BACKGROUND:This study evaluated the point during Ponseti treatment when the foot reaches a neutral position and quantified how percutaneous Achilles tenotomy influences each component of clubfoot deformity. An additional aim was to provide a visual representation of correction trends using the Dimeglio scoring framework. METHODS:Infants under six months of age with unilateral idiopathic clubfoot were assessed at each visit with the Dimeglio score. Changes in total and individual deformity parameters were analyzed throughout serial casting and following tenotomy. RESULTS:The total number of casts required before tenotomy ranged from 3 to 12 (mean 6.2). The largest drop in total Dimeglio score occurred between the initial and second casts. All the individual components exhibited the steepest reduction between the first and second casts (17.90 - equinus, 19.20 - hindfoot varus, 44.40 - midfoot rotation, and 18.80 - forefoot adduction). All the deformities except equinus approached neutral through the third cast and equinus through the fourth cast. Tenotomy improved (mean) equinus by 140, hindfoot varus by 20, midfoot rotation by 50 and forefoot adduction by 3.20. CONCLUSIONS:All major deformity elements show concurrent early improvement when managed with the Ponseti technique. Significant change occurs within the first few casts, with tenotomy offering additional correction beyond equinus alone. Larger-scale studies could help standardize the graphical correction profiles observed here. LEVEL OF EVIDENCE:IV.

BACKGROUND:Residual equinus is an important indicator for deciding the need for tenotomy and checking for recurrence of clubfoot deformity. This study aims to validate a novel, radiologic marker-the Talar Index-for objective assessment of residual equinus in clubfoot. METHODS:A cross-sectional observational study was conducted on infants with idiopathic clubfoot treated using the Ponseti protocol, assessed just before percutaneous Achilles tenotomy. The validity of the talar index was tested against the unaffected feet. A positive talar index was defined as the presence of residual equinus. Receiver operating characteristic (ROC) analysis and logistic regression were performed between positive talar index and lateral tibiocalcaneal angle and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Interobserver and intraobserver reliability of the talar index was assessed using Cohen's kappa. RESULTS:A total of 70 feet (49 affected and 21 unaffected) were evaluated. The talar index correctly identified residual equinus in 94.3% of feet, with a sensitivity of 95.9% and specificity of 90.5%. There was a strong association between a positive talar index and increased tibiocalcaneal angle (AUC: 0.929, P =0.001). Sensitivity, specificity, PPV, and NPV of the positive talar index were found to be 84%, 90.5%, 77.9%, and 93.4%, respectively. Logistic regression showed a significant model fit ( P <0.001, R ²=0.82). Inter (κ=0.84) observer and intra (κ=0.97) observer reliability was excellent. CONCLUSION:The talar index is a valid, reliable, and easily interpretable radiologic marker for assessing residual equinus in clubfoot. Its simplicity and high diagnostic accuracy make it particularly suitable for routine clinical use, including in resource-limited and high-volume settings. LEVEL OF EVIDENCE:Level III.

Benign lytic lesions of the proximal femur in children cause pain, deformity, and pathological fractures, posing major challenges for bone stability and healing. Recent studies report pathological fractures in up to 32% of pediatric proximal femoral cysts and recurrence rates of about 17% after curettage and filling. Similarly, multicenter data from the European Paediatric Orthopaedic Society (EPOS) show failure rates of 36-43% in aneurysmal bone cysts of the proximal femur, highlighting the difficulty of achieving durable healing. Therefore, it is of interest to present the results of treating lytic lesions of the proximal femur in children through an anterolateral approach using curettage and non-vascularized fibular grafting. Hence, this retrospective study included 14 skeletally immature patients (mean age 7.1 years). The hip joint was exposed using the standard anterolateral approach, and fibula was harvested through a posterolateral incision. Aneurysmal bone cysts were the most common diagnosis (57.1%). Five patients (36%) required implant stabilization. At final follow up, all patients showed radiological healing at a mean of 4 months, with a mean Harris Hip Score of 78.8. Thus, the anterolateral approach with fibular grafting provides reliable exposure, facilitates bone healing, and allows implant use while preserving the lateral cortex in pediatric proximal femoral lesions.

