Background：We report experiences of closed reduction and percutaneous pinning in these fractures, aiming to assess the results using our classification and algorithm for closed reduction.
Methods：We classified completely displaced fractures (amount of displacement ≥2 mm) into four types: completely displaced type, single rotated type, rotated and flexible type and dislocative type and created a corresponding algorithm for closed reduction of these fractures. From October 2021 to September 2023, We prospectively studied 53 completely displaced fractures, the radiographic and clinical results of patients with these fractures that were initially managed with CRPP.
Results：The radiographic and clinical results of 53 complete displaced fractures (in 32 boys and 21 girls) that were treated with closed reduction. 33 of 35 (94.3%) completely displaced type, which could have been reduced to within 2 mm of residual displacement, were treated with closed reduction and pinning with 2 or 3 Kirschner wires (K wires). 8 of 9 (88.9%) single rotated type, 5 of 7 (71.4%) rotated and flexible type, and 2 of 2 (100%) dislocative type fractures were treated with CRPP. If closed reduction failed, so open reduction and internal fixation(ORIF) was implemented. There were no complications.
Conclusion：Tateral condyle fracture that can be cured with CRPP and that lateral humeral condyle fractures with complete displacement and rotation can be initially treated with CRPP to achieve satisfactory recovery of the elbow. Kirschner wire (K wire) fixation is recommended to avoid reoperation or anesthesia for hardware removal.

Introduction: This study aims to determine the surgical intervention rate in children with type IIA supracondylar humerus fractures (SCHF) after post-casting radiographic alignment check. We hypothesized that no cases would convert to surgery following alignment checks. Methods: We retrospectively reviewed pediatric patients (≤ 18 years) diagnosed with type IIA SCHF from 2019-2022. Patients were included if they were treated with initial long arm cast immobilization, followed by a one-week post-casting radiographic check. Fractures were graded using the Wilkins-Modified Gartland classification by three fellowship-trained pediatric orthopaedic surgeons. Alignment was considered acceptable or requiring surgery based on the treating surgeons’ discretion. Exclusion criteria were patients with concomitant ipsilateral upper extremity fractures, with flexion-type fractures, lost to follow-up before cast removal, or with type I, IIB or III SCHFs. Results: Out of 128 fractures, 85 were classified as type IIA SCHF by consensus. The average age was 4.2 years (range: 1.1-10.2 years), with 52% male. Casting duration averaged 28.8 days. Alignment checks occurred an average of 10.3 days post-injury (±2.5 days). Alignment shifts were noted in 7.1% of cases (n=6). Of these, two were assessed by surgeons as having acceptable alignment. The remaining four cases underwent closed reduction
and percutaneous pinning. The conversion rate to surgery for type IIA supracondylar humerus fractures in our study was 4.7%. Conclusions: This investigation found that 4.7% of nonoperative type IIA SCHFs converted to surgery at the one-week post-casting alignment check. Future studies are warranted to determine specific risk factors for alignment loss in type
IIA SCHFs.

Introduction: Proteus Syndrome (PS) is one of the overgrowth syndromes that characterized with mosaic distribution of lesions, sporadic occurrence, and progressive course. The asymmetric overgrowth with skeletal defect could cause severe functional and cosmetic problems. There was not much evidence to guide the orthopedic management in PS. This article aimed to present a case of PS who underwent multiple orthopedic procedures and with rapid recurrence of deformities, and to provide experience of orthopedic management for this rare condition. Case Presentation: An age 5 female suffered from overgrowth of right lower limb and functional defect for 4 years. Dysplasia of left hip, oversized skeleton long of right lower limb, and bilateral genu valgum were revealed by X-rays, with a LLD of 5cm. Hypertrophy of cartilage-like tissue of right patella and distal femoral epiphysis were revealed by MRI. Staged orthopedic surgeries were performed, included: multi-level, 3D osteotomies of right femur and tibia, growth modulation with 8 plates, and resection of the patellar lesion. The outcome of surgeries kept being diminished because the uncontrollable etiology, and this patient was invited by a international clinical trial of biologic treatment at last. Discussion: Orthopedic management in PS children is challenging. Experienced surgeon and multi-disciplinary care are needed in decision making and surgeries. Osteotomies could address discrepancy and malalignment effectively in this obstinate condition while growth modulation was not adequate. The healing of OT sites was satisfactory with the tendency of increased bone formation and delayed remodeling. Radical procedures could be a choice for this situation.

