Background:Segmental bone defects present a significant reconstructive challenge in orthopaedic surgery and are traditionally reconstructed using external fixation. The advent of motorised intramedullary bone transport nails (BTNs) aims to mitigate complications associated with external fixation. Despite the theoretical advantages, the clinical efficacy and complication profile of BTNs remain unclear. This scoping review evaluates the current literature on the use of BTNs in segmental bone defect reconstruction. Methodology:A search of PubMed, Google Scholar, and Cochrane Library databases was conducted following the PRISMA-ScR guidelines. Studies published between 2010 and 2024 that reported on motorised BTNs were included. Data extraction focused on patient demographics, defect characteristics, treatment strategies, complications, consolidation indices, and functional outcomes. Due to study heterogeneity, results were synthesised descriptively. Results:Fifteen studies were included, comprising three retrospective cohorts, seven case series, and five case reports, totalling 61 patients. Most defects occurred in the femur (60.7%), with trauma (39.3%) as the most common aetiology. The mean defect size was 7.1 cm (range: 0.5-17 cm). The overall union rate was 92.3%, with a mean bone healing index (BHI) of 51.36 days/cm. A total complication incidence of 106.6% was reported, reflecting multiple complications in some patients, with device-related failures (22%), joint contractures (14%), and delayed union (9%) as common occurrences. While BTNs eliminate external fixation-associated morbidity, they introduce unique challenges such as mechanical failures and prolonged periods of non-weight-bearing. Patient-reported outcomes (PROMs) were rarely assessed, with only two studies reporting functional scores. Conclusions:Motorised intramedullary bone transport offers a promising alternative to external fixation, particularly for femoral defects. However, BTNs introduce device-specific complications and remain costly and technically demanding. Current evidence is limited to small case series with heterogeneous methodologies, precluding definitive conclusions on superiority over external fixation. Future research should focus on multi-centre comparative studies with standardised outcome measures to establish the optimal role of BTNs in limb reconstruction.
How to cite this article: Harwood P. Editorial Commentary: Ambiguity, Biology, and Caution in Open Tibial Fractures. Strategies Trauma Limb Reconstr 2025;20(3):193.
Aim and background:Femoral lengthening using a monorail external frame often involves creating two simultaneous distraction sites. This approach allows for a better distribution of the osteogenesis process and can reduce the overall treatment duration, particularly in cases of severe shortening. However, the literature on bifocal femoral lengthening is limited, with reported cases rarely exceeding 10 cm of lengthening. This case report aims to describe the treatment and outcome of a patient who underwent bifocal lengthening with a monorail external frame for severe femoral shortening. Case description:A 26-year-old female presented with a 23 cm shortening of the left lower limb resulting from previous surgeries for infection. She underwent bifocal femoral lengthening using a monorail external frame, achieving 20 cm of lengthening. Following the removal of the external fixator, a fracture occurred in the regenerated bone, necessitating intramedullary nailing. Conclusion:For severe femoral shortening, various lengthening techniques can be considered. Bifocal lengthening with a monorail external frame offers specific advantages and disadvantages that should be evaluated based on factors such as required treatment duration, expected patient compliance, and infection risks. Clinical significance:This case demonstrates that substantial femoral lengthening may be achievable with a monorail external frame, especially when two simultaneous osteotomies are utilised. For large bone regenerates, even with radiographic evidence of callus maturation, internal stabilisation may be advisable, despite the peculiar technical challenges involved.
