Blog Single Author Big - International Journal of Paediatric Orthopaedics

Neglected Convergent Elbow Dislocation in a Paediatric Patient: A Case Report

DOI- https://doi.org/10.13107/ijpo.2025.v11.i03.248

Open Access License: CC BY-NC 4.0

Submitted: 21/09/2025; Reviewed: 14/10/2025; Accepted: 10/11/2025; Published: 10/12/2025

Authors: Vivek Singh MS Ortho [1], Rahul Baishya MS Ortho [1], Rahul Mishra MS Ortho [1], Manish Kumar Shah MBBS [1], Dhaval Patel MBBS [1], Aditya K.S. Gowda MS Ortho [1]

[1] Department of Orthopedics, Paediatric Orthopaedics Unit, AIIMS, Rishikesh, Uttarakhand, India.

Address of Correspondence
Dr. Aditya K.S. Gowda,
Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India, 249203
E-mail: adityajr.orth@aiimsrishikesh.edu.in

Abstract

Background: Convergent elbow dislocation is a rare paediatric injury with medial translocation of both radius and ulna. Subtle radiographic signs lead to missed diagnoses and delayed treatment.
Case presentation: We evaluated an 11-year-old girl with persistent restriction of forearm rotation and ulnar-nerve symptoms two months after a “simple” elbow dislocation that underwent a closed reduction. The diagnostic work-up included targeted review of the radiographs and non-contrast computerized tomography (CT). Operative management was performed through a posterior approach to the elbow with release of the scar tissue, ulnar-nerve decompression, open reduction, and Kirschner wire (K-wire) stabilization of the radiocapitellar joint.
Results: Pre-operative imaging confirmed convergent radioulnar translocation and anterior calcification (“radial horn”). After K-wire removal and rehabilitation, the patient achieved functional pronation–supination and resolution of ulnar neuropathy. At 24 months follow-up, radiographs showed maintained reduction and a stable, painless elbow with symmetric range of motion.
Conclusions: In the management of trauma to the elbow in children, post-reduction restriction of forearm rotation should raise the suspicion of rare injury patterns such as convergent radioulnar dislocation. In case of delayed presentation, prompt recognition and comprehensive soft-tissue release with nerve decompression can yield excellent function.
Keywords: Elbow dislocation, Convergent dislocation, Child, Ulnar neuropathy, Open reduction.

References

1. Speed JS. Dislocation of the elbow in children. J Bone Joint Surg. 1925;7(2):255-259.
2. Borris LC, Lassen MR. Convergent dislocation of the elbow. Injury. 1982;14(2):166-169.
3. Gupta P, et al. Convergent dislocation of the elbow: A rare injury. J Orthop Case Rep. 2016;6(3):48-50.
4. Keny S, Modi N, et al. PRUT – A cadaveric study to understand the mechanism of this rare paediatric elbow injury. Trauma Case Rep. 2024;52:101067.
5. Bhaskaranand K, Bhat AK. Missed Monteggia fracture in children. Indian J Orthop. 2000;34(2):110-114.
6. D’Ambrosia R, et al. Ulnar nerve palsy in elbow dislocations. Clin Orthop Relat Res. 1981;(161):170-174.
7. Rehima S, et al. Convergent dislocation in children – case report and review. Eur J Orthop Surg Traumatol. 2012;22(3):221-224.
8. Smith FM. Unusual dislocations at the elbow. Am J Surg. 1956;91(4):560-568.
9. Weseley MS, Barenfeld PA. Ulnar nerve injury after elbow trauma. Orthop Clin North Am. 1976;7(2):403-413.
10. Singh D, et al. Late presentation of Paediatric elbow dislocation. J Clin Orthop Trauma. 2018;9(1):63-67.
11. Modabber MR, Jupiter JB. Reconstruction for neglected elbow fracture-dislocations. Hand Clin. 2002;18(1):91-102.

How to Cite this Article: Singh V, Baishya R, Mishra R, Shah MK, Patel D, Gowda AKS. Neglected Convergent Elbow Dislocation in a Paediatric Patient: A Case Report. International Journal of Paediatric Orthopaedics. September-December 2025; 11(3): 20-23.

