Genu varum in the achondroplastic patient has a complex and multifactorial aetiology. There is little mention in the literature of the role of fibular overgrowth. Using the ratio of fibular to tibial length as a measurement of possible fibular overgrowth, we have related it to the development of genu varum. Full-length standing anteroposterior radiographs of 53 patients with achondroplasia were analysed. There were 30 skeletally-immature and 23 skeletally-mature patients. Regression analysis was performed in order to determine if there was a causal relationship between fibular overgrowth and the various indices of alignment of the lower limb. Analysis showed that the fibular to tibial length ratio had a significant correlation with the medial proximal tibial angle and the mechanical axial deviation in the skeletally-immature group. We conclude that there is a significant relationship between fibular overgrowth and the development of genu varum in the skeletally-immature achondroplastic patient

Purpose: Tibial osteotomy for valgisation is a difficult procedure with a risk of over-correction or under-correction which can have significant aesthetic, functional and medicolegal consequences. In order to improve the precision, we adapted a navigation system to tibial osteotomy for valgisation. The purpose of the present work was to evaluate the feasibility and results of this technique. Material and methods: From March to November 2001, we used the Orthopilot system for 19 patients with genu varum. Mean patient age was 50.8±11.7 years (range 18–71). The indication for valgisation was genu varum, associated with joint degeneration (grade 1, 2, or 3 in the modified Ahlback classification) in 18. The aesthetic effect of genu varum was the only indication in one patient. Preoperatively, the mean HKA was 173.73±3.24° (range 169–178). The mechanical axis was determined with Orthopilot before performing an open medial osteotomy for valgisation which was fixed temporarily with a metal wedge to control as needed lower limb alignment. Orthopilot enabled verification of the desired axis. When obtained, the metal wedge was removed and replaced by a wedge of tricalcium phosphate (Biosorb®, B-Pharm) of the same size. The osteotomy was stabilised with a screw plate. The objective was to obtain a femorotibial axis between 182° and 186°, i.e. 2° to 6° valgus. Results: HKA measured peroperatively with Orthopilot was 174.05±3.06°, exactly the same as on the preoperative x-rays. After oseotomy, HKA was 183.47±1.07° (180°–184°) with Orthopilot, and 183.47±1.44° (179°–186°) on the x-rays. Eighteen knees were within the objective of 182°–186° giving a success rate of 94.7%. Discussion: Computer-assisted tibial osteotomy for val-gisation using Orthopilot is quite feasible. To have a valid assessment of this new method, results would have to be compared with a series performed without computer assistance

Purpose of the study: The purpose of this study was to assess radiological outcome of double (femoral and tibial) osteotomy for severe genu varum. Between August 2001 and November 2004, eleven double osteotomies were performed amoung a series of 157 knee osteotomies (7%). Material and methods: The series included four women and seven men, mean age 48.5 years (range 20–62 years). The right knee was involved in seven. One femal patient presented a particularly serious deformity but without oseoarthritic degeneration of the knee joint. The ten other patients all presented overtly degenerative knees. According to the Ahlback modified classification there were six grade III knees, three grade IV and one grade V. Mean preoperative radiological varus was 167.5±2.1° (ange 164–170°°. Orthopilot® was used in all cases. The first step was to insert percutaneously rigid bodies, one into the distal femur and the other into the proximal tibia. Kinematic acquisitions of the hip, the knee and the tibiotalar joint yielded the HKA for the lower limb. The second step was to perform the closed wedge lateral femoral osteotomy (5–6°) which was stabilized with an AO T-plate. The final step was to perform an open-wedge medial tibial osteotomy. After checking the desired alignment (182±2°) on the monitor, the osteotomy was fixed with Biosorb® and plated with an AO LCP. Results: There were no complications. The mean intraopeartive HKA was 168.1±2.21° (range 164–170°), identical with the preoperative findings. After osteotomy, the mean angle provided by the computer system was 182.7±1.1° (range 182–184°). Three months after surgery, the mean alignment on the standing x-ray was 180.8±1.6° (range 177–182°). The preoperative objective was achieved for all knees but one (91% success). There were no x-rays with an oblique joint space. Conclusion: Computer-assisted double osteotomy for major genu varum is a reliable accurate and reproducible technique. Use of a navigation simplifies a generally difficult procedure known to require much surgical skill to achieve the preoperative goal. This technique can be considered as an important development since it can help avoid an oblique joint space which can give rise to further problems and the need for a subsequent prosthesis

