Introduction: In children with Perthes and hinge abduction and potential for remodeling, we have performed a shelf acetabuloplasty, to contain the hip and allow remodeling. Our report has a series of 21 patients (23 hips) with severe Perthes disease and arthrographically proven hinge abduction.
Methods: Harris Hip Score and WOMAC score were used in preoperative evaluation and postoperative follow up. The different parameters evaluating the hip as :Tönnis angle, Sharp angle , center-edge angle (CEA),and acetabular coverage percentage were measured. For unilateral cases only, medial joint space ratio and epiphyseal height ratio were evaluated.
Results: The mean postoperative follow-up was 29.9 months ± 13.7 . Ten joints were in Fragmentation stage whereas 13 joints were in re-ossification stage. Based on Lateral Pillar classification; only two joints were classified as B/C and 21 joints were classified as C. Final follow up Harris hip Score (HHS) (WOMAC) ,internal rotation , abduction, (CEA) and Acetabular coverage percentage were found to be significantly higher. In contrast, Tönnis angle and Sharp’s angle were significantly decreased. For unilateral cases, it was found that medial joint space ratio and epiphyseal height ratio were significantly were significantly decreased.
Conclusion: Shelf provides a good acetabular coverage for the deformed aspherical head with LCPD and hinge abduction to improve hip clinical and radiological outcome.
Level of Evidence: Level IV prospective case series.
Key Words: Perthes disease, shelf acetabuloplasty, hinge abduction, Legg-Calve´-Perthes disease

Introduction: Slipped capital femoral epiphysis (SCFE) is a hip disorder that affects the growth plate of adolescents. This study was to compare patient characteristics and adverse postoperative outcomes between these two groups of patients. Methods: The NSQIP Pediatric database was retrospectively analyzed for patients nontraumatic and traumatic SCFE. Postoperative outcomes investigated include complications, reoperations, readmissions, and extended length of stay. Univariate analysis and binary logistic regression were used to identify differences in patient characteristics and adverse postoperative outcomes. Results: 2980 SCFE patients were identified. Concerning adverse postoperative outcomes: 27 (1.0%) had postoperative complications; 31(1.1%) had a reoperation; 6 (0.2%) were readmitted; 13 (0.5%) had an extended length of stay (> 2 days). Concerning adverse postoperative outcomes: 1 (0.4%) had postoperative complications; 5 (1.8%) had a reoperation; no patients were readmitted; 1 (0.4%) had an extended length of stay (> 2 days). Univariate analysis showed significant differences in obesity [BMI ≥30 kg/m2] (p=0.008). T-Test showed no differences in length of stay and age between non-traumatic and traumatic patients (all p>0.05). Univariate analysis also showed no differences in adverse postoperative outcomes between the two groups (all p>0.05) . Binary logistic regression analysis showed that patients with nontraumatic SCFE are more likely to be obese than those with traumatic SCFE (1.5 [1.1-1.9], p=0.009). Conclusion: Obesity [BMI ≥ 30] is a significant risk factor in SCFE patients developing the nontraumatic variant over traumatic.

BACKGROUND:
DDH is a common orthopaedic condition affecting the hip of
infants. The main objectives of the study is to assess our practice of close reduction in DDH retrospectively over 6 yr period and to assess the success rate and complication and thereby suggesting ways to improve our practice, to have
a better outcome.
METHODOLOGY:
We reviewed 72 patients of DDH who underwent Close
reduction between October 2008 and June 2014 in Royal Derby Hospital. 88 hips out of 72 pts have been taken as the sample size for our final analysis. Data was collected from theatre list, TA system clinic letters, operative notes and pacs system.
RESULTS:
Out of 72 pts, 67(82 hips) were females and 5(6 hips) were
males. Reasons for the referral include clicky hips (54%), abnormal thigh creases (18%), leg length problems (16%) and limping (12%). The spectrum of DDH in our study varies from dislocation (23%), subluxation (16%) and dysplasia (61%). Risk factors of DDH in our study includes Breech(18%),
neuromuscular disorders(10%), and prematurity(5%). Close reduction was successful in 62 hips out of 88 (70.45%). 22 hips (25%) failed in close reduction and hence proceeded for open reduction. 5 pts had pressure sores from hip spica cast. 6 hips ended up in AVN(6.8%).
CONCLUSION:
It is evident from our study that early referrals is the key for
better outcome. Recommendations were made to ensure that all newborns must undergo hip examination and clinical findings must be documented properly.