(Article Text HTML) (Full Text PDF)

Unilateral Perthes Disease Followed by Contralateral Pre-slip SCFE: A Case with Sequential Hip Disorders

DOI- https://doi.org/10.13107/ijpo.2025.v11.i03.246

Open Access License: CC BY-NC 4.0

Submitted: 19/09/2025; Reviewed: 30/09/2025; Accepted: 24/11/2025; Published: 10/12/2025

Authors: Tariq Altaf Mir MS Ortho [1], Muhammad Haseeb Gani MS Ortho [1]

[1] Paediatric Orthopaedics Department, Paras Health, Srinagar, India.

Address of Correspondence
Dr. Tariq Altaf Mir,
Consultant, Paediatric Orthopaedics Department, Paras Health, Srinagar, India.
E-mail: mirdadtariq@protonmail.com

Abstract

Background: Perthes disease and Slipped Capital Femoral Epiphysis (SCFE) are distinct paediatric hip disorders, rarely reported to occur sequentially in the same patient.
Case report: We report a case of a 7-year-old boy with Perthes disease of the Right hip treated by proximal femoral osteotomy. At the age of 9 years, he complained of Left hip pain, which on evaluation was found to be a pre-slip SCFE. He underwent in-situ pinning on the Left side and was asymptomatic at the last follow-up.
Conclusion: Recognition of this sequential presentation is important for surveillance and timely management.
Keywords: SCFE, Perthes disease, Vitamin D deficiency

References

1. Karkenny AJ, Tauberg BM, Otsuka NY. Pediatric hip disorders: Slipped capital femoral epiphysis and Legg-Calvé-Perthes disease. Pediatr Rev. 2018 Sep;39(9):454–63. doi:10.1542/pir.2017-0197. PMID: 30171056.
2. Markheim HR. Legg-Perthes disease and slipped epiphysis in the same patient: a case report. J Bone Joint Surg Am. 1949;31A:666–8.
3. Graziano GP, Kernek CB, DeRosa GP. Coexistent Legg-Calvé-Perthes disease and slipped capital femoral epiphysis in the same child. J Pediatr Orthop. 1987;7:61–2. doi:10.1097/01241398-198701000-00012.
4. Singh KA, Madegowda A, Shah H. Slipped capital femoral epiphysis in a healed Perthes hip. BMJ Case Rep CP. 2021;14:e243977.
5. Madhuri V, Arora SK, Dutt V. Slipped capital femoral epiphysis associated with vitamin D deficiency: a series of 15 cases. Bone Joint J. 2013 Jun;95-B(6):851–4. doi:10.1302/0301-620X.95B6.30806. PMID: 23723284.

How to Cite this Article: Mir TA, Gani MH. Unilateral Perthes Disease Followed by Contralateral Pre-slip SCFE: A Case with Sequential Hip Disorders. International Journal of Paediatric Orthopaedics. September-December 2025; 11(3): 16-19.

(Article Text HTML) (Full Text PDF)

Management of Stress Fracture in the Femoral Neck with an Existing Implant in Osteogenesis Imperfecta: A Case Report

DOI- https://doi.org/10.13107/ijpo.2025.v11.i03.244

Open Access License: CC BY-NC 4.0

Submitted: 14/04/2025; Reviewed: 07/05/2025; Accepted: 12/08/2025; Published: 10/12/2025

Authors: Venkatadass K MS Ortho [1], Mithun D MS Ortho [1]

[1] Department of Paediatric Orthopaedics, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, Tamil Nadu, India.

Address of Correspondence
Dr. Mithun D,
Department of Paediatric Orthopaedics, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, Tamil Nadu, India.
E-mail: dr.mithun_ortho@yahoo.com

Abstract

Introduction: Stress fracture of the neck of the femur with implant in-situ in osteogenesis imperfecta is not reported, and the management of such a scenario could be challenging. Often, the size of the neck in these patients poses a challenge regarding surgical technique and implant selection.
Case Presentation: An 18-year-old male, diagnosed to have osteogenesis imperfecta, presented with chronic left hip pain after sudden abnormal loading to the hip joint. He was diagnosed to have stress fracture of the neck of left femur despite a screw in the neck through a reconstruction type of interlocking nail spanning the femur. He was treated by valgus osteotomy and extra-cortical fibular strut grafting and fixation with a paediatric valgus osteotomy plate. Both the fracture and the osteotomy healed well and our patient had a satisfactory outcome and returned to his pre-fracture functional status.
Discussion: The management of stress fractures in hips with abnormal morphology is challenging, especially in the presence of a retained implant. In patients with osteogenesis imperfecta, bone size may be significantly decreased, impacting the surgical fixation technique.
Conclusion: This rare case illustrates that a stress fracture can happen in the neck of femur with coxa vara even when the neck is protected with a screw. Correction of coxa vara, which in turn normalizes the weight-bearing forces across the neck, is the key to success in this patient group.
Keyword: Osteogenesis, Imperfecta, Neck, Femur, Fracture, Stress.