Background: Quadriceps tendon (QT) autograft has become increasingly popular for anterior cruciate ligament (ACL) reconstruction (ACLR), and many surgeons are considering adding QT to their surgical repertoire. Objective: To assess the intra-operative learning curve of harvesting and preparing a QT autograft for ACLR in young patients.
Methods: IRB approved retrospective case series from February 2020 to May 2023 included patients <20 yrs age who underwent primary ACLR with QT with a single surgeon. Demographics and intraoperative variables were collected. Descriptive statistics and learning curve analyses using a moving averages technique were performed.
Results: 132 consecutive patients met inclusion criteria. Mean age at surgery was 15.79 years, range 13 to 20 yrs. Moving averages showed statistical differences in all intra-operative variables at 30 procedures – incision length (p<.001), graft size (p=.001), harvest time (p<.001), and tourniquet time (p=.005). There were no differences in age, gender, or laterality between groups. Decreased capsular breaches approached significance at 30 procedures (p=.077) but became significant at 40 or more procedures (p=.015).
Conclusions: QT harvest for ACLR is an increasingly popular procedure that surgeons can expect to perform consistently after approximately 30 procedures. The learning curve in ACLR is a critical determinant of patient outcomes, and as surgeons advance along the learning curve, they refine their techniques, enhance anatomical understanding, and optimize patient care. As surgeons progress, they can expect their incision length, graft harvest time, and capsular beach frequency to decrease and their graft size to increase significantly.

Introduction. Leg length discrepancy (LLD) is a common secondary deformity after hip surgery in children. The literature contains data on both limb lengthening and shortening. However, the exact factors for length changes have not yet been identified. Nowadays, correction of LLD is available by using the minimally invasive technique - guided growth. But in order to use it correctly, it is necessary to understand how exactly the length of the operated limb will change. The purpose of our study was to analyze patients operated on the hip joint after congenital hip dysplasia (CHD) and Perthes disease (PD), who subsequently underwent epiphysiodesis for correction of LLD. Materials and methods. The study included 38 patients (26-CHD, 12-PD.) with a mean age of 9 years (±2.24). The mean length inequality was 2.02±0.96 cm. 10 patients had positive Trendelenburg Test. Hip joint range of motions wasn’t significant. The shortening or lengthening of the limb after surgery, quality of gait and complaints were assessed. Results. Shortening of the operated limb occurred more often than lengthening (p=0.019). There was no statistical dependence on the pathology and gender, but a dependence on age was detected (p = 0.049). A change in length after hip surgery was noted on average after 2 years (from six months to 9 years). Considering the results, it is advisable to wait about 1.5 years after hip surgery before deciding on epiphysiodesis. Close to the end of growth, it is advisable to use blocking of growth zones at an earlier date.

Introduction: The aim of this study was to determine the etiological factors, the importance of preoperative displacement, fracture location and fracture type in the choice of open or closed reduction in percutaneous titanium elastic intramedullary nailing of forearm fractures in children. Methods: A retrospective, single center, case-control study of patients treated with titanium elastic intramedullary nailing for forearm fractures between May 2019 and January 2023. Demographic data, preoperative displacement, reduction status, fracture type, and fracture location were assessed. Range of motion and union time were also evaluated. The effect of open versus closed reduction on outcomes was also compared. Results: In this study, 148 patients were evaluated, including 112 males and 36 females. Of these, 92 underwent surgery on the left side and 56 on the right side. Patients with a preoperative displacement rate of 0-100% in the anteroposterior and lateral planes were statistically significantly less likely to undergo open reduction. However, this rate was significantly higher for open reduction with a displacement rate of 100-200% in the anteroposterior and lateral planes. Circadian rhythm of surgery, fracture location, fracture type and waiting time for surgery were not found to have a statistically significant effect on open or closed reduction. Open or closed reduction had no statistically significant effect on the likelihood of postoperative refracture and wrist and elbow range of motion. Conclusion: The most important effect on fracture healing and postoperative functional outcome was found to be the amount of preoperative displacement and the quality of intraoperative reduction.

• Introduction:The 1
st metatarsal and the big toe are of great importance for
good stability and gait so posttraumatic sever hallux varus is a disabling
deformity results in major disturbance of foot function. However, few
reports have documented the reconstruction of posttraumatic big toe
deformity with metatarsophalangeal defect and contracted scared skin,
reconstruction remains challenging.We present a case of posttraumatic
sever hallux varus that is unique since the deformity is due to a big scar
along the medial aspect of the foot with bony defect and pseudoarthrosis of
metatarsophalangeal joint in 7 years old child. Method:We describe our
surgical technique with a gradual distraction to length and correct the
deformity of the 1st ray. We used our modified circular external fixator of
two 5/8 rings fixed to the forefoot. Results: the frame removed after 4
months after full correction of the big toe and consolidation of the bone.
Conclusion: We have two issues a bony problems and huge challenge about
the soft tissue problem so the method of reconstruction is selected according
to the site and size of the soft tissue defect after excision of the scar which
can lead to fascial free flap which is a demanding technique with high risk
for necrosis. Mechanical stretching with the gradual distraction can
effectively increase the length and area of contracted scar. bone regeneration
occurs according to to transchondroid ossification phenomena.the patient
reports no limitations in performing activities of daily living and the
cosmetic appearances of big toe was near normal

