J Orthopaed Traumatol (2008) 9:11–15 Table 1 Patients’ data, procedures and outcomes. Age at operation (years) Side Knee valgus (°) Ankle valgus (°) Pre-op limb lenght discrepancy Correction Follow-up period (months) (years) 12 Patient 1 2 3 4 5 6 7 Mean 10 17.5 15 15 12 15 16 14.3 a Over-correction into varus not applicable (not corrected) Pre-op Post-op Pre-op Post-op R L L R R R L 18 12 25 14 9 18 15 17 0 0 5 2 2 +5a 13.8 20 20 15 30 20 14 10 18.4 0 0 0 0 0 +3a 20.3 None 2.5 cm 2.5 cm 2.5 cm None None None 5.0 4.5 6.5 4.0 3.5 4.5 4.5 4.6 3 8 10 6 4 3 2 5.5 Fig. 1 Anteroposterior radiograph of the lower legs of case 3. There is valgus of 15° at the ankle, and 10° at the proximal tibia, mainly due to osteochondroma of the fibula Fig. 2 Anteroposterior radiograph of left leg of case 3, in Ilizarov frame. Acute correction at the supramalleolar osteotomy, while pro- gressive correction was done at the proximal tibial corticotomy necessitate an osteotomy and the monofocal Ilizarov sys- tem was applied following distal osteotomy. In the other case the valgus deformity was manifested only at the knee; therefore, the correction was restricted to this seg- ment only. In the other five legs, a bifocal Ilizarov proce- dure was performed. The ankle correction was done acutely, while the knee deformity was corrected progres- sively (Fig. 2). In three cases there was a limb length discrepancy of 2.5 cm due to a short tibia, which was elongated in addi- tion to the correction of the angular deformities. The aver- age follow-up period was 5.5 years (range, 2–10 years). Surgical technique Preoperative planning was done based on long standing radiographs, in which the mechanical axis of the limb (femur and tibia) was measured. Assembling the Ilizarov apparatus was done preoperatively based on these measure- ments. The operation was performed under a combination of general and epidural anesthesia and epidural anesthesia was continued for 4–5 days to control postoperative pain. The apparatus was constructed of three rings. Two ref- erence Ilizarov wires were applied, one at the proximal ring and the other at the distal ring. In addition, fixation