Introduction: To explore the clinical outcome of free graft of the perforator flap based on the descending branch of circumflex scapular artery for repairing the wound located in foot or ankle in children. Methods:From Feburary 2009
to April 2011，the perforator flap based on the descending branch of circumflex scapular artery was used to repair 11 cases of pediatric patients who suffered from skin
and soft defects of foot and ankle with exposure of bone, joint or tendon. The flap size ranged from 9 cm×4cm to 15cm × 7cm． Results 10 flaps survived smoothly with primary healing，venous crisis was observed in one of double skin paddle perforator flap at 8 hours after operation, and surgical exploration proved that was due to vascular torsion, finally most of the flap lost, and skin graft had to be done for wound healing.The follow-up ranges from 3-36months(12months on average). The flaps were of good appearance，there was only one linear scar on the donor site, the cosmesis and function of the donor sites were satisfying.

Introduction: Surgical management of complex lower limb deformities in children remains challenging. 3D modelization and conception of patient-specific guides and instrumentation enable for accurate surgical corrections.
The aim of this study was to evaluate clinical and radiological outcomes in patients treated for lower limb deformities using 3D modelization and patient-specific ostetomy guides.

Methods: Twenty-five patients (34 limbs) with lower limb deformities underwent surgery with 3D planning and GPS. Technical details regarding the type of osteotomy, perioperative and postoperative complications, preoperative analysis, and planning time were recorded. Clinical and radiologicla postoperative results were analyzed. The operating surgeon was retrospectively queried about the utility of 3D planning for each case.

Results: A total of 46 osteotomies were performed. Major etiologies for treated were MOC (n=8), idiopathic deformities (n=6), vitamino-resistant rickets (n=6) and traumatic sequala (n=4). Preoperative planning time ranged from 15 minutes to 2 hours. Goniometry was normalized in 92% of cases. Patients were satisfied or very satisfied with the outcome in 91% of cases. Corrections were evaluated by the surgical team as satisfying in 88% of cases.

Discussion and conclusion:
3D planning and patient-specific instrumentation appears to be an essential tool for understanding and treating complex limb deformities. Failures can be attributed to initial planning errors, underestimation of joint laxity, and epiphyseal anomalies in patients with constitutional bone diseases. Technical difficulties, such as guide placement and plate adaptation to bone, may explain the discrepancy between the target plan and radiographic result in 8% of patients.

Introduction: To explore the feasibility and clinical efficacy of perforator flap transplantation for repairing skin and soft tissue defects in children's limbs. Method: From July 2007 to January 2024, 288 children with skin and soft tissue defects in the limbs and exposed tendons or joints caused by traffic accidents and machine injuries were treated. 91 cases were treated with inferior abdominal artery perforator flap, 81 cases were treated with circumflex scapular artery perforator flap, 60 cases were treated with thoracodorsal artery perforator flap, 5 cases were treated with radial collateral artery perforator flap, 7 cases were treated with circumflex iliac artery perforator flap, and 44 cases were treated with circumflex lateral femoral artery descending perforator flap. Among them, 45 cases were transplanted with split branch perforator flaps and 38 cases were transplanted with combined perforator flaps. The minimum area of the transplanted skin flap is 6cm x 3cm, and the maximum is 24cm x 8cm; The skin flap is directly sutured in the donor area. There were 2 cases of complete necrosis and 1 case of partial necrosis after surgery. The remaining skin flaps survived smoothly after surgery, and the wounds in the recipient and donor areas healed well. Follow up for 2-36 months postoperatively showed good color and texture of the skin flap. Five cases of the inferior abdominal artery perforator flap developed secondary swelling and underwent thinning surgery. The rest of the skin flaps recovered well in appearance, with a linear scar remaining in the flap donor area.