Chronic hematogenous osteomyelitis (CHOM) of long bones in children remains a major clinical challenge in low- and middle-income countries. The Beit CURE classification has been used to guide treatment, but its reliability across different centers and raters has not been established. Forty-four children with CHOM were evaluated using digital radiographs by 16 fellowship-trained pediatric orthopedic surgeons from five continents. All the raters were trained in Beit CURE classification and assessed each case twice, 4 weeks apart. Interobserver and intraobserver reliability were calculated using intraclass correlation coefficients (ICCs). The raters also predicted anticipated surgical management and the number of procedures needed. Interobserver reliability was fair overall (ICC: 0.467, 95% confidence interval: 0.36–0.59). Agreement was highest for types A and B4 (>80% consensus) and lowest for types B2, B3, and C (<25%). The reliability for growth plate involvement was moderate (ICC: 0.628) and was poor for site involvement (ICC: 0.269). Predictions regarding surgical planning were inconsistent, especially for B2, B3, and C lesions. The Beit CURE classification demonstrated only limited reproducibility among experienced pediatric orthopedic surgeons. While types A and B4 were reliably identified, other subtypes showed poor agreement, undermining clinical decision-making. Refinements – such as merging B2 and B3, providing clearer definitions of sclerosis and involucrum quality, and integrating clinical parameters – are needed before the Beit CURE classification system can serve as a reliable guide for treatment planning. Level of Evidence Level 2.

Background:Prophylactic trochanteric epiphyseodesis is commonly performed with proximal femoral varus osteotomy in Perthes disease to reduce relative trochanteric overgrowth. However, its effectiveness, particularly in children at the typical age for surgical containment, remains unclear. Methods:A retrospective review (2015-2025) evaluated children with Perthes disease who underwent subtrochanteric varus osteotomy with concomitant trochanteric epiphysiodesis. Inclusion criteria were a minimum 2-year follow-up and use of a standardized surgical technique. Radiographic parameters neck shaft angle (NSA), articulo-trochanteric distance ratio (rATD), center-trochanteric distance ratio (rCTD), and abductor lever arm ratio (rLAM) were measured preoperatively and at final follow-up, normalized to the contralateral normal hip. Subgroup analysis was done in children older than 8 years and younger than 8 years. Results:Sixteen patients (mean age 8.1 years; mean follow-up 5.2 years) met inclusion criteria. NSA decreased significantly following varus osteotomy (p < 0.001). rATD deteriorated markedly from 0.982 to 0.305 (p < 0.001), indicating persistent trochanteric overgrowth despite epiphysiodesis. In contrast, rCTD and rLAM showed no significant change. Subgroup analysis revealed similar patterns across age groups: rATD worsened significantly in both older (>8 years: p = 0.031) and younger children (<8 years: p = 0.010), while rCTD and rLAM remained stable. Conclusions:Prophylactic trochanteric epiphyseodesis performed during varus osteotomy did not prevent abnormal trochanteric development in Perthes disease. Its limited effectiveness was consistent regardless of age. Although CTD and LAM were preserved, the key parameter reflecting trochanteric overgrowth (ATD) continued to worsen. Routine use of this adjunct procedure during containment surgery may therefore be of limited benefit.

ObjectivePatients with metastatic gastric cancer (MGC) may require palliative surgery to manage complications such as obstruction or bleeding. While the role of stenting in MGC is clear, the role of palliative surgery in MGC shows conflicting results.MethodsWe retrospectively reviewed clinical data of patients with MGC treated at our institution between January 2007 and December 2021. The clinical outcomes of patients who underwent palliative surgery are analysed in this review.ResultsGastrojejunostomy (GJ) and palliative gastrectomy were performed in 48 and 28 patients, respectively. The median overall survival in the GJ and palliative gastrectomy groups were 9.25 and 11.25 months, respectively (p=0.21). On subgroup analysis, we found that the patients who were diagnosed with MGC intraoperatively had better survival compared with preoperatively diagnosed patients even though it was statistically not significant. The complication rates following GJ and palliative gastrectomy were 6% and 7%, respectively.ConclusionBoth palliative gastrectomy and GJ offer similar results to endoscopic stenting, as reported in the literature. Surgical palliative options continue to be relevant in selected cases due to lower rates of repeat interventions and reduced hospital visits, making them a one-time solution for patients, especially in resource-constrained settings.

