Distal femur segmental gap reconstruction using ipsilateral amputated tibia in trauma setting - A case report.

Background: A 32 year old patient who sustained an ipsilateral Gustilo Anderson 3C open fractures of the distal femur and tibia, following an MVA (Motor Vehicle Accident). The femoral shaft fracture had a 6 cm gap, which was spanned with a tibial diaphyseal autograft harvested from the amputated ipsilateral leg and stabilized with a retrograde intramedullary nail, thus enabling preservation of the knee joint and a functional weight bearing below knee prosthesis. Conclusion: Distal femur segmental gap reconstruction using ipsilateral amputated tibia in trauma setting was shown to be a feasible surgical technique.

Should I Ask Doctor Google? Reliability of Israeli Web-based Information Regarding General Orthopedic Injuries and Symptoms.

BACKGROUND: Websites serve as a source of medical information for a large part of the public, some claim to be a substitute for a physician's consultation. Many patients meet a physician after conducting internet research. Medical staff are concerned that internet sources of information are unreliable and may lead to erroneous decisions by patients. OBJECTIVES: To examine the reliability of web-based sources of information (through the Google™ search engine) regarding five common orthopedic complaints and injuries. METHODS: We performed a search of five common orthopedic complaints and injuries using the Google search engine. The reliability of web-based information was measured by the DISCERN tool, which is a valid and verified tool for examining the reliability of medical information sources to the public. The reliability of 47 websites was examined by two orthopedic surgeons and two senior residents. RESULTS: The overall average score given to the sites was 2.8, on a scale of 1 to 5. We found that the higher the site appeared in the search results, the higher the quality of its information. Commercial sites scored higher than general internet information sources. CONCLUSIONS: The internet network is a very broad source of information. For those who lack scientific education and training it is not easy to distinguish between reliable and unreliable or biased sources. The trend of searching for medical information and self-healing is increasing. We must strengthen the network with reliable sources by creating official scientific position papers by medical teams and promoting them online.

Surgical stabilisation in equivocal pelvic ring injuries - Into the grey zone.

Pelvic ring injuries comprise a spectrum of bony, ligamentous and muscular injuries, described by several common classification systems. However, the majority of injuries lie in areas of intermediate severity, where complexity and variable nature make it extremely hard to define in detail. This fact and associated injuries make it extremely difficult to conduct randomised control trials, with purpose to direct treatment guidelines. Thus, special interest and expertise are required by pelvic trauma surgeons, while surgical indications and fixation methods rely on their experience, at least in part. Namely, a significant grey zone of indication exists. As fixation methods evolve, specifically percutaneous fixation using osseous fixation pathways, some injuries in which morbidity bound with surgical fixation was considered too high relative to its benefits, may be considered eligible for surgical treatment nowadays. Moreover, due to significant progress in the treatment of the acute polytrauma casualties, the survival rate increased over the years, emphasizing the effect of long-term morbidity and functional outcome of pelvic ring injuries. The purpose of this manuscript is to describe the equivocal areas of controversies, hence "the grey zone", and to provide the readership with up-to-date published data. We aimed to collect and detail clinical and radiological clues in the diagnosis of intermediate unstable anterior-posterior compression and lateral compression injuries, and for the selection of treatment methods and sequence. Recent publications have provided some insights into specific injury features that are correlated with increased chance of instability, pain and delay in ambulation. Specific focus is given to the utility of examination under anaesthesia in selected cases. Other publications surveyed the shared experience of pelvic trauma surgeons as for the classification, indication and treatment sequence of pelvic ring injuries. Although the data hasn't matured yet to a comprehensive treatment algorithm, it may serve clinicians well when making treatment decisions in the grey zone of pelvic ring injuries, and serve as a basis for future prospective studies.

[ROAD CYCLING, DECREASED BONE DENSITY AND PROXIMAL FEMORAL FRACTURES].