Cubitus varus and valgus are frequently encountered pediatric deformities, which bear a cosmetically unsightly appearance. The aim of the study was to evaluate the results of acute supracondylar corrective osteotomy, using the principle of angulation-translation, stabilized using the Ilizarov apparatus, in the management of patients with post-traumatic cubitus varus/valgus deformities, and to study its impact on the range of motion (ROM), the Humerus-elbow-wrist (HEW) angle and the lateral prominence index (LPI). Methods: 12 patients, aged 7-16 years, with cubitus varus of ≥ 10° (n=9) and valgus (n=3) of ≥ 20 °, were retrospectively analyzed using the hospital's database. All patients had undergone acute correction using a mini-incision supracondylar osteotomy, by application of an Ilizarov frame. Results: The mean time to union was 12 (+/-2.5) weeks. The follow-up period ranged from 1-6 years (mean 2 years). Results were graded as excellent in 9 cases (75%), good in 2 (16.6%) and poor in one case (8.4%) using the grading system of Oppenheim. The mean HEW angle at final follow-up improved from 15 °of varus to 8° of valgus (in cubitus varus) and from 24 ° valgus to 14 ° valgus (in cubitus valgus). The mean flexion/extension improved from 121°/-3° pre-operatively to 125°/-4° at final follow-up. Complications encountered included pintract infections in 2 cases, lateral condylar prominence in 1 case and complete radial nerve palsy in 1 case.
Conclusion: The described method of acute corrective osteotomy coupled with the Ilizarov apparatus offers the unique advantage of post-operative adjustment and early active joint mobilization.

Introduction: Cerebral Palsy (CP) is a non-progressive upper motor neuron disease due to injury to the immature brain and is one of the commonest neuromuscular disorders seen in children. As age advances, this disorder can lead to loss of muscular balance with a mixture of spasticity and contracture of affected joints. Materials and methods: This is a study of 177 CP patients treated by us from January 2004 to December 2022. There were 105 male and 72 female. Their age ranged from 2 to 49 years. The common presentation was spastic gait. Scissoring and equinus are common deformities in lower limb and pronation and wrist flexion deformity in the upper limb. Lower limbs were operated in 141 patients and upper limb in 39. Surgical procedures included soft tissue release, tendon transfer, corrective osteotomy and arthrodesis. 42 patients who presented with rigid deformities were treated with Ilizarov external fixator. Results 21 patients were lost in follow up. All patients improved significantly. Discussion: CP is quite common in developing countries like India due to poor socio-economic conditions. Surgical treatment indicated when deformities and/or contracture interfere with activities of daily living. In early stages, most of the deformities and contracture can be corrected with soft tissue release to tendon transfer. At a later stage when deformities are rigid, they can be safely corrected with Ilizarov Fixator. The results were better in younger patients. It is concluded What surgery can achieve in hours, physiotherapy cannot in years.

Diastrophic dysplasia (DD) (OMIM #222600) is a rare congenital autosomal recessive skeletal dysplasia associated with homozygous or compound heterozygous variants in the sulfate transporter gene SLC26A2. Clinical and radiological description of DD in patients of different ages will help improve the diagnosis and orthopedic treatment.
To describe clinical and genetic characteristics of Russian patients with DD caused by previously described and newly identified pathogenic variants in the SLC26A2 gene the comprehensive examination of 28 Russian patients from 28 unrelated families aged from 3 months to 34 years with clinical and radiological examination was carried out. To confirm the diagnosis genealogical analysis, clinical examination, radiography and targeted research of the SLC26A2 gene using direct Sanger sequencing were used.
Typical clinical and radiological signs sufficient for diagnosing DD in newborns have been identified: rhizo/mesomelic shortening of the upper and lower extremities, congenital clubfoot, hand anomalies, multiple dislocations and joint contractures. In the patients we observed, 14 variants were identified in the SLC26A2 gene, 9 of which were first discovered. The most common variant identified in the Russian DD patients was c.1957T>A (p.Cys653Ser), which accounted for 50% of alleles. Clinical and genetic analysis of Russian patients with DD made it possible to identify the core of clinical and radiological signs and evaluate the polymorphism of clinical manifestations of the disease. In contrast to previously examined patients from European populations (including Finland with largest number of patients with DD), 50% of Russian population are caused by the c.1957T>A (p.Cys653Ser) homozygous or compound-heterozygous variant.