Effects of the COVID-19 pandemic on the outcome and mortality of patients with diabetic foot ulcer.

The outbreak of the coronavirus disease 2019 (COVID-19) led to events that significantly impaired the treatment and management of patients with chronic diabetes. Therefore, elective treatments at hospitals were cancelled and patients with chronic ailments were instructed to stay at home and minimise the time spent in public areas. The second was due to COVID-19-induced anxiety that deterred many patients from seeking care and adhering to periodic out-patient visits. In this study, we examined the short-term effects of the COVID-19 pandemic on patients with chronic diabetes who suffered from contaminated diabetic ulcers. We conducted a retrospective study with patients who had undergone amputations following diabetic ulcers during 2019-2020. The research group included diabetic amputees during the COVID-19 outbreak period ranging from March 2020 to December 2020. The control group included diabetic amputees from the corresponding period in 2019. Using the Wagner Scale, we measured the difference in the severity of ulcers upon the patient's initial admission. Additionally, we examined patient survival rates based on the size of amputations, by specifically focusing on the period between 1- and 6-months post-surgery. The results failed to suggest a clear and statistically significant worsening trend in the condition of patients in the research and control groups. Due to public lockdowns, transportation restrictions, scarcity of healthcare staff, and reduced adherence to exposure anxiety, patients with diabetic foot ulcers received inferior medical care during the COVID-19 pandemic. However, this study could not find a statistically significant difference in the mortality and major amputation rates in patients with diabetic ulcer before and during the pandemic. The health system should incorporate the existing institutional and technological recommendations to facilitate care and follow-up of patients with diabetic foot ulcers during the current and future pandemics.

Treatment of chronic osteomyelitis with antibiotic-impregnated polymethyl methacrylate (PMMA) - the Cierny approach: is the second stage necessary?

BACKGROUND: Chronic osteomyelitis is a challenge for orthopedic surgeons. Most patients with osteomyelitis receive two-stage management according to Cierny-Mader. The first stage includes radical debridement and insertion of an antibiotic-impregnated cement spacer (ACS) (beads, rods, nails, or blocks) into the bone defect. The second stage is performed 6-8 weeks later, when the spacer is removed and a cancellous autograft is placed within the bone defect. The possibility of ACS as definitive management for osteomyelitis, avoiding the second stage, is presented. METHODS: Sixteen patients with osteomyelitis received radical debridement and insertion of an ACS in all forms into the bone defect as a definitive management. In 8 patients, the tibia was infected, 4 had femur infection, 2 humerus, 1 fibula, and 1 ankle. The mean age at the time of the first stage of reconstruction was 49 years (range, 13-71 years). According to the Cierny-Mader classification, 1 patient was C-M IA, another was IB, 7 IIIA, 6 IIIB, and 1 was 4A. All B hosts had systemic illnesses. The mean follow-up period was 6 years (1.5-16 years). RESULTS: No patient exhibited radiographic evidence of excessive bone loss. Signs of recurrence of osteomyelitis were not noted in any of the patients, and no fractures had occurred by the last follow-up. CONCLUSION: Our study suggests that a proportion of patients with planned retention of ACS appear to function well without requiring further surgical intervention, especially in elderly or vulnerable patients.

Safety and Efficacy Results of BonoFill First-in-Human, Phase I/IIa Clinical Trial for the Maxillofacial Indication of Sinus Augmentation and Mandibular Bone Void Filling.

PURPOSE: The gold standard for bone regeneration of bone deficiencies is still an autologous bone graft, which has considerable disadvantages; namely, the need for a second major surgery and the limited volume of bone available for harvesting. BonoFill (BF) is a novel, tissue-engineered, bone graft with intrinsic osteoinductive, osteoconductive, and osteogenic properties, consisting of the patient's own adipose tissue-derived mesenchymal stem cells, attached to hydroxyapatite particles. Here, we present the safety and efficacy results of BF first-in-human clinical study for maxillofacial bone tissue regeneration. MATERIALS AND METHODS: Eleven eligible male and female subjects, aged 49-65 years, were enrolled into the clinical study in 2 clinical indications: Bone augmentation and bone void grafting in the jaws. Clinical follow-up was performed throughout a period of 6 months after BF treatment and included clinical examination, blood tests, CT scans, and biopsies collected from the transplantation site to assess chronic bone infection, changes in complete blood count, and adequate bone augmentation for implant placement. RESULTS: The study results demonstrated that BF promoted adequate bone tissue regeneration without complications. Per our evaluation, there were no incidents of chronic bone infection, or significant changes in complete blood count, and the patients reported overall good health for the duration of the study. At trial end, in the sinus augmentation indication, the BF treated sites residual bone was augmented at an average of 6.36 mm (Δ new bone, n = 10) and the total bone height at the treated area was on average 11.44 mm (n = 10). In the indication of filling of bone voids, the patient's average residual bone height of 2.91 mm was 15.76 mm (n = 1) at trial end. CONCLUSIONS: BF treatment was shown to be safe and resulted in newly generated bone, which provided adequate bone height for placement of dental implants. Thus, BF is a promising novel autologous bone graft for bone tissue repair.