INTRODUCTION: Cycling in Israel: Cycling in Israel is a common sport which is considered to be beneficial to health. However, questions arise about its impact on bone health, due to publications reporting a decrease in bone density in cyclists and the presence of fractures that characterize a relatively older population in relatively young cyclists. Exercise and bone health: It has been proven that a sporty lifestyle, exercise in general and cycling in particular, lowers the chance of fractures of the proximal femur. Cycling and bone density: Several studies have shown that cycling regularly, particularly road cycling, without a combination of off-road cycling/ running/ impact exercise, leads to a decrease in bone density especially in the hip area. The phenomenon is seen at all ages (adolescents and adults), in women and men. Improving bone density values: The only options that have been shown to increase bone density are the combination of impact exercise such as running, off-road cycling, etc. or adding whole-body vibration training to the training routine. DISCUSSION: Despite the common assumption that sports activities contribute to bone health, and therefore to a reduced risk of fractures, a review of the medical literature shows that paradoxically, road cycling has a negative effect on bone strength, and therefore is a risk factor for proximal femoral fractures. To avoid this, we recommend incorporating in the training routine: running/ off-road cycling/ impact exercise/ whole body vibration. It is also important to maintain a balanced diet, while sustaining adequate calcium intake.

Human organ rejuvenation by VEGF-A: Lessons from the skin.

Transplanting aged human skin onto young SCID/beige mice morphologically rejuvenates the xenotransplants. This is accompanied by angiogenesis, epidermal repigmentation, and substantial improvements in key aging-associated biomarkers, including ß-galactosidase, p16ink4a, SIRT1, PGC1α, collagen 17A, and MMP1. Angiogenesis- and hypoxia-related pathways, namely, vascular endothelial growth factor A (VEGF-A) and HIF1A, are most up-regulated in rejuvenated human skin. This rejuvenation cascade, which can be prevented by VEGF-A-neutralizing antibodies, appears to be initiated by murine VEGF-A, which then up-regulates VEGF-A expression/secretion within aged human skin. While intradermally injected VEGF-loaded nanoparticles suffice to induce a molecular rejuvenation signature in aged human skin on old mice, VEGF-A treatment improves key aging parameters also in isolated, organ-cultured aged human skin, i.e., in the absence of functional skin vasculature, neural, or murine host inputs. This identifies VEGF-A as the first pharmacologically pliable master pathway for human organ rejuvenation in vivo and demonstrates the potential of our humanized mouse model for clinically relevant aging research.

A comparison between Austin-Moore and Corail prosthesis regarding intraoperative periprosthetic femur fractures in hip hemiarthroplasty.

Hip hemiarthroplasty is considered the treatment of choice for displaced femoral neck fractures in elderly less active patients. One important complication of this procedure is an intraoperative periprosthetic femur fracture (IPF), which may lead to poor functional outcome and may increase morbidity and mortality. Our primary aim in this study is to compare between Austin-Moore and Corail prosthesis regarding IPFs. Our secondary aim is to assess patient and surgical technique related risk factors for the development of this complication. Inclusion criteria included patients older than 65 years of age who had a displaced femoral neck fracture and were operated for hip hemiarthroplasty between the years 2014-2018. Patient-specific data was collected retrospectively including age, gender, comorbidities, pre-injury ambulatory status, duration of surgery, surgical approach, use of Austin-Moore or Corail prosthesis, surgeon's experience and type of anesthesia applied. In addition, radiographs were reviewed for measurement of calcar to canal ratio (CDR) and classification of Dorr canal type. 257 patients with an average age of 83.7 years were enrolled in the study. 118 patients (46%) were treated with an Austin-Moore prosthesis, while 139 (54%) were treated with a Corail prosthesis. A total of 22 patients (8.6%) had intraoperative fractures. Fracture prevalence was significantly higher in the Corail group compared with the Austin-Moore group (12.2% vs. 4.2%, p = 0.025). The majority of patients had a Dorr A type femoral canal, while the rest had Dorr B type canal (70% vs. 30%). There was no difference in fracture prevalence between Dorr A and B canal type patients. We didn't find any significant risk factor for developing an IPF, neither patient wise (age, gender, and comorbidities) nor surgical technique related (surgical approach, type of anesthesia, and surgeon's experience). Intraoperative periprosthetic fracture prevalence was significantly higher in the Corail patient group compared with the Austin-Moore group. This may be an important advantage of the Austin-Moore prosthesis over the Corail prosthesis.

The effect of physical and social isolation due to the COVID-19 pandemic on the incidence of hip fractures among senior citizens.

This study aimed to explore the effects of the lockdown due to the coronavirus disease 2019 pandemic on the incidence and characteristics of hip fracture in older adults. Data from the three-month lockdown period and the corresponding period in the previous year were obtained from the computerized medical records of a large acute-care hospital. No significant differences were observed in the absolute and relative numbers of hip fractures. There were no significant differences in terms of socio-demographic and clinical characteristics, which are considered risk factors for falls. Similarly, there was no difference in the length of time between admission and surgery and the mean length of hospital stay. Compared to the previous year, there was a significantly higher incidence of hip fractures in older adults living alone during the lockdown. Health policy should provide social support and monitoring of healthcare, particularly to older adults living alone.

