The oblique iliac osteotomies used in bladder exstrophy repair were modified into L-shaped osteotomies to allow postoperative external fixation with 2 lateral supra-acetabular half pins. Combined oblique and posterior iliac osteotomies (Y-shaped) were used in cases with severe pelvic deformities. Patients with Classic Bladder Exstrophy (CBE) or bladder exstrophy variants (BEV) primarily treated at the authors’ institution between 2007-2021 were identified from a prospectively maintained database. Modified oblique ‘L-shape’ bilateral iliac osteotomies, with or without posterior uni-cortical osteotomy ‘Y-shaped’ were performed to facilitate pubic symphysis approximation and anterior closure. An external fixator plus mermaid bandage were adequate without lower limbs traction. Orthopaedic-related complications were recorded. One-hundred patients were included (90 Classic Bladder Exstrophy CBE and 10 bladder exstrophy variants CBV) with a median age of 6.6 months. Fifty-six patients had L-shaped iliac osteotomies and 44 had Y-shaped osteotomies. Infants in the L-shaped osteotomy group were significantly younger at the time of closure (4.2 vs 7.7 months of age). The median preoperative pubic diastasis was 4.6 cm in the CBE group and 5.7 cm in the BEV group. The median external fixator removal time was 27 days. All patients had a successful closure. No cases of femoral nerve palsy. Two patients had mild pin tract infections treated with antibiotics. Two patients had pin loosening without infection, one was removed earlier. One patient had mild lower midline wound dehiscence. Our modifications were safe in bladder exstrophy repair. The short-term external fixation without traction decreased postoperative orthopaedic-related complications.

Purpose: The purpose of this study is to evaluate the results of medial open reduction approach for infants who presented with hip subluxation as a sequela of septic hip arthritis. Patients and Methods: In this prospective study, eight hip in seven infants who presented with post-septic hip subluxation were included and treated in Tanta university hospitals between. Age of patients ranged between 7 months and 11 months. All had history of septic epiphysitis, which was treated by open drainage through anterior approach within 24 hours after presentation. Three infants presented after more than four days from the start of the infection. According to International Hip Dysplasia Institute (IHDI) classification, two patients were grade II, three patients were grade III and two patients were grade VI. The postoperative function was assessed by Modified Mackay score. LCEA (lateral center edge angle) and AI were used to assess the radiological outcome.Results: The mean follow-up period was 16 months. According to the Modified Mackay score, one patient had excellent result, four had good, two had fair, and one had poor outcome. The average Postoperative AI was 21.75 degrees. The Average Postoperative LCEA was 25 degrees. The average follow-up period was 13.5 months. Three infants showed proximal femoral growth disturbance; one was class 1 and the other two infants were class 2 according to salter classification.Conclusion: medial open reduction approach for infants who presented with hip subluxation as a sequela of septic hip arthritis showed acceptable clinical and radiological outcomes

The 8-plates are used to correct lower limb length discrepancy (LLD) in children although effectivenes reported in the literature is controversial. Prediction of the effectiveness is crucial for practical application. The purpose was to determine relative parameters of the effectiveness depending on age and anatomical segment. Retrospective analysis of the results of LLD correction in 94 patients using two 8-plates. Difference in the ratios of the lengths of epiphyseodesed and paired intact segments before epiphyseodesis and at the time of removal of implants was determined for the assessment of effectiveness of treatment.
Maximum efficiency was observed for epiphyseodesis of femur in the age group 2-5 years (7.59% of bone length), minimum - in the epiphyseodesis tibia in the age group 10-14 years (2.04% of bone length).Decrease in effectiveness for femur depending on age was linear (difference between younger and middle group was 1.85%, and between middle and older group - 2.8%). For tibia the difference between effectiveness in the younger and middle group was 2.42%, and between middle and older - 0.34%. We have shown general decrease in the effectiveness of correction with age, while the effectiveness for femur in all age groups was higher than for tibia. Effectiveness of the tibial epiphyseodesis was characterized by greatest decrease with age. Temporary epiphyseodesis with 8-plates is effective in correcting LLD in children. We noted important general trends that may allow optimizing the indications, realistic planning depending on the age, and also presented the evaluation method with the relative indicator of effectiveness.