Purpose of the study: It is currently accepted that ligament balance should be one of the goals for total knee arthroplasty (TKA) and that this balance should be obtained by correct bone cuts or appropriate ligament procedures. There is however no standard way of assessing this balance. The purpose of this study was to define limit values for knee laxity observed in a series of normal knees and in a series of 54 TKA reviewed at more than ten years. Material and methods: Laxity in extension of normal knees was measured on forced varus and valgus films using the contralateral knees of patients who had undergone knee surgery for osteotomy or prosthesis implantation. Laxity in extension of TKA knees was measured the first postoperative year and at last follow-up by measuring the decoaptation between the tibial and femoral pieces on single-leg stance films. The change in decoaptation over time was compared with the postoperative and last follow-up goniometry figures, the IKS knee score, the number of loosenings and the number of lucent lines. Multifactorial analysis was considered significant at p< 0.05. Results: For the normal knees in extension, the medial compartment gap was 2 mm on average (range 1.5–3.5 mm) on the forced valgus images and the lateral compartment gap was 3 mm on average (range 2–4 mm) on the forced varus images. The corresponding angular value was 1° decoaptation on the forced valgus images and 1.5° on the forced varus images. Among the 54 knees with a TKA, the first postperative single-leg stance image revealed a lateral decoaptation _ 3° for 12 knees considered to present laxity, and was _ 2° for 42 knees considered not to present laxity. At last follow-up (13 years on average, range 11–14 years) the 42 knees without laxity remained unchanged without decoaptation, including the 34 normocorrected knees (±3°) and the eight undercorrected knees presenting more than 3° varus (mean undercorection 5°, range 3–7°). The 12 knees presenting postoperative radiographic decoaptation _ 3° showed at last follow-up a significant increase in laxity (p< 0.05) and 2.5° further increase in decoaptation. The increase in decoaptation occurred on normocorrected (n=7) or undercorrected (n=5) knees. This increase in decoaptation was greater with greater residual genu varum. Four groups of knees could be distinguished: normocorrected and stable; normocorrected and unstable; undercorrected and stable; overcorrected and unstable. The number of loosenings requiring revision and the number of progressive lucent lines were significantly greater among unstable knees (two loosenings, and five progressive lucent lines) than among stable knees (no loosening or lucent lines). They were also greater in the group of normocorrected and unstable knees (one loosening and two lucent lines) than in the group of undercorrected and stable knees (no loosening or lucent line). The IKS knee score of stable knees was higher than that of unstable knees irrespective of the correction (p< 0.05). Discussion: Postoperative laxity in varus with angular decoaptation greater than 3° corresponds to a lateral compartment gap and should be avoided even if the knee is properly aligned postoperatively. If the knee is stable, moderate undercorrection (3–5° varus) does not appear to have an unfavorable long-term effect on knee laxity or on the femoral and tibial pieces. Conclusion: For knees with constitutional genu varum, moderate undercorrection with a stable knee is preferable to normocorrection at the cost of lost stability

