intervention.
Adult ; Female ; Fracture Fixation, Internal/*instrumentation/*methods ; Fractures, Malunited/radiography/*surgery ; Fractures, Ununited/radiography/*surgery ; Humans ; Pelvic Bones/injuries/radiography/*surgery

The outward angulation of elbow with supinated forearm is cubitus varus deformity. This deformity is often seen as sequelae of malunited supracondylar fracture of humerus in paediatric age group of 5e8 years. The deformity is usually non-progressive, but in cases of physeal injury or congenital bony bar formation in the medial condyle of humerus, the deformity is progressive and can be grotesque in appearance. Various types of osteotomies are defined for standard non-progressive cubitus varus deformity, while multiple surgeries are required for progressive deformity until skeletal maturity. In this study we described a novel surgical approach and osteotomy of distal humerus in a 5 years old boy having grotesque progressive cubitus varus deformity, achieving good surgical outcome.
Child, Preschool ; Elbow Joint ; injuries ; Fractures, Malunited ; complications ; Humans ; Humeral Fractures ; complications ; Humerus ; surgery ; Joint Deformities, Acquired ; surgery ; Magnetic Resonance Imaging ; Male ; Osteotomy ; methods

OBJECTIVETo report and evaluate the results of subtalar distraction bone block fusion in the treatment of malunited calcaneus fracture.

METHODSFrom September 2004 to January 2008, 32 cases of malunited calcaneus fracture were treated, among which 28 cases were classified type II and 4 cases type III by Stephens-Sander's classification. Preoperative X-ray and CT examination demonstrated a talocalcaneal angle of 18.1 degrees ± 2.3 degrees , and an AOFAS score of 36.3 ± 4.1. Subtalar distraction bone block fusion was performed in all cases in this series. Regular follow-up was done with talocalcaneal angle measurement and AOFAS scoring.

RESULTSAll the 32 patients had been followed-up of 34 months, ranging from 24 to 65 months, only to reveal a primary wound healing without infection in all but one, in which superficial skin necrosis occurred postoperatively and healed after dressing-changes. Bone healing at the fusion site was seen 3 months after operation in all cases. At the final follow-up, the talocalcaneal angle was 22.9° ± 1.9° and the AOFAS score 77.5 ± 4.1, both demonstrating a significant difference (P < 0.05), when compared with those before operation.

CONCLUSIONSubtalar distraction bone block fusion, together with the lateral wall decompression, can correct the main deformity and reduce major symptoms induced by the malunion of calcaneus fractures, being a convenient and practical option for the treatment of malunited calcaneus fracture.

Adult ; Arthrodesis ; methods ; Bone Transplantation ; Female ; Follow-Up Studies ; Fracture Healing ; Fractures, Malunited ; surgery ; Humans ; Male ; Subtalar Joint ; surgery ; Treatment Outcome

Femur ; diagnostic imaging ; injuries ; physiopathology ; Fractures, Malunited ; diagnostic imaging ; physiopathology ; surgery ; therapy ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Postoperative Complications ; diagnostic imaging ; physiopathology ; therapy ; Tomography, X-Ray Computed ; Young Adult

INTRODUCTIONSpiral and oblique fractures of distal 1/3 of tibia-fibula are relatively common fractures of long bones. Due to their types, aetiology, limited coverage and blood supply, these fractures often lead to union and soft tissue problems.

MATERIALS AND METHODSTwenty-seven patients with spiral and oblique fractures of distal 1/3 of tibia-fibula were treated with circular external fixator (CEF) between January 1997 and August 2000. All the fractures were closed. The type of fractures based on AO classification were A1 (n = 8), A2 (n = 6), B1 (n = 11) and C1 (n = 2).

RESULTSThe mean framing time was 14.1 +/- 1.8 weeks (range, 12 to 19 weeks), and the mean treatment time was 18.8 +/- 2.2 weeks (range, 15 to 24 weeks). The patients were followed up for 36 to 78 months (mean follow-up time: 51.9 +/- 10.4 months). The results were evaluated for shortness, angulation, rotation, ankle stiffness, pain and infection. After removal of the frames, 11 patients had ankle pain and stiffness, and 3 patients had loss of range of motion in the ankle even after rehabilitation. None of the patients suffered any complications such as shortness, angulation, rotational deformity and infection, and none had loss of motion in the knee.

CONCLUSIONSCEF might be a preferable alternative treatment for distal tibia-fibula fractures due to its easy application, fewer major complications such as shortness and angulation, early mobilisation and shorter treatment time.

Accidental Falls ; Accidents, Traffic ; Adult ; Aged ; Athletic Injuries ; External Fixators ; Female ; Fibula ; injuries ; surgery ; Fractures, Bone ; etiology ; pathology ; surgery ; Fractures, Malunited ; surgery ; Humans ; Ilizarov Technique ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Pilot Projects ; Range of Motion, Articular ; Tibial Fractures ; etiology ; pathology ; surgery ; Turkey

Apophyseal injuries of the pelvis have increased recently with increased participation of teenagers in contact sports. Apophyseal fractures of the pelvis should be ruled out from apophysitis, os acetabuli and bony tumors. We report a case of fracture of anterior-inferior iliac spine following indirect injury to the hip in a young football player. The patient failed to get better with nonoperative management and continued to have pain in the left hip and signs and symptoms of impingement. He improved following surgical excision of the heterotopic bone and did not have any evidence of recurrence at 2 years follow- up.
Adolescent ; Athletic Injuries ; diagnostic imaging ; surgery ; Femoracetabular Impingement ; diagnostic imaging ; surgery ; Follow-Up Studies ; Football ; injuries ; Fracture Fixation ; adverse effects ; methods ; Fractures, Malunited ; diagnostic imaging ; surgery ; Humans ; Ilium ; diagnostic imaging ; injuries ; surgery ; Male ; Osteotomy ; methods ; Risk Assessment ; Spinal Fractures ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; methods ; Treatment Outcome

According to the literature, thoracic outlet syndrome (TOS) secondary to the malunion of displaced fractures of the clavicle is rare. Various surgical methods, including simple neurolysis, resection of the first rib or clavicle and corrective osteotomy, have been reported. We report a case of TOS secondary to malunion of the clavicle that was treated by an anterior and middle scalenectomy without a rib resection.
Adult ; Humans ; Low Back Pain/etiology ; Lumbar Vertebrae/surgery ; Male ; Postoperative Complications/*microbiology ; Spondylitis/etiology/*microbiology ; Thoracic Vertebrae/*microbiology/pathology ; Tuberculosis/drug therapy/*microbiology ; Tuberculosis, Spinal/complications/drug therapy/*microbiology ; Adult ; Clavicle/*injuries ; Fractures, Malunited/*complications ; Humans ; Male ; Thoracic Outlet Syndrome/etiology/radiography/*surgery