A 52-Year-Old Man with a Gustillo-Anderson IIIB Open Tibial Shaft Fracture with Extensive Soft-Tissue Defect Requiring Limb Salvage with Artificial Deformity-Creating Technique.

BACKGROUND In this case report, an alternative way of treating Gustillo-Anderson IIIB type fractures with severe soft-tissue damage is provided for cases where, for various reasons, it is not possible to close a soft-tissue defect with a flap. CASE REPORT An artificial deformity-creating technique was applied for a patient with a right distal tibial open fracture (Gustillo IIIB type) with complete tibial cartilage and bone loss of 10 cm and severe soft-tissue defect after high-energy trauma. This technique includes damaged limb shortening, translation, angulation, and rotation for closure of soft-tissue defects using orthopedic hexapod and bifocal bone transport without need for plastic surgery. Because of the timely planning and application of the orthopedic hexapod for the artificial deformity correction, the final alignment of the limb was close to the physiological standard and had good functional outcomes. Despite the extremely severe shortening and acute angles, the total treatment time was only 75 weeks. At the 1-year follow-up after treatment completion, the patient had good functional outcomes with the 36-Item Short Form Survey score: general health, 80%; physical functioning, 85%; and social functioning, 100%. CONCLUSIONS In conclusion, we show that the artificial deformity-creating with subsequent orthopedic hexapod application and lengthening of a limb is a robust method that can be applied even for the treatment of severe open fractures with significant soft-tissue damage and bone loss, which can be performed outside high-level trauma hospitals and has good clinical outcomes without significant complications.

Efficacy of Bilateral Simultaneous Hallux Valgus Correction Compared to Unilateral.

BACKGROUND: Hallux valgus affects up to 29% of adults and can be bilateral in 84% of cases. Contemporary surgical techniques provide the possibility of simultaneous bilateral correction, but still there is no consensus on whether staged or simultaneous correction should be performed if both feet are involved. The aim of the present study was to report our experience of treatment of patients with hallux valgus and to perform comparative analysis of results obtained from unilateral and simultaneous bilateral surgical correction. METHODS: Data on 60 feet (40 patients) with hallux valgus that underwent surgery between 2010 and 2013 using scarf osteotomy and lateral soft tissue release were analyzed. Unilateral correction was performed in 30 feet (25 patients) and bilateral correction in 30 feet (15 patients). The patients from both groups were admitted to hospital for 7 days. Functional assessment (American Orthopaedic Foot & Ankle Society [AOFAS] score) and radiographic examination (intermetatarsal and hallux valgus angles) were performed preoperatively and at 6, 12, and 24 months after the procedure. Comparative analysis between groups with bilateral and unilateral correction was carried out. RESULTS: At 24 months after surgery in the bilateral and unilateral groups, the mean AOFAS score was 86 ± 6.2 and 86 ± 6.9 (P > .05), the mean intermetatarsal angle was 8.4 ± 0.5 and 8.8 ± 0.8 degrees (P > .05), and the mean metatarsophalangeal angle was 13.0 ± 1.2 and 13.0 ± 0.9 degrees (P > .05), respectively. CONCLUSION: According to the data obtained, simultaneous bilateral correction had the same functional and radiographic results as unilateral surgery. LEVEL OF EVIDENCE: Level III, case series.