Recommendations for Orthopedic Surgeons during the COVID-19 Pandemic.

BACKGROUND: Toward the end of 2019, the coronavirus disease-2019 (COVID-19) pandemic began to create turmoil for global health organizations. The illness, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), spreads by droplets and fomites and can rapidly lead to life-threatening lung disease, especially for the old and those with health co-morbidities. Treating orthopedic patients, who presented with COVID-19 while avoiding nosocomial transmission, became of paramount importance. OBJECTIVES: To present relevant methods for pandemic control and hospital accommodation with emphasis on orthopedic surgery. METHODS: We searched search PubMed and Google Scholar electronic databases using the following keywords: COVID-19, SARS-CoV-2, screening tools, personal protective equipment, and surgery triage. RESULTS: We included 25 records in our analysis. The recommendations from these records were divided into the following categories: COVID-19 disease, managing orthopedic surgery in the COVID-19 era, general institution precautions, triage of orthopedic surgeries, preoperative assessment, surgical room setting, personal protection equipment, anesthesia, orthopedic surgery technical precautions, and department stay and rehabilitation. CONCLUSIONS: Special accommodations tailored for each medical facility, based on disease burden and available resources can improve patient and staff safety and reduce elective surgery cancellations. This article will assist orthopedic surgeons during the COVID-19 medical crisis, and possibly for future pandemics.

The Utility of Diagnostic Tests for Digital Nerve Injury.

PURPOSE: The purpose of this study was to present the sensitivity and specificity of 6 clinical tests for the diagnosis of digital nerve injury. The clinical tests are as follows: light touch, pinprick, static and dynamic 2-point discrimination (D2PD), Semmes-Weinstein monofilament, and wrinkle test. METHODS: We reviewed the charts of all the patients who were admitted to our department with hand lacerations and/or suspicions of digital nerve injury that were examined before surgery with the 6-sensation test, comparing the results to the surgical findings. RESULTS: The study included 70 patients with 85 injured nerves overall. Of the 85 nerves, 51 were found with full cut, 9 with partial cut, and 25 with no cut. Only 2 variables were significantly associated with the study outcome: D2PD > 4 (P = 0.0141, odds ratio = 3.9, 95% confidence interval = 1.3-11.8, sensitivity = 80.7%, specificity = 48%) and wrinkle test (P = 0.0098, odds ratio = 4.0, 95% confidence interval = 1.4-11.6, sensitivity = 69.5%, specificity = 62.5%).Multivariable logistic regression included these variables and revealed the predictive probability for a nerve injury to be 92% if both risk factors exist and 43% if none of these risk factors exist. If one risk factor exists, the predictive probability for a cut is still very high (75%). CONCLUSIONS: The combination of positive wrinkle test and D2PD > 4 gave a predictive probability for a nerve injury as 92% in the cases in our study and should be considered in the evaluation of patients with hand lacerations and suspicions of digital nerve injury.

Outcomes of French's Corrective Osteotomy of the Humerus for Cubitus Varus Deformity in Children.