Achondroplasia and Pseudoachondroplasia are characterized by a certain similarity of clinical manifestations, but having different etiopathogenetic mechanisms and confirmation methods of molecular genetic diagnosis. Their common phenotypic features often make it difficult to differentiate diagnosis during clinical examination of patients, planning DNA-diagnostics, and proper time detection of neurosurgical and orthopedic complications. A comprehensive examination of 76 children from 74 unrelated families aged from 1 month to 18 years old with phenotypic signs of achondroplasia and pseudoachondroplasia was carried out. To clarify the diagnosis genealogical and amnestic analysis, clinical examination, neurological examination according to the standard method and radiographs analysis were used. Molecular genetic confirmation was carried out by searching for hotspot mutations in the FGFR3 gene, assessing the number of GAC repeats located in exon 13 of the COMP gene and new generation sequencing of the target panel. The leading signs in achondroplasia are disproportionate nanism from birth, macrocrania and facial dysmorphism, which are not specific for pseudoachondroplasia. Radiological features are essential in the differential diagnosis of pseudoachondroplasia, that should be considered when referring patients for molecular genetic analysis. Deletion of the GAC repeat c.1417_1419del in the COMP gene was identified in 27% of patients with pseudoachondroplasia. Based on the results, it was assumed that the analysis of these two mutations in the FGFR3 and COMP genes should be done first. In the absence of target mutations, further diagnostic search should be continued with a target panel of genes responsible for the hereditary skeletal pathology or whole exome sequencing.

Aim: To describe the surgical technique and functional outcome for the combined one stage San Diego pelvic osteotomy in cerebral palsy patients with acetabular deficiencies. Methods: Seventeen non-ambulatory spastic diplegic CP children with (21 hips) were consecutively treated with San Diego pelvic osteotomy, in combination with varus, denotational, shortening femoral osteotomy and soft tissue release. The age, gender, GMFCS level, side of operated hip, total time of follow-up and complications were recorded. Results:14 patients (82%) were classified as GMFCS level IV, and 3 patients (18%) were classified as GMFCS level V. At the time of surgery, the mean age was 8 years (range: 5-15 years). The mean migration percentage (MP) improved from 79.05% (range: 50%-100%) pre-operatively to 11.43% (range:0%-45%) at the final follow-up (P < 0.05). The mean acetabular Index (AI) improved from 33.57° (range:28.0°-54.0°) pre-operatively to 18.71° (range:14°-33°) (P<0.05).Also, the mean degree of neck shaft angle (NSA) decreased from 159.95° pre-operative to 119.10° post-operative (P<0.05). All operated hips were pain-free at the time of final follow-up visit, except one case which was presented with femoral had deformity pre-operative. We did not observe any cases of redislocation or avascular necrosis of the femoral head, only 4 cases of subluxation with (MP >33%).Conclusion: We believe that a combined approach of muscle releases, femoral shortening varus derotation osteotomy, and pericapsular San Diego pelvic osteotomy was a highly effective method for the treatment of spastic dislocated or subluxated hips in our patients.

Introduction :Congenital pseudoarthrosis of the tibia is a rare disease It can be defined as a disorder of the diaphysis which is disclosed by either pseudarthrosis at birth or by a pathological fracture presenting in bone with bowing, narrowing of the medullary canal or a cyst.
CPT is still a sever disease whose physiopathology has not been completely clarified and whose prognosis is uncertain ..
Patients and Methods:In This retrospective study, We reviewed the records of 24 children treated between 2001 and 2014. who had presented with atrophic congential pseudarthrosis of the tibia (Crawford type 4 ) There were 13 girls and 11 boys.
Result: The patients presented at a mean age of ( 4 ) years (2.5 to 10) except for two patients who had presented on age of 14 and 15 years old. Of the 24 patients, 18 patients had been treated surgically at other hospitals and by another surgeons, and the remaining 6 patient had been treated by us. Despite all the patients having had more than one surgical intervention . 13 patient had been treated by ilizarov method, 6 paient by intramedullary rod ( two of them with bone graft) and the remaining 5 by vascularized fibular graft.
Conclusion: a modified surgical technique that combines Ilizarov fixator with retrograde calcaneo tibial multiple wires in distal tibial refracture of CPT have clearly shifted from only achieving union to preventing re fractures, especially as high rates of bony union of CPT have been achieved.

