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The last years brought many advances relevant to lower limb reconstruction. It feels like guided growth has been looked at from every angle, and still there are new emerging concepts like rotational guided growth waiting to be validated. New hexapod external devices are more accurate and easier to use, and new unilateral fixators allow for more versatile and stable fixation and lengthening. Intramedullary nail lengthening has found its place as a standard procedure for various diagnoses in children and young adults. First results of new and exciting approaches like extramedullary implantable nail lengthening and lengthening plates have been reported. Pharmaceutical treatment has changed the course of certain diseases and must be integrated and considered when making a reconstructive treatment plan. As reconstructive surgery is rapidly advancing so are the technical options for prosthetic fitting, which makes it difficult for caregivers as well as for parents to make the decision between reconstruction and amputation surgery for the most severe cases of congenital deficiencies. This review is highlighting new developments of lower limb reconstruction and is reviewing the current literature., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Christof Radler, MD, Associate Professor paid consultant NuVasive/ Globus Medical; Smith & Nephew; MD Orthopedics; UNFO Inc. Joachim Horn, MD, PhD, Associate Professor paid consultant for teaching activities for NuVasive. Søren Kold, MD, Professor paid consultant for teaching activities for NuVasive/ Globus Medical. Micha Langendörfer, MD paid consultant for teaching activities Smith & Nephew, Nuvasive/Globus Medical, Stryker K2M, Biomarin. Bjoern Vogt, MD Associate Professor board membership of the GEVR e.V. (http://www.gevr.de) without compensation; paid consultant for NuVasive and Smith & Nephew, payments from NuVasive / Globus (San Diego / Pennsylvania, USA), Merete (Berlin, Germany), Smith & Nephew (Watford, UK), Orthofix (Verona, Italy), OrthoPediatrics (Warsaw, USA), BioMarin (Novato, USA) and Kyowa Kirin (Tokyo, Japan) for travel, presentations, and lectures., (© The Author(s) 2024.)

Purpose: Double and triple femoral neck lengthening osteotomies have been described to correct coxa brevis deformity. Only small studies reported the results. Our aim was to provide an overview of the outcomes of double and triple femoral neck lengthening., Methods: After an extensive search of different online databases, we included studies reporting the results of double and triple femoral neck osteotomies. Clinical and radiological outcomes, and reported complications were extracted. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines., Results: After evaluating 456 articles, we included 11 articles reporting 149 osteotomies in 143 patients (31% male, 64% female, 5% unspecified). Mean age of the patients was 20 years (range 7 years to 52 years). Indications were developmental hip dysplasia (51%), Perthes disease (27%), infection (6%), post-trauma (4%), congenital disorders (2%), slipped capital femoral epiphysis (1%), idiopathic (3%) and unknown (6%). The mean limb length discrepancy reduced by 12 mm (0 mm to 40 mm). In total, 65% of 101 positive Trendelenburg sign hips experienced improvement of abductor muscle strength. An 18% (9% to 36%) increase could be found in functional hip scores. Mean increase in articulo-trochanteric distance was 24 mm (10 mm to 34 mm). Five patients older than 30 years at the time of osteotomy and two younger patients with prior hip incongruency had disappointing results and required arthroplasty. In all, 12 complications occurred in 128 osteotomies, in which complications were reported., Conclusions: Double and triple femoral neck lengthening osteotomies in coxa brevis show good results with few complications in the literature, especially in young patients with non-arthritic hips., Level of Evidence: III., (Copyright © 2020, The author(s).)

Purpose: Missed Monteggia fracture dislocation in children is a serious condition. The treatment of this rare condition is controversial and reports on the long-term outcome are sparse. We present a series of patients treated with open reduction and ulnar osteotomy with a mean long-term follow-up of 8 years (range 3-17)., Methods: All 16 patients had Bado type 1 (anterior radial head) dislocation. The mean delay from injury to surgery was 17 months (range 1-83). Bilateral radiographs, Oxford Elbow Score, strength measurements, and range of motion were obtained in all patients., Results: There were no major complications to surgery. The radiographic results showed ten patients with reduction of the radial head and with no arthrosis, four patients with arthrosis or subluxation, and two patients with a dislocated radial head. We found a significant correlation between radiographic outcome and delay to ulnar osteotomy (P = 0.03). Typical clinical findings were a small but significant extension deficit and mean loss of supination of 10° (range 0-90, P < 0.01). Ligament reconstruction or transfixation of the radial head did not influence the radiographic or clinical outcome., Conclusions: Case reports of similar patients treated conservatively demonstrate high morbidity, and, therefore, open reduction and ulnar osteotomy seemed justified. However, this study underlines the importance of minimizing the delay between injury and ulnar osteotomy. If surgery is performed within 40 months after injury, good to fair long-term radiographic results can be obtained. Open reduction and ulnar osteotomy were performed because patients treated conservatively demonstrate high morbidity.