BACKGROUND: Supracondylar humerus fractures are the most common elbow fractures in the pediatric population. OBJECTIVES: To evaluate the outcomes of French's corrective osteotomy for correction of post-traumatic cubitus varus deformity in children. METHODS: We conducted a retrospective review of medical charts of all patients who had undergone French's corrective osteotomy in our institution from 1998 to 2012. We recorded range of motion, cosmetic deformity, carrying angle, lateral cortex prominence index, hyperextension, and lateral cortex step before and after the surgery. RESULTS: Seven patients were enrolled the study. Average follow-up time was 4.6 years (range 2-9 years). An average of 18.3º of limited flexion (range 5º-35º) compared to the healthy elbow was recorded in three patients. Lateral condylar prominence was recorded in one patient. The average preoperative carrying angle was -20.5º (range -15º-30º) and postoperative angle was 9.6º (range 7º-13º). In comparison, the average carrying angle in the healthy elbow was 8.5º (range 4º-13º). No lateral cortex prominence was recorded. An average of 27.5º (range 15º-35º) of hyperextension of the distal fragment was recorded immediately postoperatively in four patients; however, during postoperative follow-up, the hyperextension was corrected spontaneously in all patients. CONCLUSIONS: As described by French, osteotomy has the ability to correct the varus deformity only in the coronal plane. However, our research supports the assumption that hyperextension in the sagittal plane might be corrected spontaneously.

Dupuytren's Contracture: Current Treatment Methods.

BACKGROUND: Dupuytren's disease is a common benign fibromatosis of the palmar and digital fascia. The exact pathophysiology and epidemiology of this condition have not been entirely identified. Pathologic fibrous bands cause a flexion contracture of the metacarpal phalangeal joints and proximal interphalangeal joint. Treatment includes fasciectomy, needle fasciotomy, and enzymatic fasciectomy.

Treatment of physeal fractures of the distal radius by volar intrafocal Kapandji method: surgical technique.

BACKGROUND: Distal radial physeal fractures with volar displacement are rare. Several methods of operative treatment include volar plate without inserting distal screws, percutaneous technique using two anterior skin incisions and reversed Kapandji technique with pins introduced through a posterior approach and locked at the anterior cortex of the fracture. METHODS: We report three cases along with a literature review of the surgical techniques described in the past and a novel surgical technique for this uncommon fracture termed "Volar Kapandji". RESULTS: All patients had anatomic reduction at the last follow-up radiography, and all patients had a full range of motion and VAS 0 at the last follow-up. No complications were recorded. CONCLUSIONS: This case study presents the minimally invasive option for treating rare cases of physeal distal radius fractures with volar displacement. LEVEL OF EVIDENCE: V.

Complex Dorsal Metacarpophalangeal Dislocation: Long-Term Follow-Up.

PURPOSE: To describe the long-term follow-up results of complex dorsal metacarpophalangeal joint dislocation (MPJD). We hypothesize that there would be no long-term functional deficit in most patients, even with the presence of one of the familiar complications. METHODS: We describe 5 patients with a median follow-up of 13 (range, 7-36) years and review the literature focusing on follow-up and complications. RESULTS: All patients reported full function of the hand. Compared with the contralateral finger, a mild loss of MPJ flexion was noted in 2 patients. Grip strength was reduced in 2 patients. The mean QuickDASH score was 4.5 (range, 0-20.5). Two patients with osteochondral metacarpal head fractures treated with screw fixation demonstrated secondary osteoarthritis changes on x-ray. The literature indicates that complications in patients with complex dorsal MPJD are related to failure of diagnosis, multiple attempts at closed reduction, concomitant osteochondral fracture, traumatic open reduction, or prolonged immobilization, and may result in joint stiffness, early degenerative arthritis, or osteonecrosis of the metacarpal head, pain, premature epiphysis closure, and metacarpal shortening. CONCLUSIONS: The findings from this study suggest that complex dorsal MPJD treated on the day of injury with dorsal or volar open reduction techniques can eventually result in a satisfactory outcome, even with one of the complications mentioned. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic V.

[TREATMENT FOR OSTEOARTHRITIS OF THE KNEE].

INTRODUCTION: Osteoarthritis is the most common joint disorder in the world and its incidence is rising. In Western populations it is one of the most frequent causes of pain, loss of function and disability in adults. The estimated lifetime risk for knee osteoarthritis is approximately 40% in men and 47% in women. The diagnosis of osteoarthritis is complex due to a lack of specific physical and/or laboratorial findings. The American College of Rheumatology (ACR) has recommended using the following criteria for the diagnosis of knee osteoarthritis: chronic knee pain (lasting for more than 6 weeks) and at least three of the following: • Age over 50 years old. • Morning knee stiffness lasting up to 30 minutes. • Crepitus with active motion • Tenderness on bony palpation • Thickening or growth of the bones • No local heat on palpation Treatment of osteoarthritis involves alleviating pain, attempting to rectify mechanical misalignment, and identifying and addressing manifestations of joint instability. The American Academy of Orthopedic Surgeons (AAOS) has conducted a systematic review of the current scientific and clinical research and has issued clinical practice guidelines containing fifteen recommendations for the treatment of osteoarthritis of the knee, and include only less invasive alternatives to total or partial knee arthroplasty. This review presents the background, diagnosis, treatment and a summary of the AAOS guidelines regarding "Treatment of Osteoarthritis of the Knee".