References

1. Sam J, Dharmalingam M. Osteogenesis imperfecta. Indian J Endocrinol Metab. 2017;21(6):903.
2. Martin E, Shapiro JR. Osteogenesis imperfecta:epidemiology and pathophysiology. Curr Osteoporos Rep. 2007 Sep;5(3):91–7.
3. Esposito P, Plotkin H. Surgical treatment of osteogenesis imperfecta: current concepts. Curr Opin Pediatr. 2008 Feb;20(1):52–7.
4. Tsang KS, Adedapo A. Cannulated screw fixation of fracture neck of femur in children with osteogenesis imperfecta. J Pediatr Orthop B. 2011 Sep;20(5):287–90.
5. Alkhateeb JM, Aljawder AA, Alabbasi FA. Percutaneous screw fixation of fractured neck of femur in a teenage girl with osteogenesis imperfecta. A case report. Int J Surg Case Rep. 2018;49:170–5.
6. Agha RA, Franchi T, Sohrabi C, Mathew G, Kerwan A, Thoma A, et al. The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines. Int J Surg. 2020 Dec;84:226–30.
7. Nissen H, et al. (2019). “Coxa vara in osteogenesis imperfecta: A review of the literature.” Journal of Bone and Joint Surgery.
8. Papanna MC, Tafazal S, Bell MJ, Giles SN, Fernandes JA. Femoral neck fractures in osteogenesis imperfecta treated with bisphosphonates. J Child Orthop. 2017 Jun;11(3):191–4.
9. Hong WK, Lee DJ, Chung HJ, Lim C, Shin CH, Yoo WJ, et al. Patterns of femoral neck fracture and its treatment methods in patients with osteogenesis imperfecta. J Pediatr Orthop B. 2022 Mar 1;31(2):E114–21.
10. Shapiro M, et al. (2020). “Rehabilitation strategies for patients with osteogenesis imperfecta.” Physical Therapy Reviews.
11. von Kroge S, Stürznickel J, Bechler U, Stockhausen KE, Eissele J, Hubert J, et al. Impaired bone quality in the superolateral femoral neck occurs independent of hip geometry and bone mineral density. Acta Biomater. 2022 Mar 15;141:233–43.

How to Cite this Article: Hudna AS, Al-Zuhairi MM, Mohammed RM, Farwan YM, Khamis AY, Yousef KW, Al-wardi ZA. Patterns, Anatomical Distribution and Etiologies of Paediatric Fractures in a Tertiary Care Hospital in Sana’a City, Yemen: A Five-Year Retrospective Analysis. International Journal of Paediatric Orthopaedics. September-December 2025; 11(3): 02-09

(Article Text HTML) (Full Text PDF)

Patterns, Anatomical Distribution and Etiologies of Paediatric Fractures in a Tertiary Care Hospital in Sana’a City, Yemen: A Five-Year Retrospective Analysis

DOI- https://doi.org/10.13107/ijpo.2025.v11.i03.242

Open Access License: CC BY-NC 4.0

Submitted: 15/08/2025; Reviewed: 08/09/2025; Accepted: 09/11/2025; Published: 10/12/2025

Authors: Ahmed S. Hudna MD [1], Mohammed M. Al-Zuhairi MBBS [2], Reham M. Mohammed MBBS [1], Yahya M. Farwan MBBS [3], Abdulrahman Y. Khamis MBBS [4], Kamal W. Yousef MBBS [4], Zinab A. Al-wardi MBBS [5]

[1] Department of Paediatrics, Faculty of Medicine and Health Sciences, University of Science and Technology (USTY), Sana’a, Yemen.
[2] Department of Obstetrics, Al-Thawra Modern General Hospital, Sana’a, Yemen
[3] Department of Surgery, University of Science and Technology Hospital, Sana’a, Yemen
[4] Department of Medicine, University of Science and Technology Hospital, Sana’a, Yemen
[5] Al-Aliaa International Hospital, Sana’a, Yemen

Address of Correspondence
Dr. Ahmed Saleh Hudna,
Associate Professor of Paediatrics, Faculty of Medicine and Health Sciences, University of Science and Technology. Sana’a, Yemen,
drahmedhudna@gmail.com