Introduction: This is to report our experiences in managing the complications in four cases which underwent the successful management at the early stage and eventually obtained the good results in terms of both function and radiograph after the consequent surgeries. Methods: Three boys and one girl, aged from 6 to 12 years old, sustained the complications, such as AVN, post-surgical SCFE and delayed union et al after the surgical treatment of femoral neck fractures. The procedures for reconstructive surgeries were undertaken to relocate the slipped epiphysis of proximal femur in one case, to correct the deformity of coxa vara in one case by valgus osteotomy, to fix with pediatric hip plate (PHP) along with the bone implantation at the site of delayed union in one case, and to reshape the femoral head in one case. Results: All the patients were followed until the healing of AVN, for the period ranging from 3 to 4 years after the definitive surgery. There was no significant limitation of hip ROM and weight-bearing walking. The leg length discrepancy was 3 cm at the maximum. Discussion and Conclusion: Femoral neck fracture is a highly complicated entity. The complications, for a unique example of postsurgical SCFE, are treated with different ways in children from in adults. Taking the advantage of growth potential and development in pediatric population, we may have learned the practical management not only from the success, but also from the failure, which is more challenging particularly in the clinical decision-making.

Introduction: Unicameral bone cyst are relatively common in pediatric population. They are usually asymptomatic, but up to 75% of cases are diagnosed after a fracture. Case report: A 9-year-old boy sustained a low-energy fall with isolated trauma to his left lower limb. At examination, he was unable to bear weight and passive mobilization of his left hip was extremely painful. Radiographs revealed a left pertrochanteric fracture associated with a solitary osteolytic lesion. CT-scan demonstrated a fallen fragment sign, and a diagnosis of Unicameral Bone Cyst was made. The patient was submitted to closed reduction, curettage of the cyst and osteosynthesis with a locking compression plate. After 3 months, the patient referred no pain. Radiographs showed consolidation of the fracture, absence of signs of osteonecrosis and partial ossification of the cyst. Discussion: Treatment described for fractures of proximal femur due to unicameral bone cysts is internal fixation and additional curettage and grafting with or without intralesional injections. Nonetheless, data from literature is not always concurrent about the best treatment approach, since natural history of these lesions is generally favorable regardless of the treatment. In this case, curettage and internal fixation were performed without filling of the defect with bone graft, in order to avoid violation of the greater trochanteric growth plate or morbidity associated with other donor sites. However, healing potential can be compromised and revision surgery may be needed in the future. A longer follow-up is necessary to evaluate the final outcome and eventual complications or recurrence of the cyst.

Pediatric injuries involving ipsilateral Humerus, supracondylar area, elbow, forearm and wrist represent the peculiar injury pattern with considerable potential for the Neurovascular Compromise. These are rare pattern of injuries and have been managed by various methods ranging from Closed reduction to Open reduction with k wires and occasionally with the external fixator. Our aim was to evaluate the functional outcome of the patients with ispsilateral floating elbow injuries, treated at our center since last 6 years. Total 22 patients were selected, 4 patients didn’t report for follow-up, thus only 18 patients with 12 male, dominant side injury in 70% patients, majority being supracondylar fractures with forearm injuries were retrospectively followed and included in this study. The patients were operated by junior consultant with registrar on duty on particular day roasters.Results , the careful treatment with respect to the individual injuries, resulted in good functional outcome whether patient was managed urgently or subsequently incase delayed hospital presentation. The full ROM of early operated cases was achieved early but, the full ROM at 18 months was same in both scenarios. The peculiar complications were neuropraxia ( preoperative) in 4 cases, and itrogenic neuropraxia in 2 cases , however all improved without any intervention. Three cases of pulseless pink hand adequately achieved return of pulse without vascular intervention. Two cases of delayed presentation had blisters and fasciotomy was done in one case.