INTRODUCTION: Developmental dysplasia of the hip (DDH) is a disorder of abnormal development of the hip socket. The Children's Hospital Oakland Hip Evaluation Scale (CHOHES) is a modification of Harris Hip Score, designed to be used in children. We aim to determine the relationship between CHOHES and Severin score in children surgically treated for DDH with a minimum of 2 years follow-up. METHODS: All patients’ functional outcome was assessed with the CHOHES score in the out-patient clinic. Severin classification was used to grade hips on AP and lateral X-rays of the pelvis. The relationship between CHOHES and Severin scores were assessed using Pearson’s correlation coefficient and a linear regression model to adjust for confounders. RESULTS: 109 children with 141 hips and an average of 5.4 years follow-up were included. Median age at the time of surgery was 3 years (IQR:2;5.5), and 76 (70%) patients were female. The median CHOHES score was 82 (IQR:74;86), and mean Severin score was 2.981.22. The Pearson’s correlation coefficient r between the CHOHES and Severin score is 0.55, indicating a moderate correlation. The linear regression model shows a strong relationship (p<0.001) between both scores after adjusting for possible confounders. CONCLUSION: There is a strong inverse relationship between the CHOHES and Severin scores in children post-surgery for DDH. The correlation is only of moderate strength indicating that both scores cannot be used interchangeably. Radiological outcomes graded with the Severin score alone, do not adequately predict the functional outcome in children.

Bladder extrophy is an embryologic malformation that results in complex deficiency of the anterior midline, with urogenital and skeletal manifestations. Despite advances in management of bladder extrophy, the study of the patient outcome is rarely done. In Indonesia, there are no studies concerning about the anatomical and functional outcome of bladder extrophy patients in 2011-2017.

A cohort retrospective study of the hospital medical records from 2011 to 2017 was performed in January 2017. The patients were assesed for the clinical outcome in orthopaedic outpatient clinic. The anatomical outcome was assessed by calculating the percentage pubic approximation and the functional outcome was assessed by using Pediatric Quality of Life Inventory (PedsQL 4.0) and compared with those of typical peers.

Nineteen children age 4,6±2,3 years presented to outpatient clinic for a routine control. Data was collected for gender man 11 (57,9%); woman 8 (42,1%), fixation method are slabs 10 (52,6%); external fixation 9 (47,4%), the median of age at operation 6 months old with range from 1-71 month, the median of aproximation percentage 78,5% with range 65-98,1%, the mean of PedsQL score post operation 97,2±1,6. There was a significant correlation between age at operation and diastasis post operation to aproximation percentage and PedsQL score (p<0,05).

The clinical outcome of the bladder extrophy patients shows good result that’s measured by percentage pubic approximation and PedsQL score. Age at operation and diastasis post operation affect aproximation percentage and quality of life of bladder extrophy patient

Legg-Calvé-Perthes (LCP) disease is a childhood hip disorder that may result in a deformed and poorly functioning hip. This study aimed to evaluate the medium-term clinical and radiological outcome of Salter pelvic osteotomies and combined pelvic and femoral varus osteotomies in children with LCP disease and determine prognostic factors for treatment. Between 2006 and 2015, 126 children with LCP (26 girls, 100 boys) met the inclusion criteria and were enrolled in the study. 83 hips (64 %) were classified as Catterall Group IV, 46 (35 %) as Catterall Group III and 1 hip as Catterall Group II. Salter osteotomy was performed in patients younger than 6 years, and combined osteotomy was performed in older patients or if advanced containment was needed. The final follow-up radiographs were assessed according to the Stulberg classification and clinical outcomes by The non-arthritic hip score /NAHS/. The mean age at the time of surgery was 6,8 years (range 2,9-12,2). The mean time to follow-up was 6,9 years (range 4-11). Radiological outcomes: Stulberg I 29 hips (22 %), Stulberg II 46 hips (35 %), Stulberg III 41 hips (32 %), Stulberg IV 14 hips (11 %), Stulberg V 0 hips. The mean NAHS was 97,2 (range 62,5-100). 77 patients (61,1 %) achieved NAHS 100, 117 patients (92,8 %) had NAHS 90-100. Predictors of radiological outcome were femoral head involvement characterised by Catterall classification, age and presence of a metaphyseal cyst. Salter osteotomy and combined osteotomy provide good medium-term radiological and clinical results for Legg-Calvé-Perthes disease.