It is well known that tibial osteotomy of arthritic painful genu varum in patients younger than 70 years of age has advantages both for the mechanical effect of symmetrical distribution of joint loading and for the biological effect produced by the bone section on the local venous intraosseus pressure which reduces pain. Patients were selected according to pre-operative X-ray evaluation of the limbs taken with the patient bearing weight on one foot: varus deformity not greater than 25°, knee flexion not greater than 15°, joint movement not less than 90° and absence of femorotibial subluxation or other instabilities. Surgery consists in application of three proximal and two distal screws into the medial side of the tibia. An Orthofix Fixator with self-aligning body is applied and an oblique osteotomy performed medially through a 3-cm skin incision using a drill bit and an osteotome to keep the lateral cortex intact in order to avoid lateral translation of the distal segment. The patient can correct progressively the deformity himself by distracting the compression-dsistraction unit with an allen wrench. Once the desired correction has been achieved (8°–10°), a control X-ray is taken and the central body locking nut of the fixator tightened. Patients can bear full weight with crutches 4–5 days after surgery. We have treated a total of 163 patients (92 men, 71 women). Their average age was 60 yearsand average healing time 75 days. Results were excellent in 60%, good in 25%, fair in 10% and poor in 5%. The average post-operative valgus was 9%. The technique and the clinical results are discussed

Purpose: The purpose of this work was to assess the mechanical axis of 28 computer-assisted osteotomies (group A) with 28 manual osteotomies (group B) selected at random from 140 osteotomies performed between January 1997 and December 2000. Material and methods: The populations were comparable for age, gender, side, degree of osteoarthritis (modified Ahlback stages) and varus malalignment (group A: 173±3.80° (160°–178°), group B 172.8±3.18° (164°–178°) using a pangonometer to measure the HKA angle). For 52 knees, open-wedge tibial osteotomy was performed and fixed with a tricalcium phosphate wedge (Biosorb(r)) and an AO T-plate. For four knees (two in group A and two in group B), a double tibial (open wedge) and femoral (closed wedge) osteotomy was used due to genu varum measuring greater than 15°. Preoperative planning for the classical method used a plumb line from the centre of the femoral head identified fluoroscopically. The Orthopilot(r) computer-assisted method also relied on preoperative planning but intraoperative control was based on computer acquisitions of the centre of the hip, the knee and the ankle. The objective of the intervention was to obtain a mechanical axis between 182° and 186°. All knees were evaluated with pangonometry at three months to check axis correction. Results: In group A, the mean postoperative HKA was 183±0.99° (181°–185°). In group B it was 184±2.28° (181°–189°). The objective was attained in 96% of knees in group A and in 71% in group B, giving a statistical difference between the absolute data (p=0.0248) and between the standard deviations (p=0.0015). Conclusion: Computer-assisted osteotomy to correct for genu varum using the Orthopilot(r) method is feasible and remarkably reproducible. In our hands Orthopilot(r) enabled attaining the surgical objective set preoperatively. The kinetics of the acquisition of the centre of the hip, the knee, and the ankle associated with palpation of remarkable extra-articular points is an excellent method avoiding the need for intra-articular palpation which might complicate the surgical procedure

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.

We describe three cases of infantile tibia vara resulting from an atraumatic slip of the proximal tibial epiphysis upon the metaphysis. There appears to be an association between this condition and severe obesity. Radiologically, the condition is characterised by a dome-shaped metaphysis, an open growth plate and disruption of the continuity between the lateral borders of the epiphysis and metaphysis, with inferomedial translation of the proximal tibial epiphysis. All patients were treated by realignment of the proximal tibia by distraction osteogenesis with an external circulator fixator, and it is suggested that this is the optimal method for correction of this complex deformity. There are differences in the radiological features and management between conventional infantile Blount’s disease and this ‘slipped upper tibial epiphysis’ variant.