Abstract

Background: Fractures in children are a major global health concern, contributing to morbidity, healthcare burden, and potential long-term disability. In Yemen, the epidemiology and management of paediatric fractures remain poorly documented. Therefore, this study aimed to investigate the patterns, anatomical distribution, etiologies and concomitant injuries associated with paediatric fractures over a five-year period from 2020 to 2024.
Methods: A retrospective cross-sectional study was conducted at the University of Science and Technology Hospital in Sana’a between January 2020 and December 2024 involving 466 medical records of children aged ≤18 years and with documented fractures. Data on demographics, fracture characteristics, etiology, and associated systemic injuries were extracted using a structured data collection sheet. Data were summarized using appropriate descriptive statistics.
Results: Among 466 children with fractures, the majority were boys (78.8%). The mean age was 11.0 ± 4.4 years, with 52.8% aged ≤11 years. Fractures were almost equally distributed between left and right sides (50.6% vs. 49.4%) and upper and lower limbs (46.6% vs. 45.3%), with pelvic fractures being rare (0.9%). Single fractures predominated (68%), while 32% involved multiple fractures; 7.3% had fractures at multiple anatomical sites. In the upper limbs, the radius (32.2%) and humerus (29.4%) were most frequently fractured. In the lower limbs, the femur (40.1%) and tibia (35.5%) fractures predominated. Multiple-site fractures most often involved phalanges of the hand with the tibia and fibula (26.5%). Quotidian injuries were the leading cause (72.1%), followed by road traffic accidents (21.5%). Concomitant injuries occurred in 4.5% of cases, primarily affecting the nervous system (76.2%).
Conclusions: Paediatric fractures in Sana’a predominantly affected boys and children aged ≤11 years, with an almost equal distribution between limbs and sides. The radius, humerus, femur, and tibia were most frequently affected. Injuries sustained during routine activities were the leading cause, followed by road traffic accidents. Concomitant injuries, mainly neurological were uncommon.
Keywords: Paediatric fractures, Daily-life injuries, Sport injuries, Yemen