Background:Reconstruction of tumour defects in skeletally immature patients poses a particular challenge due to the resection of growing physes and resulting limb-length discrepancies. Expandable prostheses allow outpatient lengthening with fewer surgical revisions, but the limb is lengthened within the prosthesis rather than native bone. Case description:A 10-year-old girl with no medical history presented with distal right thigh pain and swelling. Imaging and biopsy confirmed osteosarcoma. She underwent wide local excision and initial endoprosthetic reconstruction, followed by a planned staged exchange to a hybrid endoprosthesis (BioXpand), in which the usual prosthetic stem is replaced by a motorised intramedullary nail (Fitbone), allowing limb lengthening via distraction osteogenesis. The patient began non-invasive lengthening on postoperative day five (approximately 0.96 mm/day), with the rate adjusted weekly based on clinical and radiological parameters. After 12 weeks, 6 cm of length was achieved, and consolidation took a further 6 weeks before full weight-bearing. Finally, the reconstruction was converted into a definitive static prosthesis once the final limb length was achieved. At the latest follow-up, the patient attends school and participates in sports, reports no pain, and is skeletally mature, with a 1-centimetre leg-length difference. Conclusion:This case demonstrates the feasibility of a staged approach to the reconstruction of paediatric osteosarcoma by combining the principles of endoprosthetic reconstruction with distraction osteogenesis. A staged strategy enabled oncologic clearance, growth accommodation, and functional preservation. Clinical significance:Staged BioXpand reconstruction offers a 'bioexpandable' alternative to expandable endoprostheses by restoring length through distraction osteogenesis rather than metal extension. A modular sequence (primary reconstruction, hybrid nail exchange for outpatient lengthening, then definitive static conversion) can equalise limb length while generating bone stock, supporting future revisions.
How to cite this article: Kubicek JG, Ferreira N. A Proposal for the Kubicek-Ferreira Modification of the Gustilo-Anderson Classification: Eliminating the Clinical Ambiguity of Grade II and IIIC Open Tibia Fractures. Strategies Trauma Limb Reconstr 2025;20(3):191-192.
Background:Vertical shear medial malleolus fracture is less common than transverse. A plurality of methods is used for fixation, including lag screws, buttress plating, neutralisation plating with screws, and antiglide plating. But none of them has been proved to be the optimal choice. The study aimed to evaluate the clinical and functional findings and complications that might occur after vertical shear medial malleolus fracture fixation using either an antiglide plate or horizontally placed parallel screws oriented perpendicular to the fracture line. Materials and methods:A prospective cohort investigation included 56 cases with vertical shear medial malleolus fractures. The individuals were categorised into two divisions based on the fixation methods used: Antigliding plate (25 cases) or screws (31 cases). The median age in the antiglide plate division was 34 years (IQR: 23-50 years), while in the screws category, it was 38 years (IQR: 29.5-48 years). Functional outcomes were evaluated using the AOFAS score. Results:Operative time and incision length were substantially shorter in the screws category compared to the antiglide plate division (P eff = 0.001 and p < 0.001, respectively) and union time was statistically shorter in the antiglide plate category compared to the screws division (P eff = 0.019), no clinically or statistically significant difference was observed in functional outcomes based on the AOFAS score at 3-month and 1-year follow-ups. Conclusion:In this type of ankle injury, the use of an antiglide plate or screws can provide nearly equal clinical and radiological outcomes, but with longer operative time and incision length towards the antiglide plate.
Purpose:Existing studies predominantly represent male patients, and no gender-specific analysis has been performed on treatment outcomes. This study aimed to investigate the influence of sex on the therapeutic outcomes of the Masquelet technique. Materials and methods:This retrospective cohort study included 58 women and 113 men treated with the Masquelet technique at the BG Klinikum Hamburg (BGKH) between July 2011 and June 2021. No sex-specific treatment protocols were employed at BGKH. The defect location and size, indication for the Masquelet technique, occurrence of complications and surgical revisions, microbial colonisation of the defect site, secondary stabilisation strategies, as well as the achievement and time to full weight-bearing were systematically assessed. Results:The analysis revealed no significant difference in the percentage of patients achieving full weight-bearing capacity between male and female cohorts (p = 0.611). Specifically, 90.3% of men and 87.9% of women attained full weight-bearing capacity. The time to achieve full weight-bearing capacity averaged 21 months for both sexes. The complication rates were not significantly different, with 57% for men and 50% for women (p = 0.422). Conclusion:Fundamental factors such as age, comorbidities, defect size, and defect localisation did not substantially differ between male and female patient cohorts in this study. Consequently, the results suggest that biological sex does not exert a discernible influence on the therapeutic outcomes of the Masquelet technique.