Introduction: Proximal femoral varus and derotation osteotomy is a common technique for treating proximal femoral and hip deformities in cerebral palsy（CP）. However, there are few reports describing the techniques and outcomes of performing extension osteotomy to improve hip flexion contracture in CP. We report a cohort of cerebral palsy patients who underwent proximal femoral extension(PFE) osteotomy to improve hip flexion contracture during three-dimensional correction of proximal femoral and hip deformities.
Methods: Retrospective analysis of 47 cases, mean age of 9.4 years, who underwent PFE osteotomy in our hospital from December 2020 to September 2022. There were 28 patients with GMFCS I- III, 19 patients with GMFCS IV -V. The mean follow-up time was 21 months. A complete preoperative examination was performed in all patients: Medical history, physical examination, imaging, and gait analysis. The Thomas test, maximum hip extension, and pelvic alignment during walking were evaluated and recorded. In non-ambulatory patients, the CPCHILD scores was also evaluated.
Results: The average extension was 18.2°, adduction was 19.4°, external rotation was 23.5°. The osteotomies healed completely in all patients. The average preoperative Thomas test was 31° and the average postoperative was 15°. In ambulatory patients, the maximum hip extension angle and pelvic anterior tilt improved during the gait cycle were improved in 22 patients. In the nonambulatory patients, postoperative CPCHILD scores decreased in 16 patients.
Conclusion: PFE osteotomy is a safe and effective method for treating hip flexion contracture in CP patients. Three-dimensional correction should always be considered when performing proximal femoral osteotomy.

Introduction: Congenital anterolateral bowing of the tibia has the possibility of impending fracture and the development of pseudarthrosis of the tibia. Congenital pseudarthrosis of tibia is one of the most difficult orthopedic conditions to treat. Irrespective of the method of treatment used, results of all methods have been variable with high Refracture rates with all of the methods. The best management of such a case is to prevent the fracture from occurring we evaluated the results of prophylactic bypass Double osteotomies performed to correct the mechanical axis of the bone to stop progression of the deformity and to prevent fracture and pseudarthrosis. Methods: This technique was performed for 11 patients from June 2014 to Feb.  2021.  With average age  was 4.2±2.34 years. The main follow up 5.3 years. results: All patients had a complete union of both osteotomies of the tibia with good alignment and leg length discrepancy, except in one patient reported refracture of the distal osteotomy .There was improvement of the mechanical axis of the tibia with the mean of mMPTA,mLDTA,PPTA, ADTA changed to (87),(87 ),(80),(.92) respectively. Complication with residual valgus deformity of the proximal tibia reported and treated later on with hemiepiphyseodesis by 8 plate. Conclusion: prophylactic bypass Double osteotomies for treatment of congenital anterolateral bowing of the tibia can correct the mechanical axis of the bone and reduce the moment on the deformed segment of the tibia to stop progression of the deformity and to prevent fracture and pseudarthrosis.

Introduction: No consensus exists about the open reduction of developmental dysplasia of the hip. We report clinical and radiological outcomes of a large monocentric study. The objectives are analyzing outcomes and giving recommendations. Materials and methods: retrospective review of 414 hips (301 patients) operated on for DDH between 2010 and 2018. The mean age was 34.6 months (14-96 months). In all,72 hips had open reduction(OR), 130 had OR with femoral osteotomy(FO),37 had OR with pelvic osteotomy(PO), and in 175 hips OR was associated with FO and PO. The mean follow-up was 6.5 years(3-10 years).Clinical outcomes were evaluated according to Mckay's classification.The acetabular index was measured,and Severin classification was used for radiological outcomes.Reduction failure and residual dysplasia were noted, and avascular necrosis of femoral head(AVN) was assessed according to Kalamchi and MacEwen classification. Results: At the last follow-up : 80.2% hips had good clinical results, 77% had satisfactory radiological results. The AI was ≤25° in 350 hips. AVN was noted (20% cases . Redislocation was founded in 12%. Overall: 72% had stable reduction without AVN with good clinical and radiological outcomes. Discussion: Clinical outcomes are better and the risk of AVN decreases when FO is performed. There were better radiological results when PO was performed. The rate of residual dysplasia was higher when PO was not performed. We recommend a FO for high dislocations (Tönnis 3 or 4) for children over 18 months and a PO for children over 36 months or over 18 months with an acetabular index > 25°.