References

1. George MP, Bixby S. Frequently missed fractures in paediatric trauma: a pictorial review of plain film radiography. Radiol Clin North Am. 2019;57(4):843-55. doi: 10.1016/j.rcl.2019.02.009.
2. Rennie L, Court-Brown CM, Mok JY, Beattie TF. The epidemiology of fractures in children. Injury. 2007;38(8):913-22. doi: 10.1016/j.injury.2007.01.036.
3. Markiewitz ND, Garcia-Munoz J, Lilley BM, Oduwole S, Shah AS, Williams BA. Epidemiologic changes in paediatric fractures presenting to emergency departments during the COVID-19 pandemic. J Pediatr Orthop. 2022;42(8):e815-e20. doi: 10.1097/bpo.0000000000002194.
4. Qiu X, Deng H, Su Q, Zeng S, Han S, Li S, et al. Epidemiology and management of 10,486 paediatric fractures in Shenzhen: experience and lessons to be learnt. BMC Pediatr. 2022;22(1):161. doi: 10.1186/s12887-022-03199-0.
5. Cintean R, Eickhoff A, Zieger J, Gebhard F, Schütze K. Epidemiology, patterns, and mechanisms of paediatric trauma: a review of 12,508 patients. Eur J Trauma Emerg Surg. 2023;49(1):451-9. doi: 10.1007/s00068-022-02088-6.
6. Rosendahl K, de Horatio LT, Habre C, Shelmerdine SC, Patsch J, Kvist O, et al. The incidence of fractures in children under two years of age: a systematic review. BMC Musculoskelet Disord. 2024;25(1):528. doi: 10.1186/s12891-024-07633-5.
7. Lindaman LM. Bone healing in children. Clin Podiatr Med Surg. 2001;18(1):97-108.
8. Rodríguez-Merchán EC. Paediatric skeletal trauma: a review and historical perspective. Clin Orthop Relat Res. 2005;(432):8-13.
9. Thornton MD, Della-Giustina K, Aronson PL. Emergency department evaluation and treatment of paediatric orthopaedic injuries. Emerg Med Clin North Am. 2015;33(2):423-49. doi: 10.1016/j.emc.2014.12.012.
10. Kalenderer O, Gürcü T, Reisoğlu A, Ağuş H. [The frequency and distribution of fractures in children presenting to the emergency service]. Acta Orthop Traumatol Turc. 2006;40(5):384-7.
11. Arora R, Fichadia U, Hartwig E, Kannikeswaran N. Paediatric upper-extremity fractures. Pediatr Ann. 2014;43(5):196-204. doi: 10.3928/00904481-20140417-12.
12. Goulding A. Risk factors for fractures in normally active children and adolescents. Med Sport Sci. 2007;51:102-20. doi: 10.1159/000103007.
13. Ryan LM. Forearm fractures in children and bone health. Curr Opin Endocrinol Diabetes Obes. 2010;17(6):530-4. doi: 10.1097/MED.0b013e32833e9c8b.
14. Varkal MA, Gulenc B, Yildiz I, Kandemir I, Bilgili F, Toprak S, et al. Vitamin D level, body mass index and fracture risk in children: vitamin D deficiency and fracture risk. J Pediatr Orthop B. 2022;31(2):e264-e70. doi: 10.1097/bpb.0000000000000867.
15. Joeris A, Lutz N, Wicki B, Slongo T, Audigé L. An epidemiological evaluation of paediatric long bone fractures – a retrospective cohort study of 2716 patients from two Swiss tertiary paediatric hospitals. BMC Pediatr. 2014;14:314. doi: 10.1186/s12887-014-0314-3.
16. Sural S, Verma A. The clinical profile of musculoskeletal injuries in children attending a major hospital in Delhi, India. J Clin Orthop Trauma. 2015;6(1):12-8. doi: 10.1016/j.jcot.2014.12.007.
17. Xiao X, Ding Y, Zheng Y, Gao Y, Li H, Liu R, et al. Epidemiological investigation of paediatric fractures-A retrospective cohort study of 1129 patients. Medicina (Kaunas). 2023;59(4). doi: 10.3390/medicina59040788.
18. Manan MR, Rahman S, Komer L, Manan H, Iftikhar S. A Multispecialty approach to the identification and diagnosis of nonaccidental trauma in children. Cureus. 2022;14(7):e27276. doi: 10.7759/cureus.27276.
19. Haney S, Scherl S, DiMeglio L, Perez-Rossello J, Servaes S, Merchant N. Evaluating young children with fractures for child abuse: clinical report. Paediatrics. 2025;155(2). doi: 10.1542/peds.2024-070074.
20. Baldwin K, Pandya NK, Wolfgruber H, Drummond DS, Hosalkar HS. Femur fractures in the paediatric population: abuse or accidental trauma? Clin Orthop Relat Res. 2011;469(3):798-804. doi: 10.1007/s11999-010-1339-z.
21. Arneitz C, Bartik C, Weitzer CU, Schmidt B, Gasparella P, Tschauner S, et al. Distribution and pattern of hand fractures in children and adolescents. Eur J Pediatr. 2023;182(6):2785-92. doi: 10.1007/s00431-023-04915-3.
22. Malik S, Malik S, Theobald P, Jones M. Distinguishing fractures from accidental and non-accidental injury in children. J Trauma Treat. 2012;1:e102.
23. England SP, Sundberg S. Management of common paediatric fractures. Pediatr Clin North Am. 1996;43(5):991-1012. doi: 10.1016/s0031-3955(05)70447-8.
24. Boutis K. The emergency evaluation and management of paediatric extremity fractures. Emerg Med Clin North Am. 2020;38(1):31-59. doi: 10.1016/j.emc.2019.09.003.
25. Musgrave DS, Mendelson SA. Paediatric orthopaedic trauma: principles in management. Crit Care Med. 2002;30(11 Suppl):S431-43. doi: 10.1097/00003246-200211001-00008.
26. Ömeroğlu H. Basic principles of fracture treatment in children. Eklem Hastalik Cerrahisi. 2018;29(1):52-7. doi: 10.5606/ehc.2018.58165.
27. Schalamon J, Petnehazy T. The management of traumatic fractures in children. Minerva Pediatr. 2009;61(2):185-92.
28. Murphy D, Raza M, Monsell F, Gelfer Y. Modern management of paediatric tibial shaft fractures: an evidence-based update. Eur J Orthop Surg Traumatol. 2021;31(5):901-9. doi: 10.1007/s00590-021-02988-0.
29. Leiblein M, Lustenberger T, Schulz AK, Schmitz-Rixen T, Marzi I. Neurovascular complications after supracondylar humerus fractures in children. Trauma Case Rep. 2017;8:16-9. doi: 10.1016/j.tcr.2017.01.013.
30. Mills LA, Simpson AH. The risk of non-union per fracture in children. J Child Orthop. 2013;7(4):317-22. doi: 10.1007/s11832-013-0521-8.