[HAND INJURIES IN ROCK CLIMBERS].

INTRODUCTION: Rock climbing, whether practiced in nature on cliffs and boulders or indoors on walls made of resin and wood, has gained tremendous popularity in recent decades. More people are exposed to injuries associated with the unique biomechanical forces of rock climbing. A series of repetitive high torque movements of the upper limbs are needed to ascend a wall or rockface. These movements subject the hand and wrist to large forces, potentially resulting in ligament and tendon sprains or rupture and even bone fracture. This review describes the anatomy, biomechanics and the common hand injuries in rock climbers.

Upper extremity fractures among hospitalized road traffic accident adults.

BACKGROUND: Upper extremity fractures (UEFs) associated with road traffic accidents (RTAs) may result in long-term disability. Previous studies have examined UEF profiles with small patient populations. The objective of this study was to examine the injury profiles of UEFs in all mechanisms of injury related to RTAs. METHODS: Data on 71,231 RTA adult patients between 1997 and 2012 whose records were entered in a centralized country trauma database were reviewed. Data on UEFs related to mechanism of injury (car, motorcycle, bicycle, and pedestrian) including associated injuries, multiple UEFs, and frequency of UEF were analyzed. RESULTS: Of 71,231 adult RTA cases recorded in 1997-2012, 12,754 (17.9%) included UEFs. Motorcycle (27%) and bicycle riders (25%) had the greater risk for UEF (P<.0001). Of 12,754 patients with UEFs, 9701 (76%) had other injuries. Pedestrians (86%) and car occupants (81%) had the greater risk for associated injuries (P<.0001). Most of the injuries were head/face/neck (52%), lower extremities (49%), and chest (46%) injuries (P<.0001). Twenty-two percent of all cases had multiple UEFs. The motorcycle riders (27%) had the greater risk for multiple UEFs (P<.0001). Of 12,754 patients with UEFs we found 16,371 UEFs. Most of the fractures were in the radius (22%), humerus (19%), and clavicle (17%) (P<.0001). CONCLUSIONS: This study contributes the largest database on reported adult UEFs related to all mechanisms of injury in RTAs and finds the comparative epidemiology of associated injuries, multiple UEFs, and frequency of UEFs. It is important that the treating surgeon is aware of the complexity of the UEF patient, the strong possibility for associated injury, the possibility for multiple fractures in the upper limbs, and the most common fractures associated with each mechanism of accident.

Upper extremity fractures among hospitalized pediatric road traffic accident victims.

BACKGROUND: Upper extremity fractures (UEFs) associated with road traffic accidents (RTAs) may result in long-term disability. Previous studies have examined UEF profiles with small patient populations. The objective of this study was to examine the injury profiles of UEFs in all mechanisms of injury related to RTAs in the pediatric population. METHODS: Data on 27 831 RTA hospitalized pediatric patients between 1997 and 2012 whose records were entered in a centralized country trauma database were reviewed. Data on UEFs related to mechanism of injury (car, motorcycle, bicycle, and pedestrian) including associated injuries, multiple UEFs, and frequency of UEF were analyzed. RESULTS: Of 27 831 pediatric RTA cases recorded in 1997-2012, 3666 (13.2%) included UEFs. Motorcycle (18%) and bicycle riders (18%) had a greater risk for UEF (P < .0001). Of 3666 patients with UEFs, 2047 (56%) had other injuries. The pedestrians (82%) and the motorcycle riders (78%) had a greater risk for associated injuries (P < .0001). Most of the injuries were head/face/neck (70%), lower extremities (36%), and chest (28%) injuries (P < .0001). Twenty-two percent of all cases had multiple UEFs. The bicycle riders (28%) had a greater risk for multiple UEFs (P < .0001). Of 3666 patients with UEFs, we found 4612 UEFs. most of the fractures in the radius (27%), humerus (25%), ulna (18%) and clavicle (17%) (P < .0001). CONCLUSIONS: This study contributes the largest database on reported pediatric UEFs related to all mechanisms of injury in RTAs and finds the comparative epidemiology of associated injuries, multiple UEFs, and frequency of UEFs.