Background and aims:Critical long-bone defects remain among the most demanding problems encountered in orthopaedic trauma and reconstructive surgery. These defects arise from a variety of causes-high-energy trauma, blast injuries, bone infection, or oncological resection-and their management almost always demands a staged approach involving infection control, soft-tissue handling, and eventual restoration of skeletal continuity. A fundamental challenge throughout this process is keeping the affected limb mechanically stable between the initial operation and the definitive reconstructive procedure. External fixation has long served this role, since it stabilises the limb without introducing implants into potentially infected territory. However, prolonged reliance on external fixation is associated with several disadvantages: Patient discomfort, pin-tract infection, limited functional activity, and practical difficulties when soft-tissue reconstruction is subsequently needed. Patients and methods:A conceptual analysis of current stabilisation strategies for critical long-bone defects was performed, including external fixation and internal fixation methods. Particular attention was given to the biomechanical conditions present in large segmental defects, where a three-component system-bone, spacer, and fixation construct-determines overall stability. Results:Standard internal fixation methods are similarly constrained when large segmental defects are present. Placing permanent implants in an infected bed risks sustaining or reactivating infection, which is rarely an acceptable trade-off at the early stages of reconstruction. Stabilisation in the setting of a large segmental defect also operates under different mechanical conditions than a simple fracture. Here, the construct must manage not just two bone ends and a fixator, but a three-component system-bone, spacer, fixator-in which the spacer occupying the defect zone is an active mechanical participant. Stability depends on how all three elements interact, not on the fixator alone. Conclusion:In this conceptual paper, we introduce temporary internal stabilisation (TIS) as a distinct framework in the staged management of critical long-bone defects. Temporary internal stabilisation describes the use of internal constructs that provide mechanical stability and preserve limb alignment and length during the period between the first operation and the definitive reconstruction. We argue that this approach can meaningfully extend the options available in reconstructive orthopaedics and offers a fresh conceptual lens through which complex bone defects can be approached.
Introduction:For soft tissue repair, the anterolateral thigh (ALT) flap has been a cornerstone since its inception. The posteromedial thigh (PMT) perforator flap, introduced in 2001, has gained traction over the last decade. This study aims to compare the two flaps to determine which is anatomically more suitable for reconstruction. Materials and methods:Both thighs of 30 cadavers were used for this study over 3 years, involving the dissection of 60 ALTs and 60 PMTs. The comparison focused on the number, length, and type of perforators along with the pedicle length. Results:The PMT flap showed a higher percentage of septocutaneous perforators while matching the ALT flap in length, number of perforators, and pedicle length. Additionally, the musculocutaneous perforators in the PMT flap had a more straightforward course. The ALT flap had an average of 1.78 perforators, having a mean perforator length of 4.35 cm, while the PMT flap had an average of 1.72 perforators with a mean length of 4.3 cm. The average pedicle length was 11.41 cm for the ALT flap and 9.98 cm for the PMT flap. The ALT flap predominantly featured musculocutaneous perforators (81.3%), whereas the PMT flap had 58.3%. Conclusion:The PMT flap is comparable to the ALT flap in all evaluated parameters. It offers advantages such as a higher number of septocutaneous perforators, an obscured scar at the donor site, and more soft tissue bulk, making it a viable alternative to the ALT flap. How to cite this article:Ayushree K, Nitisha, Kumari P, et al. A Cadaveric Comparative Study between Anterolateral Thigh Flap and Posteromedial Thigh Flap. Strategies Trauma Limb Reconstr 2025;20(2):66-71.