Background:. It has been suggested that double-level osteotomy can prevent the occurrence of joint line obliquity (JLO), as one of the complications following high tibial osteotomy (HTO). In this study, we aimed to compare the preoperative distal femoral and proximal tibial obliquity in patients with primary genu varum with a group of normal subjects (without genu varum). Materials and methods:. 75 patients with primary genu varum and 75 normal persons, contributed to a case-control study. The medial distal femoral mechanical angle (MDFMA), medial proximal tibial mechanical angle (MPTMA), joint diversion angle (JDA) and femoral and tibial JLO were measured and compared between the two groups. The percentage of patients' with > 4 degrees of JLO in both distal of femur and proximal of tibia, were then determined. Results:. The mean of MDFMA and MPTMA were significantly lower and JDA and femoral and tibial JLO were significantly higherin genu varum group (p < 0.05). Double-level osteotomy was required in 25.3% of patients with genu varum to prevent post-operative JLO. Conclusion:. JLO is a common finding in patients with genu varum and normal group; however, it is significantly higher in patients with genu varum

Purpose of the study: The stability of the patella over the femur depends on several factors, one being the rotatory freedom of the tibia. Femorotibial rotatory laxity of a total knee arthroplasty (TKA) can be:. dictated by the congruence of the polyethylene in an ultracongruent plateau;. completely free, depending solely on the ligament structures in a self-aligning prosthesis;. the consequence of a compromise between the two, using a semi-constrained prosthesis. With the OMNIA system, the unique femoral piece can be combined with a Wallaby ultracongruent plateau (WUC), a self-aligning mobile plateau (SAL), or a semiconstrained plateau with preservation of the posterior cruciate ligament (Wallaby 1, W1). A comparative study of these three prostheses was performed to evaluate the influence of femorotibial rotatory constraint on patellar stability. Material and methods: The series included 157 TKA: 68 SAL,44 WUC and 45 W1. The same surgeon operated all patients in three successive series. The operative technique was the same using the same instrument set. The femoral piece was inserted first with an automatic rotation systematically set at 5° with the posterior condyles. The knees were varus (71%), valgus (20%) and perfectly aligned (9%). A patellar prosthesis was used in only 10.8% due to excessive wear as assessed intraoperatively. A medial approach was used for the varus knees and a lateral approach for the valgus knees greater than 10°, independently of preoperative patellar stability. Radiological outcome was assessed on the 30° femoro-patellar views. Patellae tilted more than 3° and/or offset more than 5 mm were considered to be excentered. Results: In the SAL group, 55 patellae were centered and 13 off-centered. The ratio was 36 for 6 in the WUC group and 39 for 6 in the W1 group. The percentages of centered patellae were respectively 80, 85, and 86%. The difference was not significant (p=0.66. For knees with preoperative genu varum, the percentages of centered patella were 83, 84, and 86%; and for genu varum, 72, 0 and 75% (sample too small for statistical significance). Discussion: The use of rotatory constraint for TKA does not affect patellar stability. This was confirmed in a subpopulation of genu varum knees and not in genu valgum

Purpose: Over recent years, several authors have estimated that the distal femur presents an epiphyseal torsion which can be measured intraoperatively or on the preoperative scan. This measurement does not however take into account the dynamic mechanical axis, particularly the mechanical axis at 90° flexion when walking. We used a computer-assisted navigation system (Ortho-pilot®) to attempt to measure femoral rotation by dynamic gonometry in extension and 90° flexion before and after implantation of a total knee arthroplasty. Material and methods: We recorded the preoperative (Rx) and intraoperative (Orthopilot) HKA in extension and in 90° flexion before and after implantation of 50 total knee prostheses (Search®, Aesculup, AG, Tuttlingen) and again postoperatively (Rx). The series included 19 knees with genu valgum (mean HKA 187.36±5.4°, range 181°–203°), 30 knees with genu varum (HKA 169.2±4.11, range 160°–176°), and one normal axis knee. Results: The radiographic values obtained preoperatively were confirmed by Orthopilot, respectively 186.68±5.25° and 169.76±3.84° in extension. At 90° flexion, HKA was 178.63±5.7° before implantation for genu valgum giving a significant varus due to lateral opening during flexion,and 171.6±4.15° for genu varum, showing persistence of varus. After implantation of the total knee prosthesis, the values were as follows. For the genu varum: HKA in extension 180.57±0.82° and HKA in 90° flexion 176.86±2.55° giving a mean residual varus of 3.16±2.86° (from 4–8° varus) without external rotation of the femoral implant. For genu valgum, HKA in extension was 179.60±0.92° and HKA in 90° flexion was 176.1±3.23°, giving a mean residual varus of 3.26±2.86° (0–10° varus), recalling that in the event of genu valgum we impose external rotation due to the frequent hypoplasia of the lateral condyle. Discussion: Orthopilot-assisted implantation of total knee prostheses provides new information concerning dynamic gonometry, particularly the varus or valgus in flexion, which corresponds to measuring natural external or internal rotation. Measuring epiphyseal torsion of the distal femur with classical methods does not take into account the global rotation of the femur which is often an external rotation (up to 8° for genu varum). Systematic implantation of the femoral component in external rotation raises the risk of increasing considerably the varus forced to the implant during flexion