Orthopedic screws insertion simulation with immediate feedback enhances surgical skill.

BACKGROUND: Screw insertion to bones is a fundamental skill in orthopedic, spine and cranio-maxillofacial surgery. Applying the correct tightening torque is critical when compressing and fixating bone fragments. Overtightening yields in plastic deformation of the bone and destruction of the screw-bone interface, damaging the construct's stability. The surgeon is required to achieve sufficient hold and compression without stripping the bone. Several studies have investigated these skills, demonstrating much potential to enhance the future surgeons' capabilities. This study presents a novel training module, combining direct tightening followed by deliberate striping with immediate feedback suggested to enhance the surgeon's tactile perception and improve skill. METHODS: A prospective single-blinded cohort study was run. Twenty surgeons from various disciplines, excluding orthopedic and maxillo-facial surgeons, were trained using an orthopedic screws insertion model, comprised of synthetic bones. Training sessions considered inserting 40 screws into normal and osteoporotic bone models, experiencing deliberate stripping of the screws and feedback for their performance in three different sessions. FINDINGS: Success rate increased between sessions - by 24% to 48% in normal bone, and by 37% to 52% in osteoporotic bone. Stripping rate decreased between sessions - by 37.5% to 18.5% in normal bone, and by 29% to 14% in osteoporotic bone. Average ratio between tightening torque and maximum possible torque before bone stripping improved gradually and consistently from 67.3% to 81.6% in normal bone (p < 0.001), and slightly from 76.4% to 77.5% in osteoporotic bone (p = 0.026). INTERPRETATION: Immediate feedback with deliberate stripping and external feedback using a digital torque measuring screwdriver may improve cortical screw insertion technique in the surgeons' community.

Assessment of Functional Conservative Treatment of Acute Complete Achilles Tendon Rupture.

BACKGROUND: In recent years, treatment for Achilles tendon rupture (ATR) went through radical changes: from the conservative non-weight bearing approach to a functional protocol. This functional protocol allows complete weight bearing after only 2 weeks by placing the foot in a plastic boot in tapered down equines and using interchangeable wedges under the heel. This change of approach has dramatically lowered the rate of re-rupture. OBJECTIVES: To describe our preliminary results with this functional protocol and to assess outcome measures in the functional conservative treatment. METHODS: The study comprised 15 people who were evaluated clinically and by sonograph. We measured calf circumference, ankle joint range of motion (ROM), and single-leg heel-rise test (SLHRT). In addition, standard scoring methods (Achilles Tendon Rupture Score and Physical Activity Scale) were examined. RESULTS: In our cohort 14 people successfully gained SLHRT. The mean Achilles Tendon Rupture Score functional questionnaire and Physical Activity Scale physical activity questionnaire score was 85.6 of 100, and 4.7 of 6, respectively. There were no significant differences in ankle ROM compared to the uninjured limb. There was statistically significant reduction in the calf circumference and soleus muscle thickness sonographically. CONCLUSIONS: It seems that the conservative functional treatment of ATR demonstrates good functional outcomes, with the patients returning to close to normal activity, although noted muscle wasting and weakness. This protocol presents a true alternative to surgery and should be considered for most non-insertional Achilles tendon tears.

Interobserver and intraobserver agreement for Letournel acetabular fracture classification system using 3-dimensional printed solid models.

BACKGROUND: Acetabular fractures pose diagnostic and surgical challenges. They are classified using the Judet-Letournel system, which is based solely on X-ray. However, computed tomography (CT) imaging is now more widely utilized in diagnosing these injuries. The emergence of 3-dimensional (3-D) printing technology in varying orthopedic fields has provided surgeons a solid model that improves their spatial understanding of complex fractures and ability to plan pre-operatively. AIM: To evaluate the reliability of the Judet-Letournel classification system of acetabular fractures, when using either CT imaging or 3-D printed models. METHODS: Seven patients with acetabular fractures underwent pelvic CT imaging, which was then used to create solid, 3-D printed models. Eighteen orthopaedic trauma surgeons responded to questionnaires regarding fracture classification and preferred surgical approach. The same questionnaire was completed using only CT imaging, and two weeks later, using only 3-D printed models. The inter- and intra-observer agreement rates were then analyzed. RESULTS: Inter-observer agreement rates based on CT imaging or 3-D printed models were moderate for fracture classification: κ = 0.44, κ = 0.55, respectively (P < 0.001) and fair for preferred surgical approach: κ = 0.34, κ = 0.29, respectively (P < 0.005). Intra-observer agreement rates for fracture classification and preferred surgical approach comparing CT imaging or 3-D printed models were moderate: κ = 0.48, κ = 0.41, respectively. No significant difference in intra-observer agreement was detected when comparing orthopedic pelvic specialists to general orthopedic traumatologists. CONCLUSION: The Judet-Letournel classification demonstrated only moderate rates of agreement. The use of 3-D printed models increased the inter-observer agreement rates with respect to fracture classification, but decreased it with respect to the preferred surgical approach. This study highlights the role of 3-D printed models in acetabular fractures by improving spatial understanding of these complex injuries, thus providing more reliable fracture diagnoses and alternative viewpoints for pre-operative planning.

