Introduction: Ponseti Method is the gold standard for treatment of idiopathic clubfoot. Recently indications were expanded to arthrogrypotic and myelodysplastic feet. The aim of this study is to compare the use of this method in idiopathic clubfeet and clubfeet associated with myelodysplasia. Methods: We retrospectively reviewed the medical records of patients treated between 2001 and 2023. The sample was paired 1 for myelodysplastic to 3 idiopathics, in terms of laterality, gender and age of beginning treatment (< or = 2 years or >2 years). A total of 48 patients (81 feet) with myelodysplasia and 467 (819 feet) with idiopathic treated with the method were evaluated in terms of outcome, number of casts, relapses, and the need for secondary procedures. Results: The average age at the beginning of treatment was 2.3 years (SD 2.68 years) for myelodysplasia and 1.9y (SD 2.14y) for idiopathic (p=0,0001). The follow-up was bigger in idiopathic (5.1 x 3.9 years – p=0,006). There was no statistic difference between initial Pirani Score (4,9 idiopathic x 5,1 myelodysplasia), number of casts (3.2 x 3.5) and relapse (36% vs 33%). Tenotomy (84% idiopathics vs 68% myelodysplastic) and transposition of the tibialis anterior (21% vs 10%) were required significantly more in idiopathic patients than in myelodysplastic patients. There was no need for posteromedial release, just in one child. Conclusion: The Ponseti Method is a safe and reproducible treatment even in patients with myelodysplasia. It is an option without the need for extensive approaches.

Introduction: Ollier disease (OD) and Maffuci’s syndrome are rare diseases that produce leg length discrepancy and malalignment of long bones. In this case series, we propose our experience in motorized lengthening nail technique in such clinical scenarios. Methods: between 2014 and 2029, we reviewed retrospectively, in four different reference centers, patients with OD and Maffuci’s syndrome with leg length discrepancy and had implantable lengthening nails with a minimum follow-up period of 24 months. We noted lengthening rate and target, clinical tolerance for lengthening, and complications. We measured bone healing index (BHI) and evaluated all patients' EQ-5D-Y functional and visual analog scores (VAS). We also analyzed the regenerate zone and the lengthened long bone to assess the evolution of the pre-existing enchondromas on all the radiographs obtained. Results: 10 limb segments underwent lengthening with the nailing technique, eight in the femur and two in the tibias. The mean age was 13.3 years (11-16). The mean follow-up time was 53.8 months (26-108). The mean correction amount for the femur and tibia was, respectively, 6.44cm (4-8) over a mean duration of 76.8 days (53-100) and 3.75cm over 44 days (38-50). We achieved the lengthening goal. The mean VAS score was 6.63 /15 (5-8), and the mean EQ-5D-Y was 81/100 (70-95). The reamed areas showed improvement in the cortical and medullary appearance of the bone, with the healing of enchondromas in eight segments out of ten. We had no mechanical complications. Conclusion: The motorized intramedullary lengthening nail is a safe and effective technique.

Introduction: Valgus knee has a recurrent characteristic in patients with fibular hemimelia. Treatment may vary from osteotomy to gradual correction with guided growth. Recurrent valgus knee treatment was analyzed in fibular hemimelia patients with hemiepiphysiodes in comparison to idiopathic cases. Methods: Sixteen consecutive patients with fibular hemimelia treated with hemiepiphysiodesis (57 physis) were compared to 21 physis of idiopathic cases, in terms of magnitude, speed and time of correction. Behavior of the operated and adjacent physis were also studied and recurrence characteristics. Results: Correction of valgus deformity was successfully achieved in all cases of femoral and tibial hemiepiphysiodesis. In the fibular hemimelia group, children 4 years and younger had a more correction than older ones (11° vs 6.9°) and greater speed (1° vs 0.6°), with statistical significance, while time for correction was similar among these groups (11.6 mo vs 12.3 mo). Femoral distal physis corrected faster than proximal tibial physis (10.8 mo vs 16.8 mo), with statistical significance. Thirty-three physis (57.9%) were isolated and 24 (42.1%) were tibia and femur simultaneously. We found no statistical difference between the two groups regarding time for correction, magnitude, or speed. Relapse was observed in 49 physis (86%) of the fibular hemimelia patients and undergone new surgeries. Relapse occurred after 2 years of the first procedure. Conclusion: Recurrent valgus deformity in fibular hemimelia can be successfully treated with single or multiple hemiepiphysiodesis with tension band plate in skeletally immature patients in an effective and gradual manner without risk to the physis.

Introduction: Osteotomy and limb lengthening with external fixation can correct severe lower limb deformity in children, which was caused by Ollier’s disease(OD). There may be lesions in the osteotomy performed part (OP), and the external fixator inserted part(EP). This study evaluated:(1) new bone formation speed, (2) how many intact sides of the lengthened segments are necessary to provide enough stability, and (3) whether lesions influence the lengthening results.

