Introduction: Crush Injuries are associated with physical losses & devitalization of soft tissues. It needs intense management including debridement, stabilization of fractured bones and reconstructive plastic surgeries for soft tissue losses including skin grafting. However, the sole cannot be reconstructed with natural plantar skins. Biologics including Platelet-rich Plasma are emerging as part of the management of complex wounds, particularly for assisting the reconstructions. Materials and methods: A prospective interventional study was conducted at our centre and included 28 cases of crush injuries of the foot All these had severe soft tissue loss and 11 had associated impending gangrene of toes. All underwent primary debridement with minimum removal of further soft tissues including the tendons and stabilisation of bones. Further, they were treated with a protocol based on serial infiltration of autologous Platelet-Rich Plasma (PRP). Results: In all the cases the feet were reconstructed by inducing regeneration with the aid of PRP including the control of infection and salvage of nearly dead tendons. The skin regenerated on the planter aspect was nearly normal and thick as a sole. It demonstrates the potential biologics as timely minimal interventions leading to salvage of feet after severe crush injury. Conclusion: PRP infiltration, can be an essential inclusion towards salvage strategy in crush injuries of feet, preventing morbidities.

Presentation Aims: Our aim is to showcase our experience with hallux valgus surgery, specifically combining subcapital osteotomy by Kramer with osteosynthesis of the first metatarsal bone using an ITS® hallux osteotomy locking plate. Study Design: We conducted a retrospective, descriptive evaluation to assess the correction potential in changes to the hallux valgus and intermetatarsal angles. Preoperative and 6-month postoperative hallux valgus and intermetatarsal angles were verified using X-rays in 52 patients (45 women, 7 men, average age 57.2 years) at Tauernklinikum Mittersill, Department of Orthopaedics. The surgeries, performed between 2016 and 2023, allowed patients full-load mobilization with a forefoot relief shoe. Results: The preoperative hallux valgus angle was 31.2° (SD = 7.4) and postoperatively it was 11.0° (SD = 5.4). The preoperative intermetatarsal I/II angle was 15.0° (SD = 2.7) and postoperatively it was 3.7° (SD = 2.0). Conclusion: Hallux valgus surgery utilizing SCOT 1.MT osteotomy by Kramer, combined with HOL Plate Osteosynthesis, demonstrates a very good and stable postoperative clinical and radiological correction potential. This surgical combination, compared with other distal surgical techniques, exhibits higher correction potential and is recommended for the correction of mild to moderate hallux valgus cases with an intermetatarsal angle of 10° to 20° and a hallux valgus angle of 20° to 40°. Severe hallux valgus cases with an intermetatarsal angle greater than 20° were treated with basal Crescentic Osteotomy.

Background: With the advent of technology, it is now possible to correct complex orthopaedic deformities with greater accuracy, using the computer-assisted six-axis system, which offers the unique possibility of simultaneous three-dimensional correction of complicated deformities, following a single visit to the operation theatre.
Methodology: Ours was a prospective cohort pilot study in 15 patients, aged between 18-60 years, who presented with complex deformities of the foot and ankle. The objectives were to assess: (a) the results of six-axis-assisted correction, clinically, using the American Orthopaedic Foot and Ankle Society (AOFAS) scores; (b) the accuracy of correction of radiological parameters using a planning software; and (c) the rate of complications associated with the procedure. AOFAS scores were recorded pre-operatively, at six-, and twelve-months following frame removal.
Results: For bony corrections, the mean time to union was 4(+/-1.2) months. For pure soft-tissue distraction, it ranged from 1.5-2.5 months. All patients achieved a stable, plantigrade foot and exhibited normal, un-assisted gait, using modified footwear. At final follow-up, the mean LDTA was 90(+/-2)°; mean ADTA was 80(+/- 1.5)°; mean tibio-talar angle was 66°(+/- 2); mean Meary’s angle was 6(+/-2.5)°; mean AP Kite’s angle was 22(+/-1.5)°; and mean AOFAS score was 84(+/-8). The improvement in AOFAS scoring was statistically significant (p<0.05). Complications included superficial pintract infections (n=2) and joint stiffness (n=1).
Conclusion: Our study concurs the fact that perplexing foot and ankle deformities can also be corrected safely and accurately, upon adoption of this technological development, which holds great promise in the future.

Introduction:
Managing calcaneal malunion presents formidable challenges. Clinical examination discerned pain generators, guiding operative strategies to attain near-normal anatomy.