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. Methods. Between January 2013 and December 2016, 138 patients (22 children, 116 adolescents) with genu valgum or genu varum were treated with 285 flexible staples. The minimum follow-up was 24 months. These results were compared with 98 patients treated with 205 two-hole plates and 92 patients treated with 535 Blount staples. In long-standing anteroposterior radiographs, mechanical axis deviations (MADs) were measured before and during treatment to analyze treatment efficiency. The evaluation of the new flexible staple was performed according to the idea, development, evaluation, assessment, long-term (IDEAL) study framework (Stage 2a). Results. Overall, 79% (109/138) of patients treated with flexible staples achieved sufficient deformity correction. The median treatment duration was 16 months (interquartile range (IQR) 8 to 21). The flexible staples achieved a median MAD correction of 1.2 mm/month/HED site (IQR 0.6 to 2.0) in valgus deformities and 0.6 mm/month/HED site (IQR 0.2 to 1.5) in varus deformities. Wound infections occurred in 1%, haematomas and joint effusions in 4%, and implant-associated complications in 1% of patients treated with flexible staples. Valgus AD were corrected faster using flexible staples than two-hole plates and Blount staples. Furthermore, the median MAD after treatment was lower in varus and valgus AD, fewer implant-associated complications were detected, and reduced implantation times were recorded using flexible staples. Conclusion. The flexible staple seems to be a viable option for guided growth, showing comparable or possibly better results regarding correction speed and reducing implant-associated complications. Further comparative studies are required to substantiate these findings. Cite this article: Bone Joint J 2023;105-B(3):331–340

Aim: To assess the effect of lyophilised bone grafts, autologous platelet gel and autologous medullary cells on bone repair processes after tibial osteotomy for genu varum. Methods: Thirty patients, divided into 3 groups by the generation of random sampling numbers, were treated by valgus osteotomy for genu varum with a minimum correction of 8 mm and fixation using a titanium plate (TITAN plate® Citieffe). The groups were thus divided:. Group 1: lyophilised bone chips. Group 2: lyophilised bone chips + platelet gel. Group 3: lyophilised bone chips + platelet gel + packed autologous medullary cells (Buffy coat). At six weeks X-rays, MRI and needle biopsies were carried out. The tissue underwent morphological and microstructural tests. Results confirmed that the use of platelet gel and packed medullary cells as adjuvant for the lyophilised bone aid bone repair and graft integration. Morphological and morphometric tests showed that at six week the newly formed bone of group 3 had better mechanical properties. Conclusions: This study shows that the use of platelet gel and packed autologous medullary cells combined with lyophilised bone chips produces a faster and mechanically stronger recovery of bone stock in the treatment of bone defects