The use of prophylactic antibiotics in treatment of fingertip amputation: a randomized prospective trial.

PURPOSE: Fingertip amputation is a common injury. Considerable controversy exists as to whether prophylactic antibiotics are necessary for this injury. Our goal was to compare the rate of infections among subgroups with and without prophylactic antibiotic treatment. The study hypothesis was that infection rates were similar in the 2 groups. METHODS: This was a prospective randomized control trial of adult patients presenting with fingertip amputation with bone exposed, requiring surgical treatment. Patients were randomized to 2 groups: group 1 received no antibiotics, and group 2 received 1 g intravenous antibiotics (cefazolin) for 3 days. The 2 groups were matched for age, time to surgery, injury mechanism, and type of surgery. All surgical treatments were performed in the operating room, and all patients were reevaluated in our outpatient clinic after 10 days and again after a month. The primary outcome measure was the rate of infection. RESULTS: Fifty-eight patients were initially enrolled in the study; 2 patients withdrew before study completion, 29 subjects were randomized to the no-antibiotic group, and 27 subjects were randomized to the antibiotic group. No statistically significant differences on any baseline values were found between the 2 treatment groups. There was no infection in either group at the end of follow-up. CONCLUSIONS: This study suggests that routine prophylactic antibiotics do not reduce the rate of infection after fingertip amputations with bone exposed treated surgically in the operating room.

Chronic anterior monteggia lesions in children: report of 4 cases treated with closed reduction by ulnar osteotomy and external fixation.

BACKGROUND: Chronic, subacute, and chronic Monteggia fracture dislocations of the elbow are challenging problems. The literature generally recommends complex open reconstructive procedures. We present an alternative, minimally invasive, percutaneous method with external fixation. METHODS: This was a retrospective review of 4 cases presenting with chronic Monteggia lesions with anterior dislocation of the radial head. RESULTS: Reduction of the radiocapitellar joint was successfully achieved in all patients after ulnar osteotomy and gradual correction using the Ilizarov external fixation. Open reduction or reconstruction of the radio-ulnar-capitellar joint and/or ligament was not undertaken. The patients were between 9 and 11 years of age at the time of injury. The time from injury to treatment was between 3 and 56 months. At follow-up of an average of 3.5 years (range, 2 to 6 y), all patients had full movement of the elbow and normal function of the forearm. Radiographically, all radial heads were well reduced and the ulnar osteotomy showed remodeling. CONCLUSIONS: The technique is relatively simple and avoids the risks and technical challenges of open osteotomies, open reduction, and ligament reconstruction. Gradual reduction of the radial head with the aid of an external fixation is a safe and effective method of treatment for chronic Monteggia lesions.

Measuring the Femoral Head Size--An Additional Real-Time Intraoperative Monitoring Tool for the Accuracy of the Preoperative Process and Implant Selection.

The purpose of this study was to examine the correlation between the implanted cup's outer diameter and the actual femoral head diameter removed during surgery. Seventy-five patients with primary total hip arthroplasty were evaluated. The difference between the implanted cup diameter and the femoral head diameter was calculated for each patient. The mean±SD actual femoral head diameter that was removed and measured during surgery was 48.5±3.7 mm. The mean±SD cementless implanted cup outer diameter was 51.8±3.5 mm. A high correlation was found between the implanted cup diameter and the actual femoral head diameter (r=0.923). A cut-off point of 4mm of the measured femoral head diameter should be considered as an additional monitoring indicator.

Treatment of Longitudinal Epiphyseal Bracket by Excision and Polymethylmethacrylate Insertion at the Preossified Disease Stage.

Longitudinal epiphyseal bracket is a rare ossification anomaly involving the tubular bones of the hand or foot that have a proximal epiphysis, which becomes deformed as a result of the bracket. Untreated, the deformity becomes worse with age, because longitudinal growth cannot occur. The present report discusses the use of polymethylmethacrylate at the preossified disease stage in 2 patients with first metatarsal involvement. A medical record and radiographic review was performed for 2 children (3 feet), aged 1 year and 2 years and 5 months, who were treated with insertion of polymethylmethacrylate after excision of the aberrant epiphyseal bracket. Two different radiographic parameters (i.e., the intraosseous angulation and the metadiaphyseal length index) were used to measure the effect of treatment on the subsequent longitudinal growth of the metatarsals. An excellent clinical result after a long follow-up period was observed in 2 feet, and a good result was documented in 1 foot, which developed hallux valgus angulation. The use of polymethylmethacrylate as an interposition material after excision of the aberrant metatarsal epiphyseal bracket appeared to be an effective method of treatment during the preossified first stage of the disease, despite the general recommendation to use a cement spacer during the third ossified stage. Normal longitudinal growth of the metatarsals was noted without complications or risk of deformity recurrence.