31. Ahmed N, Kuo YH. Factors associated with compartment syndrome after a tibial fracture in children. Trauma Surg Acute Care Open. 2023;8(1):e001158. doi: 10.1136/tsaco-2023-001158.
32. Le B, Mudiganty S, Skalak T. Physeal growth arrest in distal radius fracture: a case report. J Orthop Case Rep. 2024;14(7):83-7. doi: 10.13107/jocr.2024.v14.i07.4584.
33. Cheng JC, Shen WY. Limb fracture pattern in different paediatric age groups: a study of 3,350 children. J Orthop Trauma. 1993;7(1):15-22. doi: 10.1097/00005131-199302000-00004.
34. Peterson HA, Madhok R, Benson JT, Ilstrup DM, Melton LJ, 3rd. Physeal fractures: Part 1. Epidemiology in Olmsted County, Minnesota, 1979-1988. J Pediatr Orthop. 1994;14(4):423-30. doi: 10.1097/01241398-199407000-00002.
35. Cheng JC, Ng BK, Ying SY, Lam PK. A 10-year study of the changes in the pattern and treatment of 6,493 fractures. J Pediatr Orthop. 1999;19(3):344-50.
36. Mahabir RC, Kazemi AR, Cannon WG, Courtemanche DJ. Paediatric hand fractures: a review. Pediatr Emerg Care. 2001;17(3):153-6. doi: 10.1097/00006565-200106000-00001.
37. Korup LR, Larsen P, Nanthan KR, Arildsen M, Warming N, Sørensen S, et al. Children’s distal forearm fractures: a population-based epidemiology study of 4,316 fractures. Bone Jt Open. 2022;3(6):448-54. doi: 10.1302/2633-1462.36.bjo-2022-0040.r1.
38. Nwadinigwe CU, Ihezie CO, Iyidiobi EC. Fractures in children. Niger J Med. 2006;15(1):81-4. doi: 10.4314/njm.v15i1.37124.
39. Landin LA. Epidemiology of children’s fractures. J Pediatr Orthop B. 1997;6(2):79-83. doi: 10.1097/01202412-199704000-00002.
40. Valerio G, Gallè F, Mancusi C, Di Onofrio V, Colapietro M, Guida P, et al. Pattern of fractures across paediatric age groups: analysis of individual and lifestyle factors. BMC Public Health. 2010;10:656. doi: 10.1186/1471-2458-10-656.
41. Koga H, Omori G, Koga Y, Tanifuji O, Mochizuki T, Endo N. Increasing incidence of fracture and its sex difference in school children: 20 year longitudinal study based on school health statistic in Japan. J Orthop Sci. 2018;23(1):151-5. doi: 10.1016/j.jos.2017.09.005.
42. Blimkie CJ, Lefevre J, Beunen GP, Renson R, Dequeker J, Van Damme P. Fractures, physical activity, and growth velocity in adolescent Belgian boys. Med Sci Sports Exerc. 1993;25(7):801-8. doi: 10.1249/00005768-199307000-00008.
43. Schalamon J, Dampf S, Singer G, Ainoedhofer H, Petnehazy T, Hoellwarth ME, et al. Evaluation of fractures in children and adolescents in a Level I Trauma Center in Austria. J Trauma. 2011;71(2):E19-25. doi: 10.1097/TA.0b013e3181f8a903.
44. Mortensson W, Thönell S. Left-side dominance of upper extremity fracture in children. Acta Orthop Scand. 1991;62(2):154-5. doi: 10.3109/17453679108999245.
45. Reddy S, Dhaniwala N. Diaphyseal fractures in paediatric age group in rural area: a demographic study. J Datta Meghe Inst Med Sci Univ. 2019;14(3):189-91.
46. Kriss S, Thompson A, Bertocci G, Currie M, Martich V. Characteristics of rib fractures in young abused children. Pediatr Radiol. 2020;50(5):726-33. doi: 10.1007/s00247-019-04599-8.
47. Deakin DE, Crosby JM, Moran CG, Chell J. Childhood fractures requiring inpatient management. Injury. 2007;38(11):1241-6. doi: 10.1016/j.injury.2007.05.023.
48. Merckaert S, Chaibi E, Meriem S, Kwiatkowski B, Divjak N, Zambelli PY. Epidemiology of paediatric upper extremity fractures in a tertiary care center in Switzerland. Pediatr Emerg Care. 2021;37(12):e825-e35. doi: 10.1097/pec.0000000000002047.
49. Harrington J, Sochett E. The child with multiple fractures, what next? Pediatr Clin North Am. 2015;62(4):841-55. doi: 10.1016/j.pcl.2015.04.006.
50. Lee S-H, Jeong W-K, Kim H-w, Song K-S, Shin H-D, Shim J-S, et al. Upper extremity fractures in children-prospective epidemiological study of tertiary medical institutes. J Korean Orthop Assoc. 2007;42(2):270-5.
51. Rossi L, Panuccio E, Leigheb M. Current concepts on paediatric clavicle, humerus, radius and ulna fractures. Chirurgia. 2023;36(5):273-80.
52. Mumtaz Hashmi H, Shamim N, Kumar V, Anjum N, Ahmad K. Clavicular fractures in newborns: what happens to one of the commonly injured bones at birth? Cureus. 2021;13(9):e18372. doi: 10.7759/cureus.18372.
53. Liu H, Wang H, Shao B, Lu H, Zhang S, Ou L, et al. Epidemiological evaluation of traumatic lower limb fractures in children: Variation with age, gender, time, and etiology. Medicine (Baltimore). 2019;98(38):e17123. doi: 10.1097/md.0000000000017123.
54. Phala MP, Rachuene PA, Socutshana B, Bila KS. Access gate-related lower limb fractures in children and adolescents: a review of injury patterns and evaluation of associated injuries. SA Orthop J. 2022;21(4):198-201.
55. Lamb LC, Montgomery SC, Wong Won B, Harder S, Meter J, Feeney JM. A multidisciplinary approach to improve the quality of care for patients with fragility fractures. J Orthop. 2017;14(2):247-51. doi: 10.1016/j.jor.2017.03.004.
56. Steiger C, De Marco G, Cuérel C, Tabard-Fougère A, Chargui M, Dayer R, et al. A retrospective epidemiological cohort study of ankle fractures in children and teenagers. J Child Orthop. 2023;17(4):348-53. doi: 10.1177/18632521231182424.
57. Engström Z, Wolf O, Hailer YD. Epidemiology of paediatric femur fractures in children: the Swedish Fracture Register. BMC Musculoskelet Disord. 2020;21(1):796. doi: 10.1186/s12891-020-03796-z.
58. Oleck NC, Dobitsch AA, Liu FC, Halsey JN, Le TT, Hoppe IC, et al. Traumatic falls in the paediatric population: facial fracture patterns observed in a leading cause of childhood injury. Ann Plast Surg. 2019;82(4S Suppl 3):S195-s8. doi: 10.1097/sap.0000000000001861.