Methods:
This retrospective case series evaluates the functional outcome of reconstruction osteotomy and osteosynthesis in patients with calcaneal malunion. Ten male patients, aged 23 to 52 years, who underwent surgery for calcaneal malunion were included in the study. patients presenting within six weeks post-injury, those with comminuted fractures and subtalar arthritis, or those treated by subtalar arthrodesis. Surgical intervention involved reconstruction osteotomy to elevate depressed posterior facet , correction of calcaneal varus, and internal fixation with plate and screw while preserving the subtalar joint. Clinical and radiological evaluations were conducted postoperatively, assessing parameters such as pain scores, walking distance, stability, and support. Radiological union of the calcaneal fractures was also assessed.

Result:
At a minimum 12-month follow-up, assessment utilizing the Maryland Foot Score (MFS) revealed satisfactory outcome.The study revealed significant improvements in pain, walking distance, stability, support, limp, and shoe wear scores postoperatively, as evidenced by the Maryland Foot Score. The radiological evaluation demonstrated successful union of calcaneal fractures in all cases within the fifth month. Pearson's correlation analysis showed a significant negative correlation between delay to surgery and total MFS score (r = -0.68, p < 0.05), indicating better functional recovery with shorter delays.

Conclusion:
Intraarticular osteotomy coupled with posterior facet elevation in the management of calcaneal intraarticular malunited fractures offers promising functional outcomes with the preservation of the subtalar joint.
Key Words : Intra-articular osteotomy, Subalar joint, Malunion.

Lisfranc injuries present a challenging scenario, often requiring meticulous surgical intervention to achieve optimal outcome and to prevent long-term morbidity. When surgery is indicated, internal fixation is mostly recommended but the option of primary fusion has role in some situations. The use of staples provides a low profile extra-articular fixation with less joint surface damage and soft tissue irritation.We retrospectively reviewed 43 patients who underwent memory staple fixation of Lisfranc injuries at a Level 1 major trauma centre over the last 10 years. All surgeries were performed by two surgeons. Patients were followed up at regular intervals after operation, with clinical and radiographic assessment of progress of healing and any complications. Clinical and functional outcomes were assessed at their final follow-up. Functional outcomes were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scores.Six patients had broken staples in follow ups. One had removal of staples and planned mid foot fusion, two had removal of staples. Three patients had associated ankle fractures. One patient with concomitant open ankle fracture, skin was not viable and had a free flap as a soft tissue cover. At the end of the follow-up, the mean AOFAS midfoot score was 71.89 (S.D-17.5, 95% CI-63.5-80.3). Gender or associated injuries did not show any statistical difference in AOFAS midfoot scores but there was some relation with poorer outcomes in patients who had broken staples and free flap.The use of staple fixation in Lisfranc injury involves simple technique with satisfactory fixation and good functional outcomes.

Introduction : The lisfranc dislocation fracture first described by Monteggia and Dupuytren then detailed by Malgaigne in 1855, these are rare and serious lesions. They can go unnoticed, most often in the context of polytrauma whose treatment remains controversial. Methods : This is a retrospective study of 20 cases within the service over a period of 6 years (from January 2014 to December 2019 Results : The average age was 39 years with a sex ratio of 4, a predominance of AVP with 75%, 65% had a cutaneous opening and vasculo-nerve lesions in more than half of the cases. A predominance of homolateral columno-spatulary luxation fractures was noted in 50% of cases.We used the AOFAS score after a collection of 24 months whose average was 76 with predominance of a good result in 45% of cases, excellent result in 30%, acceptable result in 10% and poor result in 15% of cases. In the long term, 25% had neuro-algodystrophy and 15% had osteoarthritis. Discussion : Lisfranc dislocation fractures are relatively rare, the diagnosis of which often goes unnoticed, often affect the young active subject, whose mechanism is most often at high velocity as evidenced by the Lievers meta-analysis in 2012. These are lesions of poor prognosis, including the indirect and most frequent mechanism. The diagnosis is based on standard radiography and supplemented by computed tomography to better detail the diagnostic.Conclusion: Lisfranc dislocation fractures are lesions of poor prognosis. Early management and proper anatomical reduction are prerequisites for a satisfactory functional result.