Introduction: Hip instability is the second musculoskeletal trouble in children with cerebral palsy.Its occurrence represents a dramatic shift in the disease course because of its implications in both clinical and functional ability and quality of life.The purpose of our study was to report the mid-term results of bony reconstructive surgery and its impact on quality of life.Methods: the retrospective study examined 42 subluxated/dislocated hips in 31patients with cerebral palsy over a period of 8years. All underwent a combined surgery including varus derotational femoral osteotomy and a modified Dega acetabuloplasty. Sitting ability, quality of life, hip range of motion were reviewed with at least 12months follow-up.Results : The primary complaints were pain (45%) and lack of abduction resulting in perineal care problems (32%). There were 31subluxated and 11dislocated hips before surgery.
At last follow up of 50months, 51.6% of patients were pain free according to San Salvadour scale. Among children expressing pain preoperatively, 47.5% became pain free. Pain decreased significantly in 32.5%.
The Care and comfort caregivers questionnaire (Care Q) was significantly improved. Only patients GMFCSIII have improved their gait ability. Sitting symmetry has improved in 45% of children.
Recurrence of the dislocation was observed in 28.6%. The risk of recurrence was greater when surgery was performed before 7years old. Plaster sore and implant discomfort were the main complications (respectively 31% and 45.2%).

Conclusion: One stage bony reconstruction gives good clinical and functional results in children GMFCS III. It imporves the quality of life namely pain, perineal care and transferts.

Purpose: Previous studies have suggested that obesity defined by body mass index(BMI) is a protective factor for bone mineral density(BMD), but have overlooked the potential influence of different types of obesity. This study aims to evaluate the correlation between abdominal obesity index A Body Shape Index(ABSI) and adolescent bone density, and analyze the relationship between abdominal obesity and bone metabolism.Methods: A total of 1557 adolescent participants were included in NHANES from 2007 to 2018. Calculate the ABSI using a specific formula that takes into account waist circumference and BMI. A weighted multiple linear regression model is used to evaluate the linear correlation between ABSI and BMD. Forest plots are used to analyze the correlations between subgroups, and cubic splines are limited to evaluate the nonlinear correlations and saturation effects between ABSI and BMD.Results: After adjusting for confounding factors, there was a significant linear correlation (P<0.01) between ABSI and femoral BMD, both as a continuous variable and an ordered categorical variable. The restrictive cubic spline curve indicates a significant nonlinear correlation and saturation effect between adolescent ABSI and BMD. Conclusion: Research has shown a significant negative correlation between ABSI and BMD at the four detection sites of the femur, and this correlation may vary slightly due to age, race, family income, and different detection sites. The research results indicate that compared to overall body weight, fat distribution and content may be more closely related to bone metabolism.

Introduction: Perioperative exposure radiation in paediatric orthopaedic surgery carries risks, both for children who have increased radiosensitivity and for surgeons who accumulate significant radiation exposure during their practice.
The aim of this study is to quantify the radiation dose used in paediatric orthopaedic and traumatology surgeries to demonstrate the benefits of measures taken to limit preoperative irradiation.

Methods: We retrospectively analyzed radiation doses recorded during surgery for patients under the age of 18 who underwent orthopaedic procedures over a 28-month period. For each surgical procedure, the radiation dose was quantified in terms of cumulative dose surface (CDS) expressed in mGy·cm².

Results: Perioperative radiation exposure was analyzed for 1789 surgeries. Treatments for slipped femoral epiphysis (SFE), scoliosis, and lower limb lengthening procedures were the most irradiating procedures. The mean ± standard deviation doses were 380 ± 513 mGy·cm² for SFE, 459 ± 432 mGy·cm² for scoliosis, and 327 ± 334 mGy·cm² for lower limb lengthening. Radiation doses for trauma procedures were relatively low, with means ± standard deviations of 85 ± 144 mGy·cm² for lower limb trauma procedures and 42 ± 77 mGy·cm² for upper limb trauma procedures.

Discussion: Optimizing radiation doses is essential to obtain sufficient image quality with low radiation risk. These measures have enabled the implementation of the ALARA (As Low As Reasonably Achievable) principle and have resulted in low radiation exposure compared to recent published studies.