[THE SURGERY EPIDEMIC AND TIBIAL SHAFT FRACTURES: CONSERVATIVE FUNCTIONAL TREATMENT ALGORITHM FOR TIBIAL SHAFT FRACTURE].

INTRODUCTION: With the emergence in recent years of advanced surgical methods for treatment of diaphyseal fractures of the tibia bone, there appears to be a decline in the familiarity and use of the conservative treatment based on weight bearing casts and early weight bearing. This phenomenon, dubbed "the surgery epidemic" by Dr. Sarmiento, one of the forefathers of tibial fractures treatment, refers to orthopedics surgeons' tendency to treat surgically, even in patients viable for conservative treatment. OBJECTIVES: In this study, we examined all the patients with diaphyseal tibial fracture who were treated at the Orthopedic ward at "Rambam" Hospital in the study period (2012-2016), in order to evaluate the results of the conservative functional treatment, to identify the different stages of said treatment, and to create a clear and accessible protocol for treating physicians. In addition, we sought to examine whether there is a preference for surgical treatment among physicians, even in cases where fracture characteristics, according to accepted criteria, would have allowed for conservative treatment. METHODS: Clinical and radiological evaluation of all patients who arrived with tibia bone fractures to "Rambam" hospital in the study period (2012-2106); identifying patients who fit the criteria for conservative functional treatment and were treated either conservatively or surgically. In those who were treated conservatively we documented the course of their treatment until full recovery. RESULTS: A total of 153 patients with tibial bone fracture were admitted in the study period. Of those patients, 15 were treated according to the conservative functional treatment, 33 were treated surgically despite their adherence to the conservative treatment guidelines. Of all the patients adhering to the conservative treatment criteria (48 patients), only 31.2% were treated conservatively, while 68.8% were treated surgically, unnecessarily, some would say. In other words, 25% of all the patients treated surgically for tibial bone fracture, could have been treated conservatively but instead were treated surgically with internal fixation in accordance to their surgeon's preference. DISCUSSION: In this study we observed a clear preference for surgical treatment in tibial bone fractures, even in cases where the fracture position met the accepted criteria for conservative treatment. We found that the conservative functional treatment, as practiced in our hospital, adheres to the highest standard of care. Taking into account surgery and anesthesia complications, and its added cost to the health care system, we believe it is appropriate to increase awareness among physicians to the possibility and benefits of conservative functional treatment that allows for early weight bearing and patient activity.

Spinal cord injury with central cord syndrome from surfing.

INTRODUCTION: Central cord syndrome (CCS) is an injury to the center of the spinal cord. It is well known as a hyperextension injury, but it has never been described as a surfing injury. Our report describes this injury in detail. CASE PRESENTATION: A 35-year-old male novice surfer presented to the emergency department with acute tetraplegia following falling off his surfboard and hitting sea floor at a shallow beach break. He was rescued by a fellow surfer while floating in the sea and unable to raise his head above sea level. Upon arrival at the hospital, tetraplegia and sensory deficits were noted. Radiological investigations showed advanced spinal stenosis at C4-6 levels. T2 magnetic resonance imaging (MRI) demonstrated myelopathy at C5-C6 level. He was diagnosed as having central cord syndrome, treated conservatively, and regained near full neurologic recovery after a month of rehabilitation. DISCUSSION: Unique sport activities lead to unique injuries. It is important to accurately describe these injuries in order to create protective measures against them. Neurologic injuries in surfers are uncommon. With low-energy trauma, surfer's myelopathy is still the most common diagnosis, but central cord syndrome should be in the differential diagnosis.