Finger flexor rigidity in the healthy population.

The involvement of the hand flexors in trigger finger is not clear. This study aimed to examine the rigidity of the flexor tendon in the first pulley territory in the hand by using ultrasound in a healthy population, as well as to create a reference scale of rigidity for the flexor tendons to compare those values in trigger fingers. We tested 35 healthy volunteers using a linear ultrasound transducer and the color Doppler method. Rigidity levels below the first pulley were examined and compared between the different fingers of the hand and the relationship between rigidity and sex and the three different age groups was evaluated. In the healthy population, the rigidity of the flexor tendons of the hand in the territory of the first pulley varied between 233.1 and 962.8 kPa, with an average of 486.42 kPa and standard deviation of 114.85. We showed that the flexors in the dominant hand were more rigid, there was a difference between the rigidity of the flexor tendons of the thumb and the other fingers of the same hand, and the ring finger of the dominant hand had stiffer flexor tendons than the fingers of the other hand in the male population. We created a value scale for the rigidity of the flexor tendons of the fingers. This base scale can be compared between different pathologies, including trigger finger. The study and all experimental protocols were approved by the local ethical committee.

The Effect of Total Knee Replacement on Dual-Task Gait Performance in Older Adults.

OBJECTIVE: Total knee replacement (TKR) is a common solution for patients with advanced knee osteoarthritis. Still, fall rates remain relatively high after surgery. TKR may alter pain and knee function, balance control, and proprioception. However, given the role of complex (dual-task) walking in fall prediction for older adults, it is unknown how TKR alters the attentional demand of walking in older adults. The goal of this study was to examine the effect of TKR on dual-task walking among older adults. METHODS: Participants were evaluated 1 month before surgery and 4.5 months after surgery. Participants walked along an instrumented 7-meter path for 1 minute with and without a cognitive task (serial-3 subtraction). Pain and knee function, knee proprioception, dynamic balance, and balance confidence, as well as dual-task costs (DTC) were compared before and after the surgery and factors associated with change in gait DTCs were assessed. RESULTS: Thirty-eight participants completed the study (age 72.6 years, SD = 4.9; 11 men). A significant decrease in pain was found following TKR, with no change in balance, balance confidence, or proprioception. There were no differences in gait DTCs before and after the surgery. However, change in dynamic balance, specifically reactive postural control and dynamic gait, predicted changes in gait speed and stride time DTCs. CONCLUSION: The absence of an effect of TKR on gait DTCs can potentially underlie increased fall risk after TKR. Results from this study emphasize the significance of balance as a measure and focal point for rehabilitation after TKR. IMPACT: This study contributes to our understanding of the attentional cost of walking in people before and after TKR, as well as to factors associated with it. Results from this work can assist formulation of rehabilitation programs for people with knee osteoarthritis.

Gradual correction of congenital radioulnar synostosis by an osteotomy and Ilizarov external fixation.

PURPOSE: To report the method, outcome, and complications with Ilizarov external fixation for correction of congenital radioulnar synostosis with fixed forearm pronation greater than 60°. METHODS: We treated 4 patients with an average age of 11 years (range, 9-13 y). Three patients had bilateral deformity and 1 had deformity of the right forearm only. All forearms were classified as type 3 according to Cleary and Omer. Indications were severe (> 90°) bilateral pronation deformity in 3 patients, with a mean preoperative pronation deformity of 100° (range, 90° to 110°), whereas 1 patient had unilateral right forearm deformity treated for cultural reasons. All patients underwent osteotomy at the level of the synostosis and gradual correction of the deformity using an Ilizarov external fixation device. RESULTS: Mean supination position of the forearms after the correction was 15° (range, 0° to 30°). Two patients experienced neurapraxia of the radial nerve attributed to acute initial partial correction of the deformity in the operating room; the correction was returned to its original position, resulting in complete neurological recovery. One patient experienced a pin track infection, which we treated successfully with oral antibiotics. CONCLUSIONS: Our small series demonstrated the ability to gradually correct forearm rotation deformities greater than 90° using Ilizarov external fixation devices.