Recurrent equinus remains one of the most common deformities following initial correction of clubfoot. This systematic review and meta-analysis aims to analyse the outcomes and complication rates of anterior distal tibial hemiepiphysiodesis for the treatment of recurrent equinus deformity in children with clubfoot. A systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 guideline in PubMed, Scopus, and Cochrane Library up to January 10, 2026. Eligible studies included research evaluating distal tibial hemiepiphysiodesis for equinus in skeletally immature children with clubfoot. Risk of bias was assessed using the ROBINS-I tool. A random-effects model was used to conduct the meta-analysis. Seven studies (six retrospective, one prospective; Level IV evidence) involving 102 children (134 feet) were included. Mean age at surgery was 9.1 ± 1.7 years, with a mean follow-up of 27 ± 9.5 months. Pooled data demonstrated a significant improvement in ankle dorsiflexion (mean difference: −8.64°, P = 0.0008) and a significant reduction in ADTA (mean difference: 14.40°, P < 0.00001). The mean rate of angular correction was 0.70 per month. The overall complication rate was 15.7

We studied the correlation between changes in the interscrew angle (screw divergence) and the correction achieved with tension band plates applied for valgus deformities of the knee region. Twenty-eight children with 68 operated physes were included in this retrospective review. The interscrew angle and screw trajectory angle were measured in the initial and follow-up radiographs. Additionally, changes in the mechanical lateral distal femoral angle and medial proximal tibial angle were calculated from the follow-up radiographs. The statistical calculations involved correlating the changes in the above-mentioned parameters and the magnitude of correction. The location of the implant was in the distal femur in 49 and the proximal tibia in 19 limbs. A mean correction of 12.1 degrees was achieved at a follow-up of 12.1 months. The correction was calculated as 1.1 degrees/month (SD = 0.6). The correlation of screw divergence (R = -0.01; P = 0.97) and changes in screw trajectory angle (R = -0.11; P = 0.36) to the angular correction achieved was statistically insignificant. The changes in the interscrew angle did not correlate with the angular correction following tension band plates.

Background Mothers who have a newborn with a physical defect often experience significant psychological distress. We surveyed mothers of children born with clubfoot to understand what parameters of parents’ quality of life and health are primarily affected and the changes thereof at correction of the deformity to guide the counseling process. Methods The affected mothers were administered the Impact of a Child with Congenital Anomalies on Parents (ICCAP) questionnaire. The responses were recorded prospectively at the enrolment of the child for treatment (foot with obvious clubfoot deformity) and one month post Achilles tenotomy (foot deformity fully corrected). Statistical analysis involved the use of mean responses for each ICCAP domain and intertreatment comparisons. Results Results were analyzed for 29 mothers. The affected mothers were largely satisfied (91.4 %) with their first contact with caregivers. The confidence grew significantly following the correction of deformity (scores improving from 4.39 ± 0.59 to 4.74 ± 0.3; p = 0.005). The social support remained strong throughout the Ponseti treatment. The partner relationships (pretreatment 4.57 ± 0.75; post treatment scores 4.48 ± 0.82; p = 0.69) and child acceptance (pretreatment 4.18 ± 0.62; post treatment 4.04 ± 0.59; p = 0.38) were also overall strong although somewhat affected by the casts and bracing protocol. The affected mothers recovered from a sad and depressed state following visualization of corrected deformity (pretreatment scores 3.09 ± 0.92 improving to 2.92 ± 1.04 post treatment; p = 0.52). They however continued to experience fear and anxiety regarding their child's immediate and long-term future (pretreatment scores of 3.42 ± 0.65 deteriorating to 3.56 ± 0.55 at the initiation of bracing; p = 0.34). Conclusions Mothers of children with clubfoot generally adapted well despite the child's physical deformity. The mother was subjected to early psychological stress which can extend even post correction of deformity. We suggest dedicated counseling of the affected clubfoot parents by the subject experts. The same may require periodic reinforcements during the treatment.