[THE RELATIONSHIP BETWEEN INJURIES, SHOES AND STYLE IN THE RUNNER'S POPULATION].

INTRODUCTION: We are now standing four decades after the 'running revolution' which occurred during the 70's of the previous century. Despite the developments that have occurred in medicine and the large budgets invested in the development of the sport's equipment, the runner's morbidity has not changed. In this article, we would like to review the changes in running that occurred throughout the years, as well as the common risk factors for running injuries. Furthermore, we would like to examine the scientific point of view regarding running shoes and running technique as risk factors for running injuries. A new trend, the "minimalist running", characterized by a unique technique and rigid shod might be the "game changer" in diminishing the injury rates in runners. Note, that minimalist running is not yet a common technique and thus, we might encounter a new set of injuries which we still have to evaluate.

[TOTAL ELBOW REPLACEMENT AS AN ALTERNATIVE TO SEVERELY COMMINUTED FRACTURES AROUND THE ELBOW].

BACKGROUND: Intra-articular elbow fractures are considered to be one of the most complex injuries in orthopedic trauma. Some are too comminuted for open reduction and internal fixation. Recently, total elbow replacement (TER) has gained popularity for the treatment of comminuted elbow trauma when other treatment options are not possible. METHODS: Since 2007-2013 we treated 18 patients with TER due to comminuted distal humeral fractures. We used the Disabilities of the Arm, Shoulder and Hand scoring system (DASH) to evaluate the patient's satisfaction. In addition we evaluated the elbow range of motion and collateral stability. CONCLUSIONS: Functional range of motion was achieved with high patient satisfaction. Based on the results we conclude that TER is a reasonable option for complex elbow fractures when open reduction and internal fixation is not suitable.

The effect of 'Out of hours surgery Service' in Israel on hip fracture fixation outcomes: a retrospective analysis.

BACKGROUND: 'Out of Hours Surgery Service' (OHSS) was implemented in Israel, amongst other reasons, in order to reduce the time interval between hospital admission and surgery and consequently improve outcomes. The OHSS is currently operated in the public hospitals in Israel. In this study we compared the data of patients before and after OHSS implementation to determine its efficacy in improving patient care. METHODS: This is a retrospective observational study of 792 adult patients who underwent hip fracture surgery between 2002 and 2007 in a single hospital. The study population included two groups: patients that were operated before the implementation of the OHSS (2002-2004) and after the implementation of the OHSS (2005-2007). Data regarding all patients was collected using the institution's computer program. The following variables were analyzed: patients' demographics, time interval from hospitalization to surgery, causes for delaying surgery, post-operative length of hospitalization and mortality. RESULTS: Patients in the post-OHSS group had more illnesses and higher ASA classification than those in the pre-OHSS group. The post-OHSS group had a significantly decreased length of stay in the hospital before and after the surgery. After adjusting for ASA score and age, the post-OHSS group was found to have decreased post-operative hospitalization and lower post-operative mortality. Surgery was delayed in pre-OHSS period mainly due to operating rooms unavailability. CONCLUSION: Implementation of OHSS facilitated operating room availability, thus early operation and reduced post-operative mortality. In accordance with other studies, patient's outcome is greatly influenced by the time from admission to hip fracture surgery.

Femur shaft fracture following osteoid osteoma radiofrequency ablation.

INTRODUCTION: Radiofrequency ablation is an effective modality in treating osteoid osteoma while avoiding the complications of an open procedure. Its complications are usually self-limited consisting mostly of local skin burns. This report presents a major complication, a femur shaft fracture following an osteoid osteoma radiofrequency ablation. The fracture occurred approximately one year after the ablation at the site of the osteoid osteoma. DISCUSSION: Few case reports have been published regarding subtrochanteric femur fracture after ablation of an osteoid osteoma. To our knowledge this is the first report of a femoral shaft fracture following an ablation. Another unique characteristic of the presented case is the late presentation, approximately one year following ablation. Factors which may have contributed to the fracture include lateral entry point of the drill which may have weakened the femur when taking its biological and mechanical properties into account, and the fact that the patient was a soldier who was allowed to continue his military training only six weeks after the ablation. CONCLUSION: Radiofrequency ablation is an effective and relatively safe technique in treating osteoid osteomas, however the physician should be aware of the fracture risk involved, consider mechanical and biologic factors of the bone prior to drilling, and be very conservative when recommending return to high level activity. In addition, a close follow-up should be carried on after the procedure in order to supervise bone remodeling.

