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Credibility and also practical power of accelerometry to the measurement regarding in-hand exercise in mounts.
Circular frames have been the gold standard of treatment for complex deformity corrections and bone loss. However, despite the success of frames, patient satisfaction has been low, and complications are frequent. Most recently, lengthening nails have been used to correct leg length discrepancies. In this article, we review the current trends in deformity correction with emphasis on bone lengthening and present our case examples on the use of lengthening nails for management of complex malunions, non-unions, and a novel use in bone transport.

A nonsystematic literature review on the topic was performed. Four case examples from our institute, Brighton and Sussex University Hospitals, East Sussex, England, UK, were included.

New techniques based on intramedullary bone lengthening and deformity correction are replacing the conventional external frames. Introduction of lengthening and then nailing and lengthening over a nail techniques paved the way for popularization of the more recent lengthening nails. Letegies Trauma Limb Reconstr 2020;15(1)54-61.
Various surgical treatments have been advocated for stump pain and phantom limb pain after limb amputation but the most effective is unknown. We report a case of intractable stump pain and phantom limb pain of the upper limb, which was successfully treated by end-to-end coaptation of the cutaneous nerves after multimodal treatment failures.

A 39-year-old man was referred to our department with a history of severe stump neuroma-related pain and phantom limb pain of his right upper limb. He had undergone multiple treatments over 26 years including medication, nerve blocks, and repeated surgeries. None had been successful for relief of pain. The clinical assessment showed a point of marked tenderness around the medial stump of the upper arm. Ultrasound-guided peripheral infiltration of local anaesthetic around the medial stump produced significant relief of his pain. Exploration around the medial limb stump revealed two stump neuromas of the medial cutaneous nerves of the forearm. Both stump neuromas were resected, and their stumps were coapted to each other. After 4 years, he was completely relieved of his pain and without any sensory deficit.

Successful nerve coaptations for painful stump neuromas of the upper limb are reported rarely. This case suggests this method can be helpful. The patient burden was minimal because it involved the resection and coaptation of the two neuromas. This method should be encouraged for cases of intractable stump-related pain in the upper limb.

Kadota H, Ishida K. Coaptation of Cutaneous Nerves for Intractable Stump Pain and Phantom Limb Pain after Upper Limb Amputation. Strategies Trauma Limb Reconstr 2020;15(1)50-53.
Kadota H, Ishida K. Coaptation of Cutaneous Nerves for Intractable Stump Pain and Phantom Limb Pain after Upper Limb Amputation. Strategies Trauma Limb Reconstr 2020;15(1)50-53.
The anterior approach to a tibial osteotomy commonly employs a small incision and multiple drill holes followed by completion with an osteotome. Potential complications are damage to the anterior tibial periosteum and posterior neurovascular structures.

We describe an alternative method using two small incisions, which avoids elevation of the anterior tibial periosteum and directs the osteotome away from posterior neurovascular structures.

This technique has been successfully performed on 15 consecutive tibias, with no neurovascular complications or skin healing issues.

This tibial osteotomy technique can be performed quickly and safely using a minimally invasive approach as an alternative to the traditional anterior approach.

Iobst C. An Alternative Tibial Osteotomy Technique. Strategies Trauma Limb Reconstr 2020;15(1)47-49.
Iobst C. An Alternative Tibial Osteotomy Technique. Strategies Trauma Limb Reconstr 2020;15(1)47-49.
There are several methods for correcting distal femoral valgus deformity in skeletally mature patients including fixator-assisted plating (FAP), fixator-assisted nailing (FAN) and nailing using the reverse planning method. The fixator-assisted techniques have been previously compared in the literature and found to be similarly accurate. This study is the first to compare all three procedures in a single series.

A retrospective review of patients who had undergone distal femoral valgus correction at a single institution between March 2017 and February 2020 was undertaken. Three different patient groups were identified based on the surgical technique used the FAP, the FAN and the reverse planning method. The mechanical lateral distal fimoral angle (mLDFA) was recorded and compared preoperatively and postoperatively. The body mass index (BMI), duration of surgery, postoperative range of motion (ROM) and complication profile for each patient were also recorded and compared.

A total of 27 limbs in 24 patientchnique.

Iobst C, Waseemuddin M, Bafor A. buy QX77 Accuracy and Safety of Distal Femoral Valgus Correction A Comparison of Three Techniques. Strategies Trauma Limb Reconstr 2020;15(1)41-46.
Iobst C, Waseemuddin M, Bafor A. Accuracy and Safety of Distal Femoral Valgus Correction A Comparison of Three Techniques. Strategies Trauma Limb Reconstr 2020;15(1)41-46.
Ilizarov hip reconstruction (IHR) is a traditional method of salvaging chronic adolescent problem hips but faces practical issues from external fixators leading to reduced compliance. We present the same reconstruction procedure using only internal devices with a modification in the technique and review early results.

We retrospectively evaluated eight patients between 2014 and 2017 with chronic painful hips treated by two-stage reconstruction; stage I included femoral head resection and pelvic support osteotomy using double plating, whereas stage II comprised distal femoral osteotomy avoiding varus followed by the insertion of a retrograde magnetic nail for postoperative lengthening. Patients continued physiotherapy postoperatively while protecting from early weight-bearing.

At a mean follow-up of 19 months (range, 6-36), all osteotomies healed with a bone healing index of 47 days/cm (range, 30-72). Pain improved from 8.3 (range, 7-9) to 2 (range, 0-6) while the limb length discrepancy got corrected from 4.
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