Background:The orientation of proximal femur physis is important as it can cause 3-dimensional deformity of the proximal femur. Recently, authors have described various parameters to describe the orientation of proximal femur physis. Therefore, we aim to compare the intra and interobserver reliability of these parameters in this study. Methods:Radiographs of the bilateral hip with the pelvis of children between 1 and 10 years of age were retrieved from the hospital archives to measure the Physeal orientation angle (PO), Physeal tilt angle (PTA), Head shaft angle (HSA), and Alsberg angle (AA). Intra- and inter-observer reliability was tested using Pearson's correlation coefficient and Cronbach's alpha respectively by three independent observers at two separate times, two weeks apart. Results:The total analysis included 179 radiographs, including 378 hips. PO, PTA, HSA, and AA had values ranging from 9.570 -14.040, 19.62°-25.040, 58.75°-65.820, and 24.470 -31.790, respectively, for the six data sets (three observers at two different times).The intra-observer reliability of PO, PTA, HSA, and AA ranged from 0.59- 0.72, 0.9-0.95, 0.91-0.95 and 0.86-0.95 respectively. PO, PTA, HSA, and AA had inter-observer reliability values between 0.79 -0.82, 0.88-0.92, 0.85-0.88, and 0.89-0.92, respectively. Conclusion:The study found that PTA, AA, and HSA have shown good reliability, but they may not accurately represent the true orientation of the capital femoral physis with respect to the femoral neck. For routine follow-up, PO may be a suitable alternative. However, it is not as reliable as other parameters.

We investigated to what extent the Ponseti technique is successful in radiologically aligning the deformed foot when the deformity was clinically corrected. This prospective study radiologically evaluated Ponseti-treated clubfoot children (Pirani score zero) at a minimum follow-up of 5 years. The radiographs obtained were foot anteroposterior and lateral views (standing views). The angles evaluated in the anteroposterior view were the talocalcaneal and the talus first metatarsal angle. In the lateral view, calcaneal fifth metatarsal, talocalcaneal, talus first metatarsal, tibiocalcaneal, and calcaneal pitch angles were measured. The measured radiological angles were statistically compared to the unaffected feet of the unilateral cases. The mean age of initial treatment for 91 enrolled children (unilateral 37; bilateral 54) was 4 months, and the mean follow-up was 7.2 years. The radiographs revealed similarities for the treated ( n = 145) and unaffected feet ( n = 37) for two angles (talocalcaneal and talus first metatarsal) evaluated in the anteroposterior view, indicating corrected hindfoot varus and midfoot adduction. Again, the calcaneal fifth metatarsal, talus first metatarsal, and calcaneal pitch angles matched for both feet, indicating a completely corrected cavus. There were, however, significantly lower talocalcaneal (mean 28.1 degrees vs. 32.9 degrees in the unaffected feet) and higher tibiocalcaneal angles (76.5 degrees vs. 72 degrees in the unaffected feet) in the lateral projection of the treated clubfeet, indicating the presence of residual hindfoot abnormalities. The radiological measures in the successfully treated clubfeet matched those of unaffected feet. The exceptions were abnormal lateral talocalcaneal and tibiocalcaneal angles. These might indicate the presence of a certain amount of subclinical hindfoot equinus in the treated children.

PURPOSE:Different cast configurations are available in the literature for the application of the Ponseti cast. To dispel the ambiguity and generate better evidence, we tested 2 cast configurations (standard vs. reinforced) for their effectiveness in terms of retained ankle dorsiflexion and overall cast integrity. METHODS:We randomized the 2 limbs of a child with bilateral idiopathic clubfeet (n=30 children) to receive a weight-matched standard cast (circular rolls only) or a reinforced cast (additional knee and plantar slabs). The post tenotomy cast was chosen as the index cast for the research purpose. Evaluations included clinical ankle dorsiflexion, immediate post tenotomy, and at the time of cast removal. Any cast breakages were also noted. RESULTS:The mean child's age was 3.5 months. The mean ankle dorsiflexion achieved immediately post tenotomy in either cast configuration was identical (15.5 degrees). At follow-up, 9 children presented with broken casts, 2 bilaterally. Overall, 9 standard (30%) and 2 reinforced (7%) casts were broken. For the broken casts, the ankle dorsiflexion was lost significantly. On intergroup comparisons, the reinforced casted limbs retained the ankle dorsiflexion significantly better ( P =0.008) compared with the standard configuration. CONCLUSIONS:The reinforced cast configuration retained the ankle dorsiflexion much better than the standard cast. Frequent breakages were also noted with the standard cast.