(Article Text HTML) (Full Text PDF)

Avulsion Fracture of the Plantar Calcaneocuboid Ligament in a Skeletally Immature Patient: A Case Report

DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.236

Open Access License: CC BY-NC 4.0

Submitted: 06/05/2025; Reviewed: 02/06/2025; Accepted: 14/07/2025; Published: 10/08/2025

Authors: Maulin Shah MS Ortho [1], Shalin Shah MS Ortho [1], Chinmay Sangole MS Ortho [1], Meet Jain MS Ortho [1], Vaibhav Mittal MS Ortho [1], Kunal Singla MS Ortho [1]

[1] Department of Pediatric Orthopedic Surgery, Orthokids Clinic, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Maulin M. Shah
Consultant Pediatric Orthopedic Surgeon, Orthokids Clinic, Ahmedabad, Gujarat, India.
Email: maulinmshah@gmail.com

Abstract

Introduction: Isolated calcaneocuboid ligament (CCL) avulsion is a rare and often overlooked injury, previously described only in adults. Due to subtle or absent radiographic findings, diagnosis is frequently missed which is evident only on the lateral view radiographs of foot. We report, to our knowledge, the first paediatric case of plantar CCL avulsion, successfully treated with plaster immobilization.
Case: A 9-years-old male child presented to us with a dorsiflexion and inversion injury to the foot. While no fracture was evident on dorso-plantar and oblique foot radiographs, fracture was visible on the lateral radiograph as a bony avulsion fracture on the plantar aspect of the cuboid. MRI further delineated the morphology of the fracture pattern. Conservative management in the form of below knee cast was given. Good outcome was obtained at 1 year follow-up.
Conclusion: Avulsion fracture of the plantar calcaneocuboid ligament is rare and this is the first reported case of this injury in a child.
Keywords: Calcaneocuboid ligament, Lateral foot pain, Paediatric foot

