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We describe our experience of using a volar locking plate for corrective osteotomy and bone grafting combined with early mobilisation in the treatment of distal radius malunions. Corrective osteotomy of the distal radius was performed through a volar approach, and fixated by a volar locking plate associated with corticocancellous iliac bone grafting in three patients aged 16, 71 and 75 years. Two patients had had volarly displaced malunion and one dorsally displaced malunion. Wrist motin was started immediately after surgery. The average follow-up was 15 months (range, 12–20 months). All osteotomies healed at an average 5.7 weeks post-operatively, resulting in a total arc of wrist motion of 133°, forearm rotation of 167°, and grip strength of 70% of that of the contralateral side. This treatment method proved to be effective and safe.

Joint incongruity at radiocarpal joint is a common complication of the distal radius fracture, and has received much attention and study. However, the problem and outcome of treatment of intra-articular incongruity at the sigmoid notch after distal radius fracture is rarely reported. We describe a patient with deformity of the distal radioulnar joint, and impairment of supination after distal radius fracture. The evaluation of the distal radioulnar joint revealed the absence of degenerative arthritis and malunion of the sigmoid notch of the distal radius with a prominent volar lip limiting supination. We present a method of corrective osteotomy for the malunited sigmoid notch of the distal radius, to correct the incongruity of the distal radioulnar joint and restore supination.

The avascular necrosis of the metacarpal head is a rare disease. Therefore, although a variety of surgical treatments were performed in the sporadically published case reports, the optimal surgical treatment is still controversial. Open wedge osteotomy of the metacarpal neck was first reported in 2002. However, no other reports using the same procedure have been published. We presented 13-year-old girl case of the third metacarpal head necrosis having been treated by the open wedge osteotomy of the metacarpal neck. Four years later, she had no pain and gained full range of motion of the metacarpophalangeal (MP) joint. The plain X-rays and magnetic resonance images demonstrated sufficient bone remodeling of the metacarpal head. The open wedge osteotomy of the metacarpal neck is a useful option for the metacarpal head necrosis, especially when the dorsal articular surface of the head remains intact.

Corrective osteotomies are often utilised to treat finger deformities that may occur due to a phalangeal malunion. Rotational or angular malalignment, in addition to shortening of the digit may negatively affect hand function and be aesthetically displeasing. Thorough preoperative examination of the malunion and its associated deformities is crucial in determining the type of osteotomy technique to be used. Osteotomies can create bony defects that need to be filled with bone graft or some type of graft substitute. We describe an opening wedge osteotomy with local cancellous bone graft combined with dual plating to treat a dorsal angular deformity in a proximal phalangeal malunion.

Malunion at the shaft of the middle phalanx yields less functional problems compared with malunion at the shaft of the proximal phalanx and metacarpal bones. In the present report, the patient sustained a minimally displaced fracture at the distal portion of the distal middle phalanx of the ring finger spraining the finger during playing flag football. Fracture was treated conservatively and fracture union was completed. However, the patient complained of functional problems in activities of daily living due to the malrotational deformity of the finger. We treated the malrotational deformity close to the distal interphalangeal joint of the middle phalanx with step-cut osteotomy at the affected bone successfully.

Objective: To evaluate whether 60${}^{\circ }$ and 90${}^{\circ }$ V-shaped osteotomies in sheep femurs have statistically significant differences when submitted to compressive strength tests. Material and Methods: A total of 30 left femurs of recently slaughtered sheep were removed, the proximal segment was discarded, and the bones were randomly divided into two groups of 15 specimens each. The bones underwent distal osteotomy at the supracondylar region at a 90${}^{\circ }$ angle between cuts, in group 1, and at a 60${}^{\circ }$ angle in group 2. The osteotomy was V-shaped and the distal apex started in the lateral face of the femur; medial cortical bone remained intact. Compressive tests were conducted, and four points of the deformation curve were collected for the calculation of the deformation rate using an interpolation scheme. Deformation patterns were evaluated according to two groups: intercondylar fracture and medial cortical fracture. Results: Group 1 had a mean resistance to failure to compressive load of 232kgf (SD 59.551; 150-400), whereas in group 2, mean resistance to failure to compressive load was 157.13kgf (SD 67.4; 70-346); this difference was statistically significant ($p=0.000619$, Kruskal–Wallis). Conclusions: Osteotomy at a 90${}^{\circ }$ angle had a greater resistance to compression and resulted in less weakening of the distal area of the femur after osteotomy. There were no differences in the pattern of fracture generated by compression according to osteotomy angle.

The plantar plate is a fibrocartilaginous structure that lies deep to the metatarsal heads and provides stability to the metatarsophalangeal (MTP) joints. Repetitive motion may lead to irritation, inflammation and tear of the plate. In this case, a 400m hurdler reported metatarsalgia, swelling and misalignment of the secondtoe, in the absence of trauma. Pain was experienced during the toe off phase of hurdling. The patient had a hammer toe and a positive Lachman’s Test on examination. Fluoroscopy guided second MTP joint arthrogram confirmed the diagnosis of plantar plate tear. Complete Plantar Plate Repair and Weil’s Osteotomy were then carried out for definitive management after physiotherapy and analgesia failed to provide relief. Although there are numerous conservative measures to treat this ailment, surgical management remains the most effective.