Background: Epistaxis is the most common complication associated with nasotracheal intubation (NTI). Topical vasoconstrictors are an effective method for minimising this. We compared the efficacy of xylometazoline 0.1% and adrenaline in 1:100,000 and 1:50,000 concentrations in preventing epistaxis during fibre-optic NTI. Materials and Methods: One hundred and eighty patients requiring NTI were randomised into three groups each of 60. Groups receiving topical drops were X1: adrenaline (1:100,000), X2: adrenaline (1:50,000) and X3: xylometazoline 0.1%. Three drops of medication were instilled into patient’s patent nostril 10 min prior to fibre-optic NTI. After passing lubricated, cuffed PVC endotracheal tube, epistaxis was assessed and graded as: none, mild, moderate and severe. Results: Incidence of epistaxis after application of drug X1, drug X2 and drug X3 was 54.4%, 33.3% and 43.1%, respectively. Reduction in incidence of bleeding was observed with drug X2 when compared with drug X1 (P = 0.024). The difference in incidence of bleeding was not significant in comparison of drug X1 with X3 (P = 0.226) and drug X2 with X3 (P = 0.281). Regarding the severity of epistaxis, there were no statistically significant differences among adrenaline 1:50,000, adrenaline 1:100,000 and xylometazoline groups (P > 0.05). Haemodynamic changes in the three study groups were minimal and comparable (P > 0.05). Conclusion: Topical adrenaline 1:50,000 is more efficacious than adrenaline 1:100,000 in reducing the incidence of epistaxis; however, in xylometazoline group, reduction in incidence of epistaxis was not significantly different from the other two groups.

Background Clubfoot, a common birth defect, is treated with the Ponseti method. It involves an intensive phase of weekly casting and Achilles tenotomy as the last step in most of the cases. The tenotomy scar of percutaneous Achilles tenotomy may cause aesthetic concerns that could affect parental satisfaction or impede footwear use. This study aims to objectively evaluate the scar characteristics of percutaneous Achilles tenotomy during Ponseti treatment and parental perception of the same. Methods This study enrolled children with idiopathic clubfoot treated by Ponseti protocol with percutaneous Achilles tenotomy before 1 year of age and on bracing protocol between 2 and 4 years. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS 2.0) were used to assess scar quality. Complications such as hypertrophy, keloid formation, brace difficulty, footwear difficulty, and walking difficulties were noted. Results The study evaluated 82 scars in 50 children (35 males, 15 females). At the final follow-up, most of the scars were close to the normal skin. The mean value of the VSS and overall opinion of the observer and parents regarding the scar was 3.0 ± 1.0, 1.2 ± 0.5 and 2.2 ± 2.1 respectively. All children were able to walk using normal shoes and actively take part in outdoor activities and no complications such as hypertrophic scar or keloid formation were seen. Conclusion Percutaneous tenotomy causes minimal scarring and does not interfere with the general functioning of the child. The aesthetic characteristics of the scar are well-accepted by the parents. The use of percutaneous tenotomy should not be limited by the concern of a scar.

Background The post tenotomy Ponseti cast is retained for three weeks. In a few children, the cast appears soiled especially at its proximal extent and sometimes, at the knee and foot sections as well. Some of these children manifest deterioration of the previously achieved clinical ankle dorsiflexion. This study aimed at investigating the characteristics of post tenotomy cast at follow up to study their influence on ankle dorsiflexion. Methods The study included 25 children with bilateral idiopathic clubfeet under the age 1 year treated with Ponseti method who also underwent percutaneous Achilles tenotomy for both feet (50 limbs). The cast characteristics evaluated were extent till groin, knee and ankle intactness along with firmness of plantar surface. Clinical ankle dorsiflexion was measured immediate post tenotomy and at follow up. Odds ratios were calculated to establish relationship between ankle dorsiflexion and cast characteristics. Results The mean child's age was 3.7 months. The immediate post tenotomy ankle dorsiflexion was 15.2° and at follow up was 14.2° (p = 0.0029). Sixteen casts (32 %) were found short near the groin edge at follow up. Out of these, 9 limbs (56 %) had lower ankle dorsiflexion measurements than those achieved immediate post tenotomy. Statistically, the likelihood of lost dorsiflexion was heightened 87 times with recessed groin margin compared to the intact casts (p = 0.003). Although the odds ratio of deterioration of ankle dorsiflexion with plantar surface break was even higher (odds ratio 160; p < 0.0001), isolated plantar breaks without cast recession near the groin were not observed in any of the limbs. Conclusions The deteriorated cast characteristics at follow up may be responsible for loss of achieved ankle dorsiflexion immediately post tenotomy. The post tenotomy cast should be monitored better to keep its integrity and extent intact.