Introduction: Group A streptococcal (GAS) infections have been on the rise globally, including invasive infections. Invasive osteoarticular GAS infections can become life-threatening and can cause lifelong morbidity and disability. As no systematic data collection has been done to assess a potentially changed epidemiological pattern in France, we propose to provide recent data on these GAS osteoarticular infections. Methods: A retrospective chart review from 2010 to 2023 of patients with a proven osteoarticular infection with GAS is being carried out across France. Baseline demographic data, initial clinical presentation at time of hospitalization, comorbidities and previous medical history, imaging results, laboratory results for infection markers and microbiological datas (culture and PCR) and presence of long-term sequelae will be collected. Results: Preliminary results from a single center in Paris shows an exponential increase in osteoarticular GAS infections since 2019, mostly involving male children under 5 years of age. Since 2019, we have seen a change in the potential gateway: decrease in varicella and increase in nasopharyngeal infections and less children with osteoarticular GAS infections requiring hospitalization in a pediatric intensive care unit. Discussion: Prompt and aggressive surgical and antibiotic treatment is necessary when an osteoarticular GAS infection is suspected. A national retrospective data collection is underway to assess the trends in epidemiology and outcomes of GAS osteoarticular infections in children across France. This data can help inform treatment protocols, educate clinicians with little experience in osteoarticular GAS infections, and improve future outcomes. Data collection will be completed by July 2023.

Introduction: X-linked hypophosphatemic rickets (XLH-R) is the most frequent cause of genetic and heritable rickets. Most patients have complex deformities and short stature. Surgery may be needed for deformity correction, correction of limb length discrepancy and lengthening for short stature. Limb reconstruction for XLH-R is demanding due to complex deformity, Poor bone quality, short stature, obesity, prolonged bone healing time and stress fractures at previous pin sites. Materials and Methods: This retrospective study included the cases of 10 patients with lower limb deformities due to XLH-R. There were three female and seven male patients. In each case the four lower limb segments were operated upon with 40 bone segments. Different reconstructive procedures were performed including; gradual deformity correction with concomitant limb lengthening and acute deformity correction and intramedullary fixation. Results: A total of 64 procedures were performed (average 1.6 procedure per bone segment). Ilizarov external fixator was used in 44 cases and intramedullary fixation in 20 cases. Restoration of the mechanical axis was restored in 18/20 limbs (90%). Bone lengthening ranged from 4 to 7 cm. Follow up ranged from 2 to 8 years. Discussion: Gradual deformity correction and limb lengthening for XLH-R is a predictably gratifying procedure provided that medical compliance is ensured, both for maintenance of correction and prevention of complications. Intramedullary fixation is indispensable as permanent splint and to prevent re-fractures. Surgery before skeletal maturity has a higher rate of recurrent deformity.

Introduction: Aneurysmal bone cysts (ABCs) are benign but locally aggressive cystic lesions of the bone. Pelvic ABCs are extremely rare and hard to treat, due to their high risk of local recurrence and the tough access to pelvic bones.
Methods: In this retrospective study, we evaluated the pediatric cases with pelvic ABC treated with curettage, cryotherapy and bone grafting treated in our institution between 2016 and 2022. Complications were recorded, as well as local recurrences. Patients’ post-operative functionality was assessed with the MSTS score.
Results: Seventeen consecutive cases were included in our study. Their mean age at surgery was 13.5 (5-16) years. The mean lesion’s size was 55 (20-80) mm. The mean follow-up was 38 months (13-56). Two cases (11.8%) had local recurrences, which were successfully treated with further curettage. At their latest FU, 15 cases were CDF and the remaining 2 cases NED. Only one case had a post-operative compilation (wound dehiscence). Patients’ mean post-operative MSTS score was 29.6 (28-30).
Discussion: Pelvic ABCs are a challenge even for the most experienced orthopedic surgeon. Our study, which does not find a match in modern literature, suggests that the association of an accurate curettage, intra-operative cryotherapy and bone grafting can be effective in the treatment of pelvic ABCs, as testified by our good functional outcomes and reasonable rates of complications and local recurrence.
Conclusion: The combination of curettage, cryotherapy and bone grafting could is a reliable therapeutic option for large-sized aneurysmal bone cysts.