Epidemiology of Kite Surfing Injuries among Recreational Athletes.

BACKGROUND: Kite surfing is one of the trendiest water sports worldwide. With its growing popularity evidence has begun to accumulate regarding its potential for injuries which range from minor insults to death. OBJECTIVES: To define the epidemiology and distribution of common kite surfing injuries among recreational athletes. METHODS: An open letter was published on the web calling for surfers to report injuries inflicted during recreational kite surfing. In addition, we received data from the National Center for Trauma and Emergency Medicine Research. RESULTS: Our survey yielded only a small series of 48 injuries. Most kite surfing injuries are isolated injuries, although some are life threatening as occurred in two surfers who died due to severe head injuries. Among the injuries, 72.9% are related to the musculoskeletal system, followed by head and chest injuries (18.7% and 14.6%, respectively). Of the orthopedic injuries 48.6% are fractures, the majority in the lower limbs (58.8%). CONCLUSIONS: Our findings combined with those of previous articles on kite surfing-associated injuries contribute to a better understanding of such injuries, raise awareness among emergency department personnel, and indicate precautions needed to avoid or lessen incapacitating and potentially life-threatening injuries.

Multiplanar Deformities Correction Using Taylor Spatial Frame in Skeletally Immature Patients.

BACKGROUND: Taylor Spatial Frame (TSF) is a modern circular external fixator that, using a virtual hinge, is able to correct six axis deformities simultaneously. Despite the growing popularity of this method, few reports exist about its use in children and adolescents. To evaluate the effectiveness of TSF in correcting multiplanar deformities in patients with open physis, we reviewed the results of treatment in children who had at least two planes deformities of lower limbs. METHODS: Over a period of 8 years, we treated 51 patients, 40 boys, 11 girls, with a mean age of 12.4 years (range, 2-16 years). All patients had open physis at the time of the TSF application. All patients had at least two deformities (angular and/or rotational). Fifty-five osteotomies (11 femoral, 44 tibial) were performed. Patients were divided into four groups: 13 with post-traumatic malunions, 18 with tibia vara, six with rickets, and 14 with miscellaneous deformities. Correction goal was determined as correction of deformities to population-average parameters of the lower limbs in frontal and sagittal views and normal mechanical axis deviation. RESULTS: Correction goal was achieved in all except one patient; four patients had recurrence of deformities post-operatively and were re-operated. Most common complications were pin tract infection (20 patients), delayed union (2), regenerate translation (1), post-removal femoral fractures (2), knee subluxation (1), nonunion (1), and one patient developed chronic osteomyelitis secondary to deep pin tract infection. CONCLUSION: TSF allowed accurate correction of complex limb deformities in children and adolescents with relatively few serious complications. LEVEL OF EVIDENCE: Level IV. Case series.

Is Leclercia adecarboxylata a new and unfamiliar marine pathogen?

Leclercia adecarboxylata infection is rarely reported in the context of human infections. In the scant cases reported in the literature, it usually involves individuals who are immunocompromised with infections of a polymicrobial nature. Recently, data have begun to accumulate suggesting that L. adecarboxylata is a pathogen associated with water environments. We review the literature regarding L. adecarboxylata infections and present a case of cellulitis and soft-tissue infection in the foot of a healthy surfer.

New treatment option for sclerosing osteomyelitis of Garré.

Sclerosing osteomyelitis of Garré continues to be a puzzling entity, with a nonspecific clinical description and course, an obscure pathogenesis, and no consensus on a predictable and helpful method of treatment. The proposed treatment options according to the literature are observation, analgesics and NSAIDs, and bone curettage. Here we present a 15-year-old girl treated by resection of a 12 cm-long lesion after failed conservative treatment, followed by bone transport using a circular external fixator. This treatment method has not been described previously for this condition. The duration of bone transport was 3 months, and the total duration of the frame treatment was 12 months. After hardware removal, and at 2.5-year follow-up, the patient was asymptomatic and achieved good functional results. To the best of our knowledge, this is the first description of bone resection and transport for the treatment of this condition, even though it is well described for the treatment of chronic osteomyelitis and other conditions necessitating bone resection. On the basis of this case we suggest that resection and bone transport using a circular external fixator for the treatment of sclerosing osteomyelitis of Garré might be an effective and safe method. Of course, being a rare entity, large cohorts are difficult to obtain, and more data and longer follow-up are required to form a convincing recommendation. Level IV evidence.