Introduction: This study reports a technique and result in the application of an intramedullary tibial nail for patients undergoing an open-wedge proximal tibial osteotomy. Materials and Methods: Fourteen knees of 10 patients with genu varum were treated with proximal tibial osteotomy using an intramedullary tibial nail. The average age at the time of operation was 25 years old. Tibial osteotomy was performed percutaneously through multiple drilling from the average 8.7cm below the joint line and no bone graft was performed in all cases. Concomitant fibular osteotomy was performed in 9 cases. The clinical and radiographic records were reviewed for a minimum 2 years follow up. Result: Union of the osteotomy site was obtained in all knees at a mean of 3.5 months in both anteroposterior and lateral radiographs. The mean postoperative correction angle was 11 degrees in femorotibial angle in frontal plane (P< 0.05). But significant change of tibial posterior slope was not determined (P> 0.05). The osteotomized tibia was lengthened average 6mm in postoperative anteropsterior radiograph. Range of motion of the knee was full at the latest follow up. There was no significant complication such as infection, deep venous thrombosis, nerve palsy, or implant failure. Conclusion: Open-wedge proximal tibial osteotomy using an intramedullary tibial nail for genu varum provides firm initial stability and early rehabilitation. Furthermore, there is no need of bone graft and no significant alteration in tibial slope after surgery. Thus this technique can be a viable option for the proximal tibial osteotomy in the treatment for genu varus

Aim: to assess the effect of lyophilized bone grafts, autologous platelet gel and autologous medullary cells on bone repair processes after tibial osteotomy for genu varum. Methods: thirty patients, divided into 3 groups by the generation of random sampling numbers, were treated by valgus osteotomy for genu varum with a minimum correction of 8 mm and fixation using a titanium plate (TITAN plateA8 Citieffe). The groups were thus divided:. Group 1: lyophilized bone chips. Group 2: lyophilized bone chips + platelet gel. Group 3 lyophilized bone chips + platelet gel + packed autologous medullary cells (buffy coat). At six weeks X-rays, MRI and needle biopsies were carried out. The tissue underwent morphological and microstructural tests. Results: preliminary results confirmed that the use of platelet gel and packed medullary cells as adjuvant for the lyophilized bone aid bone repair and graft integration. Morphological and morphometric tests showed that at six week the newly formed bone of group 3 had better mechanical properties. Conclusions: this study shows that the use of platelet gel and packed autologous medullary cells combined with lyophilized bone chips produces a faster and mechanically stronger recovery of bone stock in the treatment of bone defects

Introduction. Distal femoral and proximal tibial osteotomies are effective procedures to treat degenerative disease of the knee joint. Previously described techniques advocate the use of bone graft to promote healing at the osteotomy site. In this present study a novel technique which utilises the osteogenic potential of the cambial periosteal layer to promote healing “from the outside in” is described. Materials and Methods. A retrospective analysis of a consecutive single-surgeon series of 23 open wedge osteotomies around the knee was performed. The median age of the patients was 37 years (range 17–51 years). The aetiology of the deformities included primary genu valgum (8/23), fracture malunion (4/23), multiple epiphyseal dysplasia (4/23), genu varum (2/23), hypophosphataemic rickets (1/23), primary osteoarthritis (1/23), inflammatory arthropathy (1/23), post-polio syndrome (1/23), and pseudoachondroplasia (1/23). Results. There were two cases lost to follow-up with a median follow-up period 17 months (range 1–32 months). Union was achieved in all cases, with 1/23 requiring revision for early fixation failure for technical reasons. The median time to radiographic union 3.2 months (95% Confidence Interval (CI) 2.5–3.8 95% CI). CT scans demonstrated early periosteal callus, beneath the osteoperiosteal flap, bridging the opening wedge cortex. Clinical union occurred at 4.1 months (95% CI 3.9–4.2 months). Complications included superficial surgical site infection (1/23), deep vein thrombosis (1/23), and symptomatic metalwork requiring removal (7/23). Conclusions. The osteoperiosteal flap technique was a safe and effective technique for opening wedge osteotomies around the knee with a reliable rate of union