The post birth revelation of child with physical anomaly taxes maternal hopes of a healthy child. However, unlike many other congenital anomalies, the Ponseti method has enabled an early and effective treatment of the clubfoot deformity. Our study aimed to assess the quality of life (QoL) of mothers with child born with idiopathic clubfoot through various stages of its management compared to a healthy infant. The study was conducted on mothers of children born with untreated congenital idiopathic clubfoot presenting within first 3 months after birth and undergoing Ponseti treatment. The WHO Quality of Life Instrument (QoL), Short Form (WHOQOL-BREF) questionnaire was used to capture maternal responses at enrolment of the child at the clubfoot clinic, at percutaneous Achilles tenotomy, 3 weeks post tenotomy, and 1 month after prescription of foot abduction brace. Intertreatment comparison of QoL responses was performed. Baseline values for QoL domains were obtained for mothers born with healthy infants (controls). Responses from 29 affected mothers and 30 controls were available. The QoL responses from affected mothers were significantly lower than those born with healthy children. The domains most affected were psychological health and environment (P < 0.001). Subsequent responses through various stages of Ponseti management remained comparable. Although the affected mothers’ QoL was lower than mothers of healthy child, they were pacified by the available treatment and the counseling for clubfoot. Physical health and social relationship domains were no longer areas of concern for them. Further, there was no change of QoL across sequential Ponseti management.

The aim of this study was to appraise various factors influencing the correction rate in temporary hemiepiphysiodesis (THE) around the knee joint. Specifically, the study analysed the relationship of correction rate with age, gender, aetiology, type and location of deformity. The retrospective study included children who underwent THE for a coronal plane deformity (genu valgus or varum) around the knee joint (distal femur or proximal tibia) over a ten year period (2010–2020). The primary outcome of interest was the correction rate of the deformity. Thirty-three children (27 females and 6 males) with a mean age of 8.1 years involving 86 plates were included in the study. The mean correction achieved was 12.2° over a treatment period of 13.3 months. Subgroup analysis showed significant differences between the type (varus (0.8° per month), valgus (1.1° per month)) and the location of deformity femur (1.2° per month) and tibia (0.7° per month)]. On multivariate analysis, the location and the duration of treatment showed significant associations with the correction rate. The correction of coronal deformities following temporary hemiepiphysiodesis is influenced by several factors. Valgus, femoral and deformities in younger children correct at a faster rate. Location of deformity and duration of treatment emerged as potential factors affecting the correction rate.

Surgical scissors form an essential part of both basic and specialty surgical sets. Their prime function is to cut tissues. They are also used for blunt dissection/development of tissue planes and piercing tissues. A wide variety of scissors are available for use in practice. This review article briefly describes common surgical scissors in orthopaedic use. The basic construct, biomechanics, types, their identification, specific uses, and care aspects are also discussed. A surgeon should be aware of the different types of scissors, their biomechanical features, and specific uses, as they are an important tool in his/her armamentarium. (Journal of Surgical Orthopaedic Advances 33(1):001-004, 2024).

Purpose The study is aimed at evaluating the long-term (at a minimum follow-up of 10 years) impact of non-vascularized fibular harvest on the donor limbs. Methods There were 27 donor limbs ( n = 19 children) available for retrospective radiological review. The graft was obtained bilaterally in eight patients. The following parameters were evaluated in the follow-up radiographs: continuity/non-continuity of fibular regenerate, width of the regenerated fibula, distal fibular station, medial proximal tibial angle, posterior proximal tibial angle, lateral distal tibial angle (LDTA), anterior distal tibial angle, and tibia diaphyseal angulation (interphyseal angles). For analysis and comparisons, the donor limbs were compared to the healthy limbs (controls) of the children with unilateral harvest. Additionally, the impact of continuous and non-continuous fibular regeneration was separately analyzed. Results The mean child’s age at the time of fibular harvest was four years. The mean follow-up was 12.8 years. The fibula was found regenerated in continuity in 22 limbs of 15 children (81.5%). When analyzed as a combined group (both continuous and non-continuous fibular regenerations), all the donor limb radiological parameters matched those of healthy limbs except LDTA ( p = 0.04). In the subgroup analysis between non-continuous and continuous fibulae, significant abnormalities were again obvious in LDTA ( p = 0.0001). The non-continuous fibulae were significantly lesser in width. All limbs with non-continuous fibular regeneration manifested ankle valgus. Conclusions The non-vascularized fibula emerged as a relatively safe procedure in the long term with minimal affections of the knee, ankle, or tibial anatomy when longitudinal integrity of fibula was restored. The non-regenerations of the fibula may be prone to developing ankle valgus.