The purpose of our retrospective study is to critically assess the long-term outcome of tuberculosis of the foot and ankle in children and to define an initial classification system that would relate to prognosis.

Background Displaced acromial fractures are challenging to treat. Complex bony anatomy, variable fracture morphology and limitations of available implants present challenges in achieving favourable surgical outcomes. We determined to what extent currently available scapular and clavicular plating systems are able to provide adequate fixation options. Methods Patients presenting to an urban trauma centre with acromial fractures sustained from blunt trauma between 2012 and 2016 were identified (n = 15, 14M / 1F). The fracture patterns were categorized according to location (Type I = 13%, Type II = 27%, Type III = 60%). Computed Tomography (CT) scans were reconstructed to produce three-dimensional (3D) printed anatomical models on which a quantitative fit analysis was performed. Measurements were performed twice, by five separate observers, with fit graded as anatomical fit (< 2mm), intermediate fit (> 2mm) or no-fit. Results The anterior clavicle 6 hole plate fitted best in 45.7% of cases. Acromial plates only achieved 27.3%. The acromion short plate together with the lateral clavicle short plates performed the best in Type II fractures. An inter-observer intraclass correlation coefficient (ICC) agreement of 0.974 was obtained. Conclusion The available commercial acromial plating system fails to provide adequate congruency and fit for fixation. Clavicular plates were superior alternative implants. 3D printed anatomical models can be used effectively to assist in templating implants preoperatively.

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Purpose: We aimed to assess functional and clinical outcomes of patients who underwent open reduction and internal fixation of distal intra-articular fractures of the humerus through a previously undescribed approach through the triceps tendon called the Triceps-Off, Transfascial Sleeve (TOFS) approach. Method: We conducted an Ambispective cohort study of 10 patients who underwent open reduction and internal fixation of the distal humerus through the TOFS approach at a tertiary hospital between March 2016 and January 2019. Patients were identified from the prospectively kept surgical database. All had AO type C fractures of the distal humerus. The mean age was 36.7 ± 14.9 years (range 19 to 68). The assessment consisted of a review of their hospital records, range of motion, triceps strength, ultrasound evaluation of triceps tendon integrity, X-rays for union rates and adequacy of reduction, and DASH scores. Results: The mean time of follow up was 10.8 ± 4.7 months (range 6 to 19). The mean arc of motion was 114.7 ± 25.1 degrees (range 80 to 150 degrees). There was a decrease in mean triceps muscle strength compared to the uninjured side; 66% at 45 degrees of flexion, 70% at 90 degrees and 86% at 120 degrees of elbow flexion. The mean DASH score was 15.7 ± 8.9 indicating mild residual impairment (range 5 to 31). The DASH score had a strong correlation (r = 0.71; p<0.05) with the follow-up period. All tendons were intact on ultrasound evaluation. One patient had deep surgical site infection, treated with surgical debridement, antibiotics and plate removal with resolution of sepsis and healing. All fractures united by 6 months. Conclusion: TOFS is a successful surgical approach for reduction and fixation of AO Type C intra-articular distal humerus fractures, with excellent tendon healing rates. It is however, associated with mild residual functional impairment and residual triceps weakness.

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