OBJECTIVES: To present benefits of MIS TTC in a society with growing metabolic co-morbidities for maximising the outcome and cost.
MATERIAL AND METHODS: In the past 24 months 4 cases have been successfully performed using intensifying imaging in a modified described MIS TTC fusion, two 5 mm incisions anteromedial and anterior were used to prepare the ankle joint, further single 5 mm incision was used to prepare subtalar joint laterally, all preparation done using MIS burrs & Osteotomes under intensifier imaging guidance. A Valor retrograde hindfoot nail was used, additional plantar nail insertion and stab incisions were performed. No bone grafts was used. Tourniquet used only during application of the Nail. The time for this surgery was 15 minutes less than those using scopes. RESULTS: Follow up was obtained at about 12 months with good healing results and a VAS score averaging at 7-8. Alignment correction was between 5-15°. No infection cases, no neurovascular injury, wounds healed per primam.
CONCLUSION: The implementation of MIS TTC fusion using a hindfoot nail and intensifier imaging rather than scopes has a beneficial impact on high-risk patients with less soft tissue complications, surgical time & reduces the cost of arthroscopy usage with similar results.

Background: Complex distal intraarticular lower leg fractures involving tibial plafond are a challenge to treat, and the case treated for a such fracture is presented in this paper. Case presentation: Female patient, 45 years old, sustained an AO/OTA 43-C3 fracture. Due the risk following ORIF at large ankle swelling presented, initial closed fracture reduction and Mitkovic type unilateral external fixation were initially performed. Two proximal pins were set in the proximal tibial fragment and two other pins were set in the foot – in calcaneus and in the first metatrsal bone. Three weeks after the first surgery, new minimally invasive surgical intervention was performed to provide an additional internal fixation, to secure the fracture position. Five weeks after the first surgery, the pin in the first metatrsal bone was removed at outpatient. At the same act, the bar of the fixator frame was set to a changed direction to provide one clamp carrier of the frame to be set in the axis of the ankle joint. This was necessary to enable further external fixation to be dynamic, thus to prevent the ankle joint contracture before the fixator removal. External fixator was removed 16 weeks after the first surgery and the patient was fully satisfied with the final functional results at the end of physical therapy. Conclusion: Mitkovic type external fixator was approved as a high addaptable device, providing a safety and good final ankle function in a complex intraarticular distal lower leg fracture treatment.

Keywords:dynamic external fixation, tibial plafond, ankle

Introduction: delayed untreated club feet or unsuccessful treated club feet in childhood varies from slight to severe deformities and cause disability in everyday life also emotional stress, and traditional surgical methods of treatment like just tipple arthrodesis can cause foot shortness and patient discomfort, for this reason to have normal foot size, shape and stable foot, I modified a small simple external hinge fixation system. Method ; SLDF./ Salamehfix 2 / consists of just three small arcs which can fit the size of every patient and can fix main foot elements , with performing tipple arthrodesis after two weeks we can perform gradual lengthening and correction of main foot components in different direction using various fixator hinges and rods until the foot achieve normal shape and size then the fixator fixed until consolidation usually 4 months , stable fixation and comfortable system can allow patient for walking with partial wight bearing later on external fixation removed and a plaster applied on the foot and ankle joint for one month , results ; we have 15 cases of clubfeet treated using this system , 9 had excellent results 4 good , 2 fair as there was some collapse after correction due to patient who interrupted treatment. complications mainly superficial pin infection which treated locally, conclusion; mini external fixation system can help to achieve excellent results in treatment severe to moderate clubfeet deformities.

Introduction: children over 3 years of age with rigid clubfoot or unsuccessful treatment, over pull of muscle tibialis anterior, make it difficult to correct, for these reasons mini external hinge distraction system \ Salamehfix 2 / was modified. Method: In clubfoot over 3 years until 11 years of age, we applied the external hinge distraction system Salamehfix 2, which consists of 3 small, hinged arcs, gradual distraction and reduction of foot components, after 6 weeks fixator removal. split tibialis anterior m. transfer to peroneus brevis tendon before insertion extensor tenon, cast bellow knee applied 6 weeks. we had control group of children which treated only with external fixation. Results: from 1998 to 2023, 36 cases, first group 25 cases with combined external fixation and split muscle transfer second group 9 cases with only external, in first group 1 case relapsed, in second 7 cases relapse needed further m. transfer. Conclusion: treatment of relapsed clubfoot is not easy and over pull of muscle tibialis anterior have an essential roll, we have to consider and combined external fixation and muscle transfer have a great roll and lot of surgeon experience is needed. Conclusion: relapsed clubfoot is a major problem in pediatric orthopedic surgery and need special experience and surgeon skill to treat and combined mini external fixation with muscle transfer can give excellent results.