Introduction and Objective. Virtual Surgical Planning (VSP) is becoming an increasingly important means of improving skills acquisition, optimizing clinical outcomes, and promoting patient safety in orthopedics and traumatology. Pediatric Orthopedics (PO) often deals with the surgical treatment of congenital or acquired limbs and spine deformities during infancy. The objective is to restore function, improve aesthetics, and ensure proper residual growth of limbs and spine, using osteotomies, bone grafts, age-specific or custom-made hardware and implants. Materials and Methods. Three-dimensional (3D) digital models were generated from Computed Tomography (CT) scans, using free open-source software, and the surgery was planned and simulated starting from the 3D digital model. 3D printed sterilizable models were fabricated using a low-cost 3D printer, and animations of the operation were generated with the aim to accurately explain the operation to parents. All procedures were successfully planned using our VSP method and the 3D printed models were used during the operation, improving the understanding of the severely abnormal bony anatomy. Results. The surgery was precisely reproduced according to VSP and the deformities were successfully corrected in eight cases (3 genu varum in Blount disease, 2 coxa vara in pseudo achondroplasia, 1 SCFE, 1 missed Monteggia lesion and 1 post-traumatic forearm malunion deformity). In one case, a focal fibrocartilaginous dysplasia, the intraoperative intentional undersizing of the bone osteotomy produced an incomplete correction of a congenital forearm deformity. Conclusions. Our study describes the application of a safe, effective, user-friendly, VSP process in PO surgery. We are convinced that our study will stimulate the widespread adoption of this technological innovation in routine clinical practice for the treatment of rare congenital and post-traumatic limb deformities during childhood

Purpose. Angular deformity in the lower extremities can result in pain, gait disturbance, cosmetic deformity and joint degeneration. Up until the introduction of guided growth in 2007, which has since become the gold standard, treatment for correcting angular deformities in skeletally immature patients had been either an osteotomy, a hemiepiphysiodesis, or the use of staples. Methods. We reviewed the surgical records and diagnostic imaging in our childrens hospital to identify all patients who had guided growth surgery since 2007. All patients were followed until skeletal maturity or until their metalwork was removed. Results. 113 patients, with 147 legs were assessed for eligibility. Three were excluded for various reasons including inadequate follow-up or loss of records. Of the 144 treated legs which met the criteria for final assessment 32 (22.2%) were unsuccessful, the other 112 (77.8%) were deemed successful at final follow up. Complications were few, but included infection in one case and metal failure in another. Those with a pre-treatment diagnosis of idiopathic genu valgum/genu varum had a success rate of 83.6%. Conclusions. In our hands, guided growth had a seventy-eight percent success rate when all diagnosis were considered. Those procedures that were unlikely to be successful included growth disturbances due to mucopolysaccharide storage disease (28% failure rate), Blounts disease (66.6% failure rate) and achondroplasia (37.5% failure rate). If you exclude those three diagnoses, success rate for all other conditions was 81.4%. We continue to advocate the use of guided growth as a successful treatment option for skeletally immature patients with limb deformity

A new method for the measurement of tibial torsion using computerised transverse tomography is presented. Its accuracy is equal to that of cadaveric skeletal measurement. This method may be used in patients with unilateral post-traumatic torsional deformities, especially when these are combined with genu varum or valgum. The study of torsional aberrations in connection with congenital abnormalities of the foot is of further interest

Aim: to assess the effect of lyophilized bone grafts, autologous platelet gel and autologous medullary cells on bone repair processes after tibial osteotomy for genu varum. Preliminary results confirmed that the use of platelet gel and packed medullary cells as adjuvant for the lyophilized bone aid bone repair and graft integration. Morphological and morphometric tests showed that at six week the newly formed bone of group 3 had better mechanical properties. This study shows that the use of platelet gel and packed autologous medullary cells combined with lyophilized bone chips produces a faster and mechanically stronger recovery of bone stock in the treatment of bone defects