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This study evaluates the use of the Taylor Spatial Frame (TSF) for the correction of acquired and congenital tibial deformities in children. The purpose is to underline problems, obstacles and complications that can be observed during treatment to reveal the learning curve and potential risk factors and to propose solutions to avoid difficulties during its use 86 tibia deformities were corrected in 66 children during a period of 7 years and were classified according to anatomical and dominant type of deformity. Follow up was 54.2 months. Gradual correction was performed according to the individualized time schedule. We faced 42 difficulties: 29 problems, 10 obstacles and 3 complications, distributed across all years. Significant correlation was found between patient's age and number of difficulties. The incidence of the difficulties was equally spread over the different etiologies, but it was statistically significant across the years. Proximal tibia and complex multi-plane deformities seem to be related to an increased incidence of postoperative difficulties. TSF can yield accurate results, is easy to handle and provides an excellent concomitant 3-direction correction.

Although the clinical and biomechanical advantages of pedicle screws are well documented, the accuracy of their insertion is always a concern.Injury of neurovascular structures could be devastating. Perforation of the aorta from posteriorly placed screws is fortunately rare but could end up being lethal. We present a review of the current literature along with two illustrative cases with aorta perforation from posterior pedicle screws. An 82-year-old female with a history of thoracic kyphosis and a 26-year-old female with scoliotic deformity were referred to our institution owing to back pain. Both patients had undergone correction of their deformities and posterior fixation using posterior pedicle screws and rods 5 years previously. During the diagnostic work-up, which included CT scans, we incidentally found one pedicle screw to be malpositioned, exiting the vertebral body and perforating the aorta. The patients were offered a combined orthopaedic and vascular procedure, including screw removal and endovascular stenting of the aorta. Potential complications from the presence of a screw inside the pulsatile aorta, and the complexity of revision surgery should be well considered before proceeding to such a difficult surgical procedure. Systemic postoperative follow-up imaging and safer intraoperative practices during screw placement are important.