The aim of this study was to retrospectively evaluate the effectiveness of corrective osteotomies in lower limb axis disorders at different levels of non-idiopathic (post traumatic, developmental, post-septic) etiology. A total of 50 patients were divided into three groups: A—thigh segment alignment disorder (24 patients); B—tibia segment alignment disorder (18 patients); C—thigh and tibia segment alignment disorder (8 patients). Radiological evaluation of digital lower limb postural X-ray was performed laterally and for AP, and included mLPFA, mLDFA, MAD, CORA coronal and sagittal plane parameters for the femur segment and mMPTA, mLDTA, MAD, CORA coronal and sagittal plane for the tibia segment. Clinical assessment was based on the LLFI. The mean follow-up was 55.8 months (12–86). Improvements in the radiological parameters and statistical significance were achieved for all measurements in all groups (p < 0.05). The most common plane of deformation was the coronal plane (varus/valgus), followed by the transverse (rotational) and sagittal planes (procurvatum/recurvatum). In this study, we examined 29 post-traumatic deformities and 21 other etiologies. Improvements in the LLFI score performance after corrective osteotomies were observed in all three groups. Corrective osteotomies are a safe and useful but challenging method of preserving joints in cases of post-traumatic, developmental or post-septic lower limb alignment disorders.

Background: Combined bone and soft-tissue loss of the lower extremity requires complex reconstructive pathways. While acute post-traumatic infected defects and chronic osteomyelitis differ clinically, both present reconstructive challenges that demand radical debridement, infection-directed therapy, and radiology-guided soft-tissue coverage. Objective: To evaluate treatment options and functional recovery using a standardized orthoplastic workflow supported by radiological planning in patients with lower-extremity combined bone and soft-tissue loss of acute traumatic infectious etiology and chronic osteomyelitis. Methods: In this retrospective case series, 27 patients treated between May 2021 and December 2023 were included and divided into two groups: (A) acute post-traumatic bone and soft-tissue loss (n = 17) and (B) chronic osteomyelitis with fistula and soft-tissue loss (n = 10). Patients received multidisciplinary orthoplastic management with local and/or free flaps selected according to defect characteristics and radiology-guided vascular assessment (CT/MRI and angiographic CT; Doppler ultrasound for regional flap planning). Empirical broad-spectrum antibiotics were started after intraoperative biopsy sampling and later tailored to microbiological results. Healing was defined by bone union, infection/inflammation resolution, and flap healing. Functional outcomes were assessed using the Lower Limb Functional Index (LLFI). Due to baseline differences and a small sample size, within-group pre- vs. post-treatment changes in LLFI were analyzed separately. Results: Both groups demonstrated clinically relevant improvements in LLFI after treatment when assessed within each group. Flap selection and antibiotic strategy were implemented according to predefined multidisciplinary endpoints, achieving the study healing criteria in the included patients. Conclusions: A standardized orthoplastic reconstruction strategy supported by radiology-guided planning appears feasible in distinct clinical contexts of acute infected traumatic defects and chronic osteomyelitis, with improvement in lower-limb function assessed within groups.

Introduction: Management of fractures or osteomyelitis with accompanying soft-tissue damage in the lower extremities remains challenging. This study evaluated the effectiveness of a multidisciplinary orthoplastic approach in patients with severe bone and soft-tissue defects of traumatic or infectious origin. Particular attention was given to the role of radiological techniques—Doppler ultrasound and Angio-CT—in preoperative planning. Imaging provided essential information on the number, location, size, and branching patterns of perforators, supporting functional and aesthetic outcomes. Material and Methods: This retrospective case series included 27 patients treated between May 2021 and December 2023. Group A comprised 17 patients with acute post-traumatic bone and soft-tissue loss, and Group B included 10 patients with chronic osteomyelitis, fistula, and soft-tissue defects. Treatment involved multidisciplinary reconstruction using local and free flaps following radiological assessment. Bone stabilization was achieved with low-contact locking plates or intramedullary nails. In osteomyelitis cases, polymethyl methacrylate bone cement served as a filler and local antibiotic carrier. Functional outcomes were assessed using the Lower Limb Functional Index (LLFI). Osteomyelitis and open fractures were classified according to Cierny–Mader and Gustilo–Anderson systems. Fourteen patients undergoing propeller or ALT flaps received preoperative Doppler ultrasound and CT angiography. Results: Mean follow-up was 17.9 months in Group A and 24.4 months in Group B. Doppler ultrasound findings were consistent with Angio CT results, with no false-positive perforators confirmed intraoperatively. Ultrasound additionally provided information on flow velocity and vessel diameter, supporting surgical planning. No infection recurrence was observed, and bone union was achieved in all patients. LLFI scores improved significantly (p<0.05), and all patients reported satisfaction with outcomes. Conclusion: A collaborative orthoplastic approach ensures favorable outcomes in complex lower limb reconstruction. Radiological assessment, particularly Doppler ultrasound, plays a key role in flap planning and may serve as a reliable standalone preoperative tool. Combined radical debridement, stable fixation, flap reconstruction, and local antibiotic therapy effectively manage complex orthoplastic conditions.