Methods: Group OD comprised 11 lower limb lengthenings, and Group Control(normal lengthened bone) comprised 29 lengthenings. Two groups were compared with the number of intact sides of the lengthened segments, angular correction(AC), and lengthening length(LL), lengthening speed. In Group OD, the lengthening results were compared in lesion and non-lesion at OP/EP subgroups.

Results: Full correction of the lower deformity and length were achieved in all cases. The mean AC(14.3°-vs.-5.9°) and distraction index(DI, 0.99mm/day-vs.-0.80 mm/day) were significantly larger, while the lengthening gap(LG, 6.3days-vs.-7.2days), bone healing index(BHI, 30.0 days/cm-vs.-41.2days/cm), and external fixation index(EFI, 41.9days/cm-vs.-56.3days/cm) were all significantly shorter in Group OD than in Group Control(P<0.05). There was no significant difference in the incidence of complications. In Group OD, there was no significant difference in lengthening results(AC, DI, BHI, EFI) between Group-intralesional(9cases/9cases) and Group-extralesional(2cases/2cases), Group-intact cortex(4cases/2 cases) and Group-incomplete cortex(5cases/7cases, 2cases with only 2/1cortical surface intact) at OP/EP.

Conclusion: In children with OD, full restoration of the lower limb deformities could be achieved, even when performed intralesionally and incomplete cortex at OP/EP, and new bone formation accelerated throughout the lengthening period.

Objectives: To compare the outcomes of unicameral bone cysts ( treatment using the endoscopic assistance and standard approach) . Methods: A retrospective analysis of data from 55 patients was conducted. All patients received surgery via standard approach (n = 23; mean age 9.9 years; CI = 95%; SD = 4.9) and endoscopic assistance (n = 32; mean age 11.7 years; CI = 95%; SD = 3.6). Cryotherapy was used: 1 group n = 13(56.5%), 2 group n = 15 (46.9%). Bicalcium phosphate was used: 1 group n = 19(82.6%), 2 group n = 26 (81.3 %); an allograft was used: 1 group n = 4 (17.4 %), 2 group n = 6 (18.7 %). Follow-up was 1.5-10 years. Results: The duration of hospitalization was: 1 group 7.6 days (CI = 95%, SD = 1.7), 2 group 6.9 days (CI = 95%, SD = 2.1); p>0.05. The relapses were: 1 group n = 9 (39.1%), 2 group n = 5 (15.6%) (p = 0.0640). No statistically significant differences in the frequency of relapses were found when using or not using intraoperative cryotreatment (p = 0.7585); did not have a statistically significant effect on the recurrence rate and the type of graft used (p = 0.6702). All patients are satisfied with treatment. There were no fractures. 14 reoperations for recurrent cysts were performed with a positive outcome. Conclusions: The methods of the surgery have no effect on the outcome of the treatment; and depend of the surgeon's and the patient's preferences.

Introduction: Bow legs and Blount’s disease is a multi-level and multi-planar deformity that affects the pediatric population leading to varus alignment of the lower extremities. The purpose was to assess the correction of deformity in patients with Bow Legs & Blount’s disease using Ilizarov technique. These complex deformities can be corrected by corrective osteotomy with the use of Ilizarov external fixation which is a well-established treatment. Materials & Methods: From 2020 to 2023 a retrospective analysis of 60 consecutive patients (male 36, female 24 and mean age 7) with surgically corrected bow legs and Blount’s disease using Ilizarov technique with tibial and fibular osteotomies was identified. Patient charts and radiographs at three different time points (pre-operative, fixator removal, and follow-up) were reviewed. With these deformities being multi-planar, it is not always possible to obtain a lateral radiograph of the femur and proximal tibia in the same view. Patients had frontal plane analyses consisting of mechanical axis deviation (MAD), tibial–femoral angle (TFA), medial proximal tibial angle (MPTA), and posterior proximal tibial angle (PPTA) measured. The total Ilizarov fixation time, total operative time, and post-operative complications were recorded. Results: The duration of Ilizarov fixation was 130 days on average. The deformity correction was achieved with a proper alignment in all the cases. Conclusion: Bow Legs & Blount’s Disease can be corrected simultaneously by Ilizarov fixation with minimum complications. There were no recurrent deformities in our cases.

Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare and severely disabling genetic disorder. The worldwide prevalence is approximately 1 per 2 million. Heterozygous mutations in ACVR1/ALK2 gene exist in all sporadic and familial cases of FOP. The primary aim of this study is to describe the clinic and management of three children suffering from FOP and followed for nineteen, twenty-three and forty years, respectively. Secondary aim is to provide clinical advice on how to diagnose the condition with special reference to the great toes malformation and give current best therapeutic approaches, including controversial issue of surgery. The three cases characterized with malformed great toes initially followed by progressive loss of mobility for a period from nineteen to forty years. Two of three patients presented here had surgical intervention according to specific indication. Additional attention is given to the natural history of the great toe malformation and stepwise decrease of patients’ mobility status. Conventional radiology indicates the diagnosis and RNA/DNA test confirm it. Conclusion: Short and valgus deformity of the great toe combined with progressive heterotopic ossifications in the soft tissue is “almost” pathognomonic for FOP, but the RNA/DNA testing of the ACVR1 gene is strongly recommended to confirm diagnosis. Long-term natural history of the great toe malformation shows influence on mobility status in patients with FOP. Maintaining of the best possible mobility status is of utmost important goal of conservative supporting treatment and even in selected cases surgical intervention. Prevention of any trauma, of soft tissue including intramuscular injection is recommended.

Aim:
The main objective of this study was to analyze the hypothesis of the occurrence of new epiphyseal slippage after in situ fixation in a 4-year retrospective study.
Materials and Methods:
A retrospective study was carried out that included 29 patients diagnosed with SCFE who were treated surgically with cannulated screw, minimum follow-up of 6 months. The screw-joint ration (SJR) was established, which was calculated as the distance from the tip of the screw to the femoral head in relation to the length of the screw. The neck-screw ratio (NSR) was also established, which was calculated as the distance between the joint and the physis divided by the length of the screw.
Results:
The 29 patients had a mean age of 12.1 year at the time of surgery and a mean follow-up of 1.16 years. The average SJR increased from 9.5 mm to 11.4 mm. The average NSR increased from 22.94mm to 34.2mm. In one case, there was a decrease in SJR and NSR.. In one of the operated cases, new epiphyseal slippage occurred 1 year after the initial surgery.
Discussion/Conclusion:
In the case where there was no growth, avascular necrosis of the femoral head occurred. This analysis demonstrates that there is the possibility of new epiphyseal slippage after in situ fixation, probably associated with the fact that in most patients there is persistent growth even after surgical fixation. The SJR and NSR may be useful in predicting this rare complication of SCFE.

Objective: Pelvic osteotomies were used to treat hip displacement in Cerebral Palsy (CP) patients previously, but few studies about triple innominate osteotomy were seen. This study was to evaluate the efficacy of our extraperiosteal pelvic osteotomy (modified triple innominate osteotomy, MTIO) in the treatment of CP hip disorders. Methods: 28 hips in 23 CP patients were retrospectively reviewed. Pain was presented in 8 hips. All hips were treated with MITO and combined proximal femoral varus derotational osteotomy(VDRO). The median age at surgery was 7.7 (6.9, 8.9)years. The median follow-up time was 18 (13, 24) months. Clinical evaluation included hip mobility and pain. Radiographic parameters included acetabular index(AI), migration percentage(MP) and acetabular offset (AO). Results: Pain was released in 7 hips(87.5%), and hip mobility of 27 hips(96.4%) was preserved. Postoperative AI 1.0°(-3.3°，11.8°) was statically different from the preoperative AI 29.4°(26.3°，38.0°) . Postoperative MP 0%(0% ，0% ) was statically different from the preoperative MP 50.5% (38.2%，75.8%). Postoperative AO 69.8(66.0，76.0)mm was statically different from the preoperative AO 72.3 (69.1，81.1)mm. The follow-up MP 0%(0%，10.0%) wasn’t statically different from postoperative MP. No avascular necrosis of femoral head and redislocation were observed. There were 2 hips (7%) with nonunion in the iliac arcuate line. There was residual pain and stiffness in 1 hip postoperatively. Conclusion: MTIO combined VDRO could effectively address acetabular deformity and hip displacement in CP children. Longer following is needed to investigate this procedure.

Introduction: Addressing paediatric spinal deformity poses challenges due to intricate 3D anatomy and alterations in pedicle morphology across all planes. Intraoperative computed tomography (CT)-guided robotic navigation systems have demonstrated success in achieving accurate pedicle screw placement. Methods: Twelve patients with diverse paediatric spinal deformities underwent robotic-assisted deformity correction, posterior spinal instrumentation, and fusion using the "scan and plan" workflow. A Schanz pin bone mount, placed either in the posterior superior iliac spine or vertebral pedicle, aided the procedure. O-arm time, Robot time, and mean radiation exposure were recorded. Post-operative O-arm scans assessed pedicle breach, with all procedures conducted under neuromonitoring.
Results Instrumentation ranged from the most cranial vertebra (T2) to the most caudal (L4). On average, most patients required two sets of O-arm scans. The mean O-arm time was 8.4 minutes, robot registration time averaged 7.5 minutes, and the mean time per screw was 2.5 minutes. The mean radiation dose to the patient was 41.1 mGy, with no instances of intraoperative neuromonitoring signal loss.
Conclusion: Robotic-assisted spine deformity correction mitigates the risk of pedicle breach, enabling precise drilling of trajectories. The navigable burr further facilitates safe execution of 3-column vertebral column osteotomies.