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Treatment of juvenile hallux valgus can be challenging. Initial treatment with conservative measures is appropriate until exhausted. Surgical treatment should be delayed until after skeletal maturity when possible. Before any intervention, a thorough understanding of the whole patient and any underlying systemic contributors to their hallux valgus, in addition to the radiographic foot parameters, is imperative. Careful and individualized surgical planning should be done to optimize results and decrease the risk for recurrence.

Purpose Supracondylar humerus fractures are among the most common injuries in the paediatric population, accounting for 16% of all paediatric fractures and roughly 60% to 70% of all paediatric elbow fractures. Typical treatment for displaced and unstable supracondylar humerus fractures is surgical intervention, often with percutaneous Kirschner-wire (K-wire) fixation. Timing of surgery is dependent on the patient's neurovascular status on presentation, with surgical emergencies being performed at all hours of day and night. Percutaneous fixation of paediatric elbow fractures can be challenging as a result of the propensity for the elbow to become quite swollen with these fractures, particularly in smaller and physiologically more immature elbows. Methods We have developed a simple operative technique to guide placement of percutaneous wires for supracondylar humerus fractures using a hypodermic needle as a reference marker. Results In our experience, trainees utilizing this technique demonstrate greater appreciation for start point and trajectory of wires during percutaneous pinning, with better communication amongst surgical team members about necessary adjustment for optimal placement of K-wires. Conclusion Utilization of this technique has the potential to refine surgical technique by minimizing errant wire passes, radiation and operative time when performing percutaneous pinning of reduced type III supracondylar humerus fractures. Level of Evidence V, Novel Surgical Technique

Background Rotational tibial osteotomy seeks to address pathologic tibial torsion. Inclusion of fibular osteotomy during this procedure remains controversial. This study aimed to determine how external rotation through a tibial osteotomy, with or without a fibular osteotomy, would influence tibiofibular joint congruity. Methods Eight cadaveric legs underwent distal tibial osteotomies. Pins were placed to designate neutral, 10°, 20°, 30° of external rotation. Computed tomography (CT) imaging was performed at each rotation without, then with a fibular osteotomy. Magnetic Resonance Imaging was performed prior to fibular osteotomy to confirm that ligaments remained intact. Custom software calculated tibial torsion using CT scan 3D reconstructions. Proximal tibiofibular joint rotation, distal tibiofibular gapping and ankle mortise were measured on each CT exam. Groups without and with fibular osteotomy were compared. Findings There was no difference between tibial osteotomy rotation magnitude with or without the fibular osteotomy (P = 0.2). The group without the fibular osteotomy had greater proximal fibular rotation at the tibiofibular joint at 20°, 30° (P 0.05), greater posterior distal tibiofibular gap at 10°, 20°, 30° (P 0.05) and less anterior distal tibiofibular gap at 20°, 30° (P 0.05). The medial tibiotalar space was narrowed without the fibular osteotomy at 20°, 30° (P 0.05) compared to pre-rotation. Interpretation Deformity at the proximal tibiofibular and ankle joints become most pronounced at20° of tibial rotation without a fibular osteotomy. The first joint to be affected is the distal tibiofibular joint. To limit ankle and proximal tibiofibular articular deformation during tibia rotational osteotomy, a fibular osteotomy is recommended when correcting over 20° of rotation.