Aim and background:The introduction of the 'Vitruvian' Foot concept in 2019 established initial parameter measurements of the 'normal' foot quadrilateral (FQ) in the sagittal plane. This effort had been aimed at increasing precision when analysing alignment abnormalities in post-traumatic and congenital foot deformities, so as to more accurately guide corrective treatment planning with osteotomies. The current study enhances the prior, existing data with an expanded normal cohort. We also offer a case report that describes the successful application of the revised reference angles for our analysis and correction of a congenital foot deformity in a 29-year-old woman. Materials and methods:Included in the present analysis were 100 normal radiographs (78 patients). We followed the FQ delineated by our previous studies, which uses the distance between the posterior process of the talus and the anterior edge of the articular surface of the talus body (points a and b, respectively) to form the talus joint line (TJL). The FQ is then transcribed in the sagittal plane, anchored by the dual weight-bearing apices created by the junctures of the TJL and the most definitively plantar points of (1) the first metatarsal head (c) and (2) the posterior calcaneus (d). Reference angles were designated as: The anatomic lateral talometatarsal angle (aLTMA, ∠bcd), the mechanical talometatarsal angle (mLTMA, ∠bac), and the lateral heel angle (LHA, ∠acd). Additionally, we measured ∠dab, ∠abc, and ∠cda, as well as the proportional values of line lengths bc:ab (k1), cd:ab (k2), and ad:ab. Results:The resulting, revised measurements and standard deviations (SDs) were as follows: ∠abc = 144.5 ± 3.7 degrees, ∠bcd = 32.6 ± 1.9 degrees, ∠cda = 79.1 ± 3.7 degrees, ∠dab = 103.8 ± 3.4 degrees, k1 = 3.02 ± 0.24, k2 = 3.83 ± 0.31, and k3 = 1.62 ± 0.17. Conclusion:We expanded the dataset of previous publications and to corroborate and more accurately define upon the concept of the normalised 'Vitruvian' foot. The larger sample size allowed refinements in the previously established reference values. Though the newer calculations showed only slight referential changes, there was a noticeable tightening of the SD over the previously published reference lines and angles (RLAs) measurements. Clinical significance:The updated normalised parameters can offer the surgeon a reliable framework to enhance precision in foot deformity correction planning. Level of clinical evidence:III. How to cite this article:Solomin L, Ukhanov K, Kirienko A, et al. Enhanced Precision for Deformity Correction Planning: Revision of Values for the Vitruvian Foot Quadrilateral with Demonstrative Case Report. Strategies Trauma Limb Reconstr 2025;20(2):72-81.
Background:Ollier's disease, characterised by multiple enchondromas, can result in significant limb length discrepancy and angular deformities. Anecdotal evidence suggests faster healing rates and a risk of premature consolidation during lengthening. The aim is to evaluate healing rates in Ollier's and assess the need for change in practice. Materials and methods:A total of 12 patients with Ollier's disease underwent limb lengthening utilising an external fixator or intramedullary lengthening nail. A latency period of 6 days was followed by a lengthening rate of 1 mm per day. Parameters, including lengthening index (LI), bone healing index (BHI), and external fixation index (EFI), were recorded. The regenerate quality was assessed using the pixel value ratio (PVR) when lengthening was achieved, at frame removal, and equivalent cortex formation following a nail. Change in lengthening rates and complications were noted. Results:Eleven males and one female underwent 20 lengthening episodes at a mean age of 14 years (8-29 years). The mean lengthening was 4.9 cm (1-10 cm). Full regeneration consolidation occurred in all patients. Following external fixation, the mean LI was 17.78 days/cm (9.5-71), the BHI was 33.62 days/cm (4-133), and the EFI was 53.60 days/cm (21.43-210). A lower, but not statistically significant, BHI of 11.23 days/cm (3.5-22.86) was recorded in the nail group. The mean PVR was 0.84 (0.53-1.2) at the end of lengthening and 0.94 (0.64-1.13) at frame removal following external fixation, compared to 0.78 (0.74-0.86) and 0.86 (0.77-0.94) with nails; again, no significant difference was noted. Complications included one case of premature consolidation during humeral lengthening requiring re-osteotomy. One case of knee flexion deformity and pain during radial lengthening required a slowing of the distraction rate. One case of tibial valgus deformity was deliberately corrected slowly to avoid traction injury to the common peroneal nerve. No other cases had a change in lengthening rate or rhythm. Discussion:All our patients undertook successful lengthening with good bone consolidation. The healing indices recorded are similar to the published literature. We accept the limitations of a retrospective study with small numbers. With only one case of premature consolidation, we have no evidence to support the concept of faster regenerate consolidation in patients undergoing lengthening in Ollier's disease. How to cite this article:Calder P, Wanas J, Tissingh EK, et al. Ollier's Disease Regenerate Healing Rates: Is there Cause for Concern? Strategies Trauma Limb Reconstr 2025;20(2):59-65.
