Metatarsal bone stress injuries (BSI) are painful, overuse injuries commonly seen in athletes and military personnel. High strain magnitudes combined with repetitive loading cycles causes bone fatigue and microdamage accumulation. To protect against BSI, it is necessary to determine how to limit bone strain magnitude without sacrificing physical activity. This study examined maximum and minimum principal dorsal strains of metatarsals 2-4 during tibial dorsiflexion/plantarflexion, external/internal rotation, and varus/valgus alignment with four underfoot conditions. Five lower-limb cadaveric specimens were instrumented with strain gauges on metatarsals 2-4 and a robotic actuator applied 25% bodyweight and moved the ankle/foot through its envelope of passive motion. Dorsiflexion and varus tibial motion produced the greatest increase in strain magnitudes during all underfoot conditions. Adding half-inch blocks beneath the medial and lateral forefoot caused principal strain magnitudes to increase threefold within the metatarsals adjacent to the block across all motions. Passive engagement of the windlass mechanism during dorsiflexion caused approximately a threefold increase in maximum principal strain of metatarsals 2-3 coinciding with a significant decrease in metatarsal 4. The results emphasize the role that the arch and its supporting structures play in modulating metatarsal loading even within a passive model.

Conventional intraoperative gap assessment is performed in standardized reference positions that do not replicate many functional postures patients assume during daily activities. Physiologic lateral compartment opening becomes most apparent in postures combining flexion, hip external rotation, and relative varus alignment, such as sitting cross-legged, and shoe or sock application. The Figure-of-4 position reproduces this combination intraoperatively. The purpose of this study was to describe the Figure-of-4 maneuver as an intraoperative positional assessment during robotic total knee arthroplasty (rTKA) and quantitatively characterize compartment behavior during its execution using standardized robotic measurements.

A woman in her 50s with a comminuted intertrochanteric femoral fracture, including an avulsed lesser trochanter fragment, underwent fixation using a proximal femoral nail antirotation device.Immediate postoperative imaging demonstrated acceptable positioning indices, although reduction was in mild varus alignment with only partial cortical apposition.

BackgroundRelapsed congenital talipes equinovarus (clubfoot) in children who have undergone previous surgical intervention presents a significant treatment challenge due to soft tissue scarring, joint stiffness, and complex multiplanar deformities. The Ilizarov method offers a minimally invasive approach that allows gradual correction while preserving soft tissue integrity.MethodsThis retrospective case series evaluated 26 relapsed clubfeet in 21 patients treated between January 2020 and June 2024. All patients had previously undergone operative treatment and presented with rigid or partially correctable deformities. Management consisted of minimally invasive soft tissue procedures, including percutaneous tendo-Achilles lengthening and selective plantar fascia release, followed by gradual correction using an Ilizarov frame. Clinical deformities (equinus, hindfoot varus, forefoot adduction, and supination) were measured pre- and postoperatively. The mean follow-up period was 2.4 years.ResultsAll feet achieved a plantigrade position at the time of frame removal. The mean duration of treatment in the Ilizarov frame was 11.1 weeks. There was significant improvement in all deformity components (p < 0.001), with equinus improving from a mean of 25° to 1°, varus from 28° to 4°, adduction from 31° to 4°, and supination from 23° to 2°. Full or near-complete correction (≤5° residual in all components) was achieved in most feet, and functional outcomes were favourable, with restoration of near-normal gait and ability to wear standard footwear. Complications were minor; superficial pin-site infection occurred in 10 of 26 feet (38.5%), all managed conservatively. Recurrence was infrequent and did not significantly affect functional outcomes.ConclusionThe Ilizarov method combined with minimally invasive soft tissue release is a safe and effective technique for the management of relapsed congenital clubfoot. It allows gradual correction of complex deformities with preservation of joint mobility, low complication rates, and satisfactory functional outcomes. This approach represents a valuable alternative to repeated open surgical procedures, particularly in younger children.

For decades, paediatric orthopaedics have been analysing the developmental changes in axes, length and torsion in children. Throughout the entire growth period, these relationships change continuously. Understanding them and being able to classify them as physiological or pathological is essential. If, during growth, greater axis deviations or limb length discrepancies arise, minimally invasive growth modulation can often be performed.Guided growth using staples or screws is among the most well-established method. By far the most common indication is the axis deviation in the frontal plane, such as valgus or varus deformities of the knee joint. In these cases, the growth plates around the knee are partially restrained on one side, leading to increased growth on the opposite side and thus gradually correcting the deformity over time. Knee extension deficits or reduced osseous dorsiflexion of the ankle joint can also be improved through growth modulation.Leg length discrepancies can likewise correct themselves over time through inhibition of the growth plates at the knee. Both temporary and permanent methods are used, each with their respective advantages and disadvantages. Torsional deformities, however, remain a problem that has not yet been fully resolved. Although various approaches to modulation exist, no concept has yet become established in clinical practice.All guided growth methods share one common feature: their dependence on growth and the associated uncertainty in prediction. Clinical experience, as well as various models that use chronological or skeletal age, can help determine the optimal timing of intervention.Through guided growth, angular deformities of the legs can be corrected using a minimally invasive procedure making use of the childrens' natural growth.

Objective This study aimed to determine whether standing long-leg radiographs (LLR) underestimate the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) compared with CT in a Japanese population, and to evaluate the resulting coronal plane alignment of the knee (CPAK) classification based on the arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO). Methods This retrospective study included 90 patients (97 knees) who underwent robot-assisted total knee arthroplasty (TKA) between April 2024 and October 2025. Patients with previous surgery on the affected limb or post-fracture malunion were excluded. The MPTA and LDFA were measured using LLR and CT. The aHKA and JLO were calculated, and the CPAK classification was determined. Results There were significant differences between LLR and CT measurements for the MPTA, LDFA, aHKA, and JLO (p < 0.05). Compared with CT, LLR underestimated varus lower limb alignment and JLO. Although there was no significant difference between the two imaging modalities in the distribution of CPAK classifications, CT showed a higher proportion of types I-III and a lower proportion of types IV-V. Conclusions In a Japanese population, LLR underestimated the degree of varus lower limb alignment and JLO compared with CT. Although the distribution of CPAK classifications did not significantly differ between the two imaging modalities, CT showed greater varus alignment and lower JLO values than LLR, suggesting that it may be useful for evaluating knees near the boundaries between CPAK classification types.