References

1. Andermahr J, Helling HJ, Maintz D, Mönig S, Koebke J, Rehm KE. The injury of the calcaneocuboid ligaments. Foot & ankle international. 2000 May;21(5):379-84.
2. Nicastro JF, Haupt HA. Probable stress fracture of the cuboid in an infant. A case report. JBJS. 1984 Sep 1;66(7):1106-8.
3. Simonian PT, Vahey JW, Rosenbaum DM, Mosca VS, Staheli LT. Fracture of the cuboid in children. A source of leg symptoms. The Journal of bone and joint surgery. British volume. 1995 Jan;77(1):104-6.
4. O’Dell MC, Chauvin NA, Jaramillo D, Biko DM. MR imaging features of cuboid fractures in children. Pediatric radiology. 2018 May 1;48(5):680-5.
5. Melão L, Canella C, Weber M, Negrao P, Trudell D, Resnick D. Ligaments of the transverse tarsal joint complex: MRI–anatomic correlation in cadavers. American Journal of Roentgenology. 2009 Sep;193(3):662-71.
6. Leland RH, Marymont JV, Trevino SG, Varner KE, Noble PC (2001) Calcaneocuboid stability: a clinical and anatomic study. Foot Ankle Int 22:880–884
7. Wiley JJ. Tarso-metatarsal joint injuries in children. J Pediatr Orthop. 1981;1:255Y260.
8. Wiley JJ. The mechanism of tarso-metatarsal joint injuries. J Bone Joint Surg Br. 1971;53:474Y482
9. Englaro EE, Gelfand MJ, Paltiel HJ. Bone Scintigraphyin Preschool Children with Lower Extremity Pain of Unknown Origin.
10. Blumberg K, Patterson RJ. The toddler’s cuboid fracture. Radiology. 1991 Apr;179(1):93-4.
11. Bahel A, Joseph SY. Lateral plantar pain: diagnostic considerations. Emergency radiology. 2010 Jul 1;17(4):291-8.
12. Senaran H, Mason D, De Pellegrin M. Cuboid fractures in preschool children. Journal of Pediatric Orthopaedics. 2006 Nov 1;26(6):741-4.

How to Cite this Article: Shah M, Shah S, Sangole C, Jain M, Mittal V, Singla K. Avulsion Fracture of the Plantar Calcaneocuboid Ligament in a Skeletally Immature Patient: A Case Report. International Journal of Paediatric Orthopaedics . May-August 2025; 11(2): 27-30.

(Article Text HTML) (Full Text PDF)

Focal Fibrocartilaginous Dysplasia of the Distal Femur with Secondary Genu Valgum and Patellar Dislocation: Case Report and Literature Review

DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.234

Open Access License: CC BY-NC 4.0

Submitted: 09/10/2024; Reviewed: 02/11/2024; Accepted: 11/06/2025; Published: 10/08/2025

Authors: Rakesh Kumar DNB Ortho [1], K. Venkatadass MS Ortho [1], S. Rajasekaran MS Ortho [1]
[1] Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.

Address of Correspondence
Dr. K Venkatadass
Fellow in Paediatric Orthopaedics, Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
E-mail: Vk@gangahospital.net

Abstract

Background: Focal fibrocartilaginous dysplasia (FFCD) is a rare fibrous dysplasia that predominantly affects the long bones of children, often leading to angular deformities and limb length discrepancies. The condition is characterized by the presence of fibrous tissue and hyaline cartilage and can mimic other bone disorders.
Case Presentation: A 3-year-old girl presented with progressive left-sided genu valgum and patellar dislocation, noticed since the onset of ambulation at 18 months. Initial management involved observation, but due to worsening symptoms, further evaluation was sought. Clinical examination revealed a range of motion of the left knee from 0 to 100 degrees and lateral dislocation of the patella at 60 degrees of flexion. Radiological assessments showed a mechanical lateral distal femur angle (mLDFA) of 59 degrees and a well-defined fibrotic band on MRI, indicative of FFCD. A limb length discrepancy of 2 cm was