Introduction: The upper-type brachial plexus birth palsy leads to the limitation of the flexion of the elbow by the obstacle of the abdomen and/or chest, resorting to residual abduction, accompanied by the progressive and irreversible glenohumeral deformity. The recovery of the hand-face plane of movement is the main goal. Objective: To present our experience in functional recovery after the humeral derotational osteotomy in obstetric brachial paralysis with external rotation deficit, stable shoulder, elbow flexion, and functional hand. Material and methods: Descriptive and prospective study, with a total of 9 cases of upper -type of brachial plexus birth palsy. 6 Males and 3 females from 3 to 16 years-old. Clinically shoulder not dislocated, elbow flexion 90°, Thromped sign positive and a mild glenohumeral deformity grade (waters III-IV). Physical and symptomatic capacity was measured by QuickDASH. Follow-up 12 months. Results: An increase in active elbow flexion range was obtained, they managed to reach the face, in all cases however it was only possible to recompose the plane the hand-face plane of movement in 8 cases. A significant improvement according to the QuickDASH scale. Conclusion: The humeral derotational osteotomy in Waters III-IV glenohumeral deformities would improve the functional capacity of the upper limb, restoring the hand-face plane of movement, but without improving the shoulder mobility range. However, we recognize that the number of cases is still small, and an increase in the number of cases is required.

Abstract
Background: limb length discrepancy can be caused in many ways, one of the causes are warfare injuries especially in areas where there is war for example Afghanistan. Objectives: Bone loss is not only a cosmetic concern but its also functional concern especially in lower limb, the main objective of our study is how to replace the bone loss, to have an equal limbs. Methods: This descriptive study is done from 2019/06/01-2020/12/30 on 30 patients in 300 bed Police Central Hospital in Kabul Afghanistan,25(83.3%) patients had lower limb discrepancy and 5 (16.6%) upper limb discrepancy. 27(90%) patients were male ,age 20-35 years,3(10%) patients were females age 15-35 years. The procedure of lengthening in 3(10%) patients were done by bone graft and internal fixation and 2(6.6% ) patients with Intramedullary nailing along with Ilizarov , 4(13.3% )patients with Ilizarov external fixator and 19(63.3% ) patients with Nasir Awais external fixators. According to the cause of bone lose, 8(26.6%) patients Mine explosions and 22(73.3%) patients due to Gun shout injuries. Results: 30 patients with limb length discrepancy ranging from 5-13 cm average was 7cm that were included in this study, a: 18(60%) Excellent result, b: 6(20%) good results: 4(13.3%) poor results: 2(6.6%) complications. Conclusion: The patients treated with several devices but we used Nasir Awais External fixators more than others.

Non-ossifying fibromas (NOFs) are common, benign lesions typically found in the long bones. Although the definitive diagnosis of NOFs is based on biopsy, most lesions can be identified on a plain radiograph alone. The use of other imaging modalities is unnecessary in most cases and should only be considered for complex cases. The purpose of this study was to provide an overview of the patient profile and current practice in NOF investigations in Addenbrooke’s Hospital with a specific focus on evaluating the imaging requirements in these patients. A retrospective, descriptive study was conducted on five patients diagnosed with one or more NOFs between 2015-2020. An evaluation of the patient demographics showed that 40% were male and the average age of diagnosis was 15.2 years. The majority of NOFs were seen in the metaphysis (60%), most commonly in the femur (40%). All patients received an MRI and 80% of patients also received an X-ray. 60% were seen again and the follow-up period ranged from 4 months to 3 years. Our study showed an overuse of MRI for NOF investigations suggesting the need for greater confidence in NOF recognition. This is especially important in the paediatric population where the consideration with regards to investigation tolerability is required. We conclude that plain radiographs are sufficient to investigate NOFs and the use of MRIs should be reserved when clinical evidence suggests more sinister differentials.