Pediatric kyphosis is a specific disease entity of sagittal plane back deformity in pediatric and adolescent patients. Smooth round kyphosis is frequently encountered in this age and it can be differentiated as posture kyphosis and Scheuermann’s disease. Other types of kyphosis include syndromic kyphosis, congenital kyphosis and miscellaneous causes. In this paper, we will discuss the diagnosis and evaluation methods, treatment options and surgery for pediatric kyphosis. The doctors should be familiar with different surgical approach and osteotomy methods to facilitate prognosis, minimize complications and improve patient’s quality of life.

The result of 27 Chiari pelvic osteotomy were analyzed to determine the efficacy of the operation in the treatment of subluxated and/or painful dysplastic hips. The length of follow-up ranged from 2 to 14 years. Eighteen patients had had developmental dysplasia of the hip; four sequelae of the septic hip; two, cerebral palsy and one had had poliomyelitis. The osteotomy can be done by power saw and osteotome. A large threaded K-wire was used for internal fixation. Bone graft was necessary even with the displacement of more than 50%. The overall result were: 12, excellent; 8, good; 5, fair; and 2 poor. In 11 patients, the osteotomy had to be displaced more than 50% to provide good coverage of the femoral head. There were no major complications such as sciatic nerve injury or delayed union. This procedure is most suited for the patient with painful hip dysplasia in whom a concentric reduction is not possible.

Background: Patients with some thumb polydactyly subtypes are regarded as having a high risk of secondary deformities or poor treatment outcomes. Radially deviated type is one of these subtypes, but its characteristics and definitive treatment outcomes remain unclear. This study aimed to evaluate the pre- and intraoperative findings and surgical outcomes of this subtype.

Methods: We identified eight patients with unilateral and proximal phalanx-type polydactyly. The mean age at surgery was 14.6 months, and the mean follow-up period was 7.2 years. We investigated the patients’ initial radiograms, surgical procedures and findings, changes in alignment of the retained thumb, and postoperative outcomes using the Japanese Society for Surgery of the Hand scoring system.

Results: Although the gross appearance of the thumb was a radial deviation, there was an ulnar deviation at the metacarpophalangeal joint on radiography. The ulnar proximal phalanges were delta phalanges in three patients and were connected with the radial proximal phalanges by cartilage in five patients. We retained the ulnar thumbs in all patients and corrected the alignment in seven cases; open wedge osteotomy was performed for three patients with a delta phalanx, and tendon transfers from the radial to ulnar thumb were performed for the other four. The mean outcome score was 17.6/20, with one patient with excellent, six with good, one with fair, and none with poor scores. One patient experienced recurrent radial deviation around the interphalangeal joint five years after surgery and underwent corrective osteotomy, but the other patients maintained good alignment.

Conclusions: Radially deviated thumb polydactyly is not simply radially deviated; the shape of the proximal phalanx of the ulnar thumb is important to determine the surgical procedure. However, our results indicated that the alignment is almost manageable, and the surgical outcome was comparable to that of patients with a proximal phalanx-type thumb polydactyly.

A Galeazzi-equivalent lesion occurs in children and adolescents following a traumatic distal radius fracture when the strong radioulnar ligaments and relative weakness of the ulnar physis result in an avulsion-type Salter-Harris III fracture of the distal ulna. In unreduced fractures, the osteogenic nature of the torn periosteal sleeve may result in the formation of a bifid distal ulna. We describe two cases of bifid distal ulna that developed after missed Galeazzi-equivalent lesions. The first case was treated with resection of the volar limb and reduction of the ulnar fracture, whereas the second case was treated with simple resection of the dorsal limb. Negative ulnar variance developed in both cases.

Level of Evidence: Level V (Case report)

Corrective osteotomy of malunion of both forearm bones is a challenging procedure because it needs accurate angular and rotational correction of both bones. Recent advances in three-dimensional (3D) printing techniques have shown promising results in the correction of complex deformities. We report a patient with malunion of both bones of the forearm in whom we determined site and degree of correction required based on the computed tomography images of the affected side and mirrored images of the contralateral healthy side. We then created 3D printed sawbones and simulated osteotomy to confirm stable dynamic forearm rotation. This method enabled satisfactory restoration of anatomical and functional outcomes. Preoperative dynamic motion simulation using 3D printed anatomic bone model is helpful for complex corrective osteotomy of forearm fracture malunion.

Level of Evidence: Level V (Therapeutic)

Physeal injury is not uncommon in pediatric orthopedics, with Salter–Harris type II (SH II) fracture being the most common type that may lead to growth arrest and eventually limb shortening. Therefore, research on SH II fracture will hold great potential to benefit children with such an injury. This chapter outlines the creation of a partial growth plate defect model in rabbits that mimicks a SH II fracture for applications in various growth plate or articular cartilage research topics. The establishment of an SH II rabbit model described in this chapter provides some relevant and applicable evaluation methods. This model will be helpful for research on the biology of premature physeal closure during injuries or the exploration of new biomaterials for physeal reconstruction.