Pelvic osteotomies are essential to approximate widened symphysis pubis in exstrophy – epispadias complex, yet it is unknown which osteotomy type would cause the greatest decrease in the pelvic volume. We, therefore, used virtual surgery to study the change in pelvic volume with three commonly used osteotomies (posterior, oblique and horizontal). Preoperative CT scans of two cloacal and one classic bladder exstrophy patients were used. Simulations were free-hand or constrained to keep minimal strain in the sacrospinous SSL and sacrotuberous STL ligaments. Changes in the inter-pubic distance, pelvic volume, SSL and STL strains were measured. The mean pelvic volume decreased by 10% with free hand compared to 23% with constrained simulations (P = 0.171) and decreased 7% with posterior, 17% with oblique and 26% with horizontal osteotomies (P = 0.193). SSL and STL were strained by 20% and 26% respectively with free-hand simulations. Statistically significant moderate positive correlation was found between the decrease in inter-pubic distance and reduction in pelvic volume (r = 0.6, P = 0.004). Mean pelvic volume decreased 0.05%, 0.37% and 0.62% for each mm of pubic symphysis approximation with posterior, oblique and horizontal osteotomies respectively. Moreover, virtual surgery accurately predicted the residual diastasis in actual cloacal exstrophy surgical reconstructions. Oblique osteotomies can be a compromise, avoiding technical difficulties with posterior osteotomies and excessive pelvic volume reduction seen with horizontal osteotomies. Understanding how osteotomy type affects pelvic morphology with virtual surgery may be an effective adjunct to pre-operative planning in exstrophy – epispadias complex spectrum.

Introduction: Large segmental long bone defects are notoriously difficult to manage. Treatment is resource-intensive due to the complexity.. Truss designs are known for their triangular shapes organized in web configurations. This allows for maximal mechanical strength, the least mass, and a lattice that can be filled with bone graft. Using a truss cage combined with contemporary internal fixation provides immediate stability for bone ingrowth. The implant is designed using virtual 3D modelling of the patient’s bone defect based on a CT scan. The truss cage can be used in a staged procedure combined with Masquelet’s induced membrane technique. This study aims to review the outcomes of patient-specific, locally designed 3D titanium truss cages packed with cancellous autograft in treating segmental, long bone defects in the lower limb in a developing country setting.
Methods: This retrospective series reviewed cases performed at various institutions between January 2019 and March 2022.
Results: Nine cases were included for review, with a mean age of 36 years (range 19–52). Defects ranged from 60 to 205 mm, and eight cases were staged procedures. Eight cases used reaming, irrigation aspiration method as bone graft. Contemporary intramed-ullary nails were used for fixation in all cases. All cases progressed to early functional union.
Conclusion: 3D-printed titanium truss cages combined with bone graft appear to be an effective and affordable treatment of large bone defects in the lower limb in a developing country setting.. No complications were encountered, facilitating early weight bearing and fewer theatre episodes to traditional techniques.

Background: External fixators used frequently in standard limb- lengthening and deformity-correction procedures. Lengthening over an intramedullary nail has been a successful technique to provide satisfactory results after resection of long segment chronic osteomyelitis femur.
Methods: Between 2014 and 2023, twenty femur in twenty patients with a median age of twenty-seven years underwent reconstruction with an intramedullary nail and a unilateral fixator. mean amount of shortening was 6.33 cm . Resection was performed acutely and secured by intramedullary nail, which was locked distally, and the same external fixator used. Moreover, Utilized for lengthening and segment transfere. At the end of the distraction, proximal locking screws placed in the intramedullary nail and the external fixator was removed. At final follow-up, bone healing were assessed clinically and radiographically.
Results: external fixation ideal method for treatment of infection and lengthening mean bone-healing index was 36.66 days/cm. A knee flexion contracture developed in one patient and resolved after intensive rehabilitation. One patient underwent two revisions because of Schanz screw cause cortical fracture and broken schanz, and four patients with pin-track infections were treated with local wound care and antibiotics.
Conclusions: femoral lengthening and deformity correction can be obtained with an external fixator, plastic deformation of the regenerated bone after removal of the fixator are major disadvantages.so , fixator-assisted nailing and lengthening over an intramedullary nail, to decrease time of fixator and patient comfort was increased. In addition, the intramedullary nail prevented fracture and deformation of the regenerated bone.

Introduction: Morphology of the lateral atlantoaxial articulation (LAA) seems to contribute to pathological changes in basilar invagination (BI) with atlantoaxial dislocation (AAD). No study has investigated its impact on the outcome of surgical reduction. This study aims. to investigate (1) LAA morphology BI with AAD and healthy individuals (2) its relationship with the severity of dislocation and (3) the effect of the LAA morphology on reduction degree (RD) after surgery. Methods: In this retrospective propensity score matching case-control study, imaging and baseline data of 62 patients with BI and AAD from 2011 to 2022 were collected. 613 participants without occipitocervical junctional deformity served as controls. Logistic regression analysis and receiver operating characteristic curve was used for analysis. Results: There were no significant differences in sex, age, and BMI between the two groups after propensity score matching. Sagittal slope angle (SSA) and coronal slope angle (CSA) was lower and greater, respectively, in the patient group than in the control group. Regression analysis revealed a significant negative correlation between SSA and severity of dislocation. However, no relationship was found between CSA and the severity of dislocation. Multivariate logistic regression found minimum-SSA was an independent predictor of satisfactory reduction (RD ≥90%). The area under the curve was 0.844, and the cut-off value was -40.2. Conclusion: SSA in patients group was significantly smaller and more asymmetric than that in the control group. Dislocation severity was related to SSA but not to CSA. SSA can be used as a predictor of horizontal RD after surgery.

