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INTRODUCTION: There have been osteotomy methods that corrected or overcorrected the ulna deformity as part of surgical treatment for chronic radial head dislocation. METHODOLOGY: We reported surgical technique and outcome of oblique sliding ulna osteotomy that created acute lengthening, deformity correction or both to assist open reduction of radiocapitellar joint in four patients with neglected Monteggia fracture dislocation. RESULT: Patients aged 3-12 years old had trauma duration of 4 weeks to 3 years. Two patients had Bado type I injury, and the other two had Bado type III. There was no acute nerve injury. During the final follow-up, all patients achieved union, with the limitation of motion range in the rotation arch being less than 20°. The radial head had no recurrent dislocation. CONCLUSION: This case series has shown sliding osteotomy safely, providing acute correction and lengthening of the ulna without requiring bone graft to facilitate stable reduction of the neglected Monteggia lesion.

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The choice of treatment for unstable and severely displaced slipped capital femoral epiphysis (SCFE) is controversial. This meta-analysis was conducted to determine the prevalence of femoral head avascular necrosis (AVN) following various treatments for unstable SCFE. Various databases were searched to identify articles published until 4 February 2022. A random-effects model was used to examine prevalence as well as risk ratios with confidence intervals (CIs) of 95%. Thirty-three articles were analyzed in this study. The pooled prevalences of AVN in pinning in situ, pinning following intentional closed reduction, pinning following unintentional closed reduction, and open reduction via the Parsch method, subcapital osteotomy and the modified Dunn procedure were 18.5%, 23.0%, 27.6%, 9.9%, 18.6% and 19.9%, respectively. The risk of developing AVN in pinning following intentional closed reduction was found to be 1.62 times higher than pinning in situ; however, this result was not significant. The prevalence of AVN in open reduction was lowest when performed via the Parsch method; however, this finding should be interpreted with caution, since the majority of slips so-treated are of mild and moderate types as compared with the subcapital osteotomy and modified Dunn procedures, which are predominantly used to treat severely displaced slips. As the risk ratio between intentional closed reduction and the modified Dunn method showed no significant difference, we believe that the modified Dunn method has the advantage of meticulously preserving periosteal blood flow to the epiphysis, thus minimizing AVN risk. In comparison with intentional closed reduction, the modified Dunn method is used predominantly in cases of severe slips.

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Limb lengthening of fibular hemimelia is associated with progressive ankle valgus deformity. We reported a successful tibial lengthening in fibular hemimelia without recurrence of ankle valgus in 2 cases. The procedure involved 2 stages. First stage was a resection of the fibular remnant followed by a bending osteotomy through the distal tibial physis before the age of 2 years old. The second stage was a tibia lengthening up to 25% of its original segmental length performed at the age of 5 years old. There was neither progressive ankle valgus nor distal tibial growth arrest observed at 4 years follow-up.

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Background: The objectives of this study were to investigate whether severity of clubfoot, age, and weight of the patients at initial manipulation and casting influence the total number of castings required. Methods: This prospective study was conducted on 38 idiopathic clubfoot patients undergoing weekly manipulation and casting using the method recommended by Ponseti. The patients’ age, weight, and foot Pirani score at the start of manipulation and casting were analysed against the total number of castings required to achieve correction to 60° abduction. Results: Simple linear regression analysis on the influence of weight, age, and Pirani score at the time of cast initiation showed that the Pirani score was the only significant predictor for the total number of castings required. Conclusion: The total number of castings required to treat clubfoot was determined by the severity of clubfoot but not by the weight and age of patients.

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Operative treatment for neglected fracture of lateral humeral condyle (LHC) is difficult because of contracted muscle, fibrous tissue formation, and indistinct bony edges. Its success depends on the ability to preserve blood supply during the surgery. We retrospectively reviewed eight cases of neglected fracture of LHC in children treated with open reduction with selected multiple 'V' lengthening of common extensor muscle and internal fixation. The patients were between 3 and 8 years of age. The period of neglect was between 3 and 20 weeks. Four patients with displacement of more than 10 mm and neglect for 5 weeks or more required lengthening of common extensor muscle aponeurosis. The follow-up assessments were between 1 and 6.3 years with a mean of 4.4 years. All patients had union by 2 months. They gained improvement of flexion range of motion between 60° and 120° with a mean of 86.3°. Loss of final range of motion compared with the normal side was between 5° and 35° with a mean of 10°. No patient had limitation of activities or pain. Six cases had excellent and two cases had good Dillon functional score. All patients had lateral condyle prominent with different severities. There was one mild avascular necrosis and one fishtail deformity. Both of them had almost full range of motion. All patients had early physeal closure, except one, who had only 1 year follow-up. There was no case of progressive valgus deformity. Children with neglected fracture of LHC would benefit from anatomical reduction and internal fixation through a proper exposure and if indicated combined with multiple 'V' lengthening of common extensor muscle aponeurosis. This is a level IV study.

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