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1/3. Correction of complex foot deformities using the Ilizarov external fixator.

    There are many drawbacks to using conventional approaches to the treatment of complex foot deformities, like the increased risk of neurovascular injury, soft-tissue injury, and the shortening of the foot. An alternative approach that can eliminate these problems is the Ilizarov method. In the current study, a total of 23 deformed feet in 22 patients were treated using the Ilizarov method. The etiologic factors were burn contracture, poliomyelitis, neglected and relapsed clubfoot, trauma, gun shot injury, meningitis, and leg-length discrepancy (LLD). The average age of the patients was 18.2 (5-50) years. The mean duration of fixator application was 5.1 (2-14) months. We performed corrections without an osteotomy in nine feet and with an osteotomy in 14 feet. Additional bony corrective procedures included three tibial and one femoral osteotomies for lengthening and deformity correction, and one tibiotalar arthrodesis in five separate extremities. At the time of fixator removal, a plantigrade foot was achieved in 21 of the 23 feet by pressure mat analysis. Compared to preoperative status, gait was subjectively improved in all patients. Follow-up time from surgery averaged 25 months (13-38). Pin-tract problems were observed in all cases. Other complications were toe contractures in two feet, metatarsophalangeal subluxation from flexor tendon contractures in one foot, incomplete osteotomy in one foot, residual deformity in two feet, and recurrence of deformity in one foot. Our results indicate that the Ilizarov method is an effective alternative means of correcting complex foot deformities, especially in feet that previously have undergone surgery.
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2/3. Hemi-metatarsal transposition: the use of autogenous bone grafting to treat brachymetatarsia--a unique approach.

    Many surgical procedures have been developed for relieving symptoms and improving cosmesis for brachymetatarsia. The etiology, clinical consequences, various surgical alternatives, and a unique case report are discussed. Surgical correction, demonstrating the use of autogenous bone grafts in hemimetatarsal transpositions, was performed. The authors believe that this procedure is unique and efficient. It reestablishes the metatarsal parabola, restores function, relieves symptoms, and provides an excellent cosmetic result.
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3/3. Post-traumatic brachymetatarsia.

    A case report of post-traumatic brachymetatarsia of the fourth right metatarsal is presented. The literature is reviewed and surgical alternatives are discussed. Treatment consisted of a step-up elongational osteotomy with good results and rapid patient recovery.
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