Introduction:In the modern digital era, social media platforms, such as TikTok, have become significant sources of medical information for the general public. This study explores the content of TikTok videos related to cosmetic limb lengthening to understand the quality and accuracy of information shared. Methods:The 50 most-viewed English-language videos tagged with #Heightsurgery and #lengtheningsurgery on TikTok were analysed by two independent reviewers. The analysis covered creator demographics, video format, and predominant themes. Each video was also evaluated for medical accuracy and scored for clarity and actionability using the patient education materials assessment tool (PEMAT). Results:The selected videos amassed 186.5 million views, 7.9 million 'likes,' 1,52,000 'shares,' and 67,000 comments. Nearly half (47%) were produced by healthcare professionals (HCPs), with orthopaedic surgeons accounting for 70% of the HCP contributors (32.9% of total creators). Medically accurate content was found in 60% of all videos, with 80% of HCP videos featuring accurate information. Educational content dominated (72%), with the remainder being anecdotal (28%). Tone varied, with videos presenting either positive (50%), negative (32%), or neutral (18%) perspectives. Common themes included post-operative experiences (30%), medical education (15%), surgical techniques (12%), risks vs benefits (10%), and treatments for achondroplasia (10%). Concerns about pain, fear, permanent injury (24%), cost (10%), and a lack of understanding of procedures (10%) were also frequently mentioned. Notably, there was no focus on racial or socio-economic barriers in any of the videos. The average understandability and actionability scores, according to the PEMAT, were 67.5 and 67.15%, respectively. Conclusions:The widespread popularity of these videos underscores the growing role of social media in disseminating medical information. This analysis highlights the need for HCPs to leverage platforms like TikTok to provide accurate, reliable information and address common concerns, misconceptions, and fears surrounding cosmetic limb lengthening. How to cite this article:Ramlawi AA, Sidani M, Missi C, et al. Accuracy and Actionability of TikTok Content on Cosmetic Limb Lengthening: A Comparison between Healthcare Professional and Non-professional Sources. Strategies Trauma Limb Reconstr 2025;20(2):90-93.
Aim:The aim of the present study was to assess the precision, safety and limits of hexapod external fixator (HEF) systems for the correction of primary and secondary lower limb deformities and for the treatment of lower limb complex fractures [damage control setting - damage control orthopaedics (DCO)] in a consecutive series of 16 patients. Materials and methods:Clinical and radiographic data of 16 consecutive patients with primary and secondary complex lower limb deformities or lower limb complex fractures (DCO) were analysed. The difference between pre-operative and post-operative deformity measurements on X-rays was compared in order to assess the efficacy of the hexapod systems used. The precision of the hexapod systems in deformity correction was expressed as the agreement between pre-operative planning values and final correction values. Results:A statistically significant difference between pre-operative and post-operative deformity parameters (p = 0.01) for both angular and linear parameters was found confirming the deformity correction to be effective. The difference between planned values of correction and obtained values of correction was statistically significant for angular corrections (p = 0.010) but not for linear corrections (p = 0.12). Conclusion:The HEF is an efficient treatment of both acute traumatic and primary or secondary chronic complex deformities of the lower limbs. The difference found between software-generated correction planning and end-correction parameters for angular corrections reveals a limit of the hexapod system. Level of evidence:IV. How to cite this article:Conteduca J, Sessa P, Lanzetti R, et al. Accuracy, Efficacy and Limits of Hexapod External Fixators in the Treatment of Lower Limb Complex Deformity. Strategies Trauma Limb Reconstr 2025;20(2):82-89.
Circular frames are applied to control fracture and osteotomy mechanics, which is dependent on frame design. As the clinical application of these devices is individualised, clinical performance can be difficult to compare from one case to another. In fine wire constructs, stability is dependent on wire tension, which can degrade over time. As such, wire tension is a parameter that surgeons may attempt to keep consistent between cases or indeed adapt to the clinical situation. However, there is little evidence regarding what variables in fixator application might influence this. The aim of the study was to monitor wire tension in an in vitro symmetrical circular frame construct using strain gauge instrumented wires and to use these to investigate the clinical factors in assembly and use of a frame that may be associated with tension loss. The results demonstrated that variability in wire tension was associated with the application of the tensioner itself, along with wire slippage associated primarily with the bolt torque used to tighten the ends of the wires to the frame. These two variables could easily lead to a 50% variation in the actual wire tension achieved. Surprisingly, under dynamic loading, despite an initial loss in tension due to slippage, wire tension generally remained constant and was not significantly different between wires applied with different wire pre-tensions after the initial three cycles. A calibrated tensioner with a high initial tension (110 kg), along with a controlled wire clamp bolt torque (14 Nm), is required to achieve the most consistent frame performance. How to cite this article:Burridge IS, Howard A, Harwood P, et al. In Vitro Wire Tension in Circular External Fixation Frames. Strategies Trauma Limb Reconstr 2025;20(2):94-99.
Aim:To describe a retrograde femoral shortening technique that allows simultaneous deformity correction over an intramedullary nail. Background:Leg length discrepancy (LLD) can be managed by lengthening the short limb or shortening the long limb, either gradually or acutely. To our knowledge, the combined femoral shortening and deformity correction using a retrograde nail has not been previously reported in the literature. Technique:Shortening and correction are planned using a modified Baumgart reverse-planning method. Based on the planning, the position of the guidewire is replicated intraoperatively. After achieving the "cortical contact" point, further steps are taken for the nail insertion. A percutaneous shortening osteotomy is then performed, with bone and nail alignment controlled using locking and poller screws. Conclusion:This report outlines a reproducible retrograde technique for femoral shortening osteotomy with concurrent deformity correction. Clinical significance:This method provides a safe, technically straightforward, and effective option for treating LLD with associated femoral deformity in the longer limb. How to cite this article:Musielak B, Fernandes JA. Novel Approach for Closed Femoral Shortening Osteotomy with Deformity Correction Using Reverse Planning and Retrograde Surgical Technique. Strategies Trauma Limb Reconstr 2025;20(2):130-134.
Background:Transcutaneous osseointegration following amputation (TOFA) is an alternative to standard prosthesis by directly anchoring a metal implant to the skeletal residuum. However, there is a paucity of data concerning whether TOFA is safe and reasonable for patients with lower limb amputation to manage complications of sepsis. The primary aim of this study was to record adverse post-TOFA events for nine patients (15 limbs) whose index amputations were performed to manage sepsis-related complications. The secondary aim was to compare the pre- and post-TOFA mobility and quality of life (QoL). Methods:A retrospective review of our practice's prospectively maintained osseointegration database was performed. Patients with transfemoral and/or transtibial osseointegration for a limb in which the original amputation was performed to manage sepsis, at least two years prior to the study date, were included. This yielded nine patients with 15 osseointegrated limbs. Adverse events were antibiotics for infection or unplanned surgery. Outcomes were recorded using the SF-36 Health Survey and the Questionnaire for persons with a transfemoral amputation. Formal mobility evaluations included a 6-minute walk test and physician-determined K-levels. Results:The cohort had a mean age of 42.8 ± 6.5 (range: 35.0-52.4) years. The mean body mass index (BMI) was 27.2 ± 11.0 (18.4-54.5). Six patients (67%) underwent bilateral osseointegration, and three (33%) patients underwent unilateral osseointegration. Six patients (67%) representing 12 limbs (80%) had an uneventful course post-osseointegration. One (11%) patient had intravenous antibiotics to manage a superficial infection. One (11%) other patient had a periprosthetic femur fracture managed by open reduction internal fixation. No systemic complications, additional surgeries, or implant removals occurred. 75% (6/8) achieved K-level ≥ 2 post-osseointegration. There was no significant change in the 6-minute walk test. Conclusion:Lower limb osseointegration is a safe and effective rehabilitation option for patients whose amputations were a result of sepsis. Clinical significance:Further judicious use of TOFA for these patients seems highly merited. How to cite this article:Panzures AC, Akhtar MA, Hoellwarth, JS, et al. Transcutaneous Osseointegration for Amputees as a Result of Sepsis Management: A Case Series of Nine Patients with a Mean Follow-up of 4 Years. Strategies Trauma Limb Reconstr 2025;20(1):17-24.
Aims and background:In the field of deformity analysis, the values for reference lines (both anatomical and mechanical) and reference angles of the femur and tibia are established. However, current data regarding the reference lines and angles of the humerus are limited, which limits comprehensive planning for deformity correction.The aim of this research was to establish standard values for the anatomical axis and angles of the humerus as measured in both the frontal and sagittal planes. Materials and methods:Radiographic images of the upper arms of 36 healthy participants (comprising 15 women and 21 men) were examined by utilizing two common imaging techniques: Anteroposterior and lateral views. Inclusion criteria for participants were over 18 years of age, have no prior upper limb injuries; no reports of pain in the upper limb joints; the lack of any musculoskeletal diseases and the absence of deformities. On the anteroposterior radiograph, assessments were made of joint intersections with the anatomical axis, along with the anatomical medial proximal humeral angle (aMPHA) and the anatomical lateral distal humeral angle (aLDHA). The lateral radiograph analysis focussed on joint intersections with the anatomical axis, the anatomical posterior proximal humerus angle (aPPHA) and the anatomical posterior distal humerus angle (aPDHA). Results:In the frontal plane, the anatomical axis intersected the proximal joint line of the humerus at the border of 36.6 ± 5.7 mm (76.57%) medially and 11.1 ± 4.5 mm (23.43%) laterally. At the distal joint line, the intersection occurred at the border of 22.5 ± 3.9 mm (37.88%) medially and 36.9 ± 5.6 mm (62.12%) laterally. In the sagittal plane, the anatomical axis intersected the proximal joint line at the border of 41.1 ± 11 mm (39.83%) in front and 62.1 ± 12.4 mm (60.17%) behind, and the distal joint line at the border of 16.1 ± 3.4 mm (76.3%) in front and 5.0 ± 2.1 mm (23.7%) behind. The following reference angle values were obtained: aMPHA = 45.2° ± 5.0°, aLDHA = 78° ± 4.1°, aPPHA = 56.8° ± 8.8° and aPDHA = 16.4° ± 3.1°. Conclusion:The obtained data will allow us to perform analysis, preoperative planning and evaluate the results of correction of humeral bone deformities with the accuracy required for clinical needs. Clinical significance:This study provides orthopaedic surgeons with new reference lines and angles of the humerus that are essential tools for deformity correction planning and estimating the results of deformity correction. How to cite this article:Vilenskii VA, Baushev MA, Solomin LN. Reference Lines and Angles of the Upper Arm. Strategies Trauma Limb Reconstr 2025;20(1):1-5.
Lower limb free flaps require regular monitoring in the immediate days postoperatively and often involve prolonged outpatient wound care. Post-operative dressings are complicated when a circular external fixator is used. Circumferential post-operative dressings are the standard option, such as Jelonet/gauze/wool/crepe. An alternative option is the use of Jelonet and gauze, with Gamgee (JGG) wrapped loosely over the frame instead. This allows easier monitoring with complete flap visualisation, avoids constriction and allows much quicker dressing application. This dressing option has been previously described, but no comparative study between standard dressings and JGG dressings has been made. A retrospective study was conducted for consecutive patients treated with a circular frame and free flap for reconstruction of either an acute open tibial fracture or fracture-related infection between January 2022 and October 2023. Demographics, comorbidities, perioperative details, flap and wound healing outcomes were recorded and analysed using Jamovi 2.3.21. Thirty-one patients (average age 43 years) were identified, 81% open fracture, 42% gracilis, 36% ALT. A total of 48% had standard dressings, and 52% JGG. No statistically significant difference was found between the dressing groups for flap failure, inpatient stay, or time to complete healing. This study demonstrates clinical equivalence in outcomes between standard and JGG dressings for this patient group. The JGG dressing also has the advantages of quick and easy application, with improved flap visualisation. We recommend its use in this patient group. How to cite this article:Jageer P, Kiely J, Day S, et al. A Comparative Analysis of Standard vs Jelonet/Gauze/Gamgee Dressing for Lower Limb Free Flap Reconstruction. Strategies Trauma Limb Reconstr 2025;20(1):56-58.
Background:Controversy remains on the most effective method of treating open tibia shaft fractures. The timing of the different treatment variables remains at the heart of this dispute. This study aimed to investigate outcomes of open tibial shaft fractures. Specific objectives were to determine the association of time delay to antibiotic administration, surgical debridement, definitive skeletal stabilisation and soft tissue reconstruction, and the development of fracture-related infection (FRI). Materials and methods:A total of 227 patients with 237 open tibia shaft fractures were included. The time from arrival to (1) antibiotic administration (<3 hours vs >3 hours); (2) primary debridement in theatre (<24 hours vs >24 hours); (3) definitive skeletal stabilization (<5 days vs >5 days); (4) definitive soft tissue reconstruction (<5 vs >5 days); and (5) time to union was recorded. The number of debridements and the length of hospital stay were also recorded. Results:Patients who waited more than 5 days for definitive skeletal fixation or soft tissue reconstruction had a significant increase in FRI [odds ratio (OR) 4.7, 95% confidence intervals (CI): 2.0-10.9 and OR 4.7, 95% CI: 2.0-11.0, respectively]. Patients who underwent more than two formal debridements also had a higher risk of developing FRI than those who only had ≤2 debridements (OR 15.6, 95% CI: 5.8-41.6). Conclusion:Time delays in managing open tibia shaft fractures are associated with an increased risk of FRI. Definitive soft tissue reconstruction and skeletal stabilisation should not be delayed for more than 5 days. Clinical significance:Fracture-related infection following open tibia shaft fractures can be mitigated by reducing treatment delays, specific to definitive soft tissue reconstruction and skeletal stabilisation. How to cite this article:Kock FM, Basson TR, Burger MC, et al. The Effect of Treatment Delays on Fracture-related Infection in Open Tibia Shaft Fractures: A Retrospective Cohort Study. Strategies Trauma Limb Reconstr 2025;20(1):25-30.
Background:Elective stature lengthening (ESL) has gained popularity among individuals seeking to increase their height. Despite its growing appeal, online information about ESL often lacks consistency and transparency. This study evaluates the quality and comprehensiveness of online resources available to prospective patients, focusing on clarity in communication, cost, recovery expectations, and complications. Methods:Using a secret shopper methodology, we contacted 27 eligible orthopaedic practices globally that offered ESL, posing as a healthy 35-year-old male seeking ESL. Practices were contacted via email and follow-up phone calls using a standardised script. Responses were analysed to evaluate the availability, depth, and variability of information on key topics, including surgery duration, recovery time, cost, insurance coverage, and complications. Results:Contact was successfully established with 17 (63%) of practices. However, only 3/27 (11%) of the contacted practices answered all scripted questions. Cost estimates varied substantially, ranging from $15,000 to $150,118 (mean = $77,133, SD = $35,603.58). Recovery time was similarly variable, ranging from 2 to 365 days (mean = 202 days, SD = 137.27). Crucial details, such as patient eligibility and potential complications, were frequently omitted. Conclusion:The study highlights a critical need for improved transparency and standardisation in online resources for ESL. Addressing these gaps could enhance patient trust, satisfaction, and informed decision-making, underscoring the importance of establishing guidelines for consistent communication in this emerging field. How to cite this article:Shenoy DA, Santamaria G, Gomez-Alvarado F, et al. Information Transparency for Elective Stature Lengthening Surgery: A Secret Shopper Study. Strategies Trauma Limb Reconstr 2025;20(1):31-36.