Introduction: Adhesive Capsulitis is one of the most common benign conditions of the shoulder.In this study a comparison has been made between the efficacy of Combination of Arthroscopic capsular release with subacromial decompression,Rotator interval release plus MUGA and only MUGA. The results obtained in the study are also discussed and compared with the existing literature. Materials and methods:An observational study of 40 patients aged between 30 to 60 years suffering from primary adhesive capsulitis of shoulder refractory to treatment with Physiotherapy [Dr.Brian Dierckman protocol] and analgesics for 6 months hence treated with combination of Arthroscopic adhesiolysis with subacromial decompression,Rotator interval release plus MUGA and only MUGA was done. Patients have been randomly allocated into each group [20 patients in one group.]with chit method. The outcome of the patients in each group has been observed and followed up to a period of 6 months.Result:Statistically there is a significant difference between the outcomes of only MUGA and Combination of Arthroscopic adhesiolysis with subacromial decompression,Rotator interval release and MUGA. Arthroscopic adhesiolysis with Sub acromial decompression, Rotator interval release and MUGA showed superior results in both the Oxford Shoulder Score and Visual Analogue Scale from 1 month follow up to 6 months follow up.Conclusion:This study hence-forth brings the superior efficacy of Combination of Arthroscopic Capsular Release with Subacromial decompression,Rotator interval release and MUGA compared to only MUGA over a follow up period of 6 months in a study group of 40 patients who are refractory to conservative treatment for a period of 6 months.

Introduction:
Series of studies had compared the outcome of treating posterior malleolar fracture with screws and plate. However, no study investigated locking versus non-locking plate in the aspect of treating posterior malleolar fracture. Thus, we reviewed patients with posterior malleolar fracture treated with plating and compared the image outcome of both groups.
Method:
40 patients underwent surgery of open reduction and plate fixation for posterior malleolar fracture between 2015 and 2020. 22 patients were treated with locking plate and 18 patients with non-locking plate. Image follow-up was performed for at least 1 year. Results were assessed according to Takakura ankle osteoarthritis classification system.
Result:
The demographics of both groups didn't achieve statistical significance. Blood loss, operation time, hospital stay, reduction quality and complications were also insignificant. However, osteoarthritis was more common in patients treated with non-locking plates.
Discussion:
With direct visualization of fracture site with posterior approach, reduction quality was similar. Stronger implant construction of locking plate may contribute to better holding power of fracture fragments, which lead to lesser chance of development of osteoarthritis.
Conclusions:
Both locking and non-locking plates achieved similar image outcomes when it accounts to union. However, locking plates may offer more benefits in stabilization and less osteoarthritis were noted in this study.

Introduction: It is relatively common for a scoliosis deformity to be associated with a lumbar spondylolisthesis in adolescents (up to 48 % of spondylolistheses). In the literature, two types of curves have been described: ‘sciatic’ or ‘olisthetic’. However, there is no consensus in the literature on how best to treat these deformities. Some authors advocate a single surgical intervention, where both deformities are corrected; whereas, others advocate treating them as separate entities. In this situation, it has been shown that scoliosis will be correct with the treatment of spondylolisthesis. Methods: We present an 11-year-old girl who had a concomitant grade 2 spondylolisthesis and severe scoliosis (Cobb’s angle> 60degree). Her main complaints were those of low back pain and L5 radiculopathy. We took the decision to treat the spondylolisthesis surgically but observe scoliosis, rather than correcting them both surgically at the same sitting. Results: Although the immediate post-operative radiographs don’t show complete resolution of scoliosis, 1-year follow-up demonstrated almost full correction of the deformity (Cobb’s angle< 10degree). This girl also had relief from her low back pain and leg pain following the surgery. Conclusion: There are no standard guidelines and therefore, we discuss the management of this difficult problem, exemplifying a case of a young girl who had high-grade spondylolisthesis along with clinically non-flexible scoliosis treated at our institution. We demonstrate that it is safe to observe scoliosis, even in high-grade spondylolistheses.

Introduction:
Diabetic foot related infections are the main causes of major amputations in diabetic patients. Major amputation rates and mortality of hindfoot infections are higher compared to those in the forefoot or midfoot, with a study reporting a 52% rate of major amputation in heel osteomyelitis. A subtotal calcanectomy can be a viable alternative to major amputation in diabetic related hindfoot infections, with preservation of ambulatory status in a higher proportion of patients compared to patients undergoing major lower limb amputations.

Methods:
We conducted a retrospective study of a cohort of diabetic patients undergoing a open subtotal calcanectomy in our institution for diabetic foot related hindfoot infections. A total of 13 patients were identified, with the mean follow-up period being 20.2 months.

Results:
A total of 13 patients were included in the final analysis. Patients were followed up for a minimum of 6 months post-operatively. A significant proportion of patients (50 %) maintaining their pre-operative mobility statuses compared to currently published data on major lower limb amputations. Nearly 70% of our patients also had documented full wound healing, with a mean healing time of 8.33 months. Our case series also showed that approximately 21% of patients undergoing a subtotal calcanectomy eventually required a below knee amputation.

Conclusion:
A subtotal calcanectomy is a viable limb salvage alternative to major lower limb amputations in diabetic related hindfoot infections, with a significant proportion of patients (50%) maintaining their pre-operative mobility statuses, comparable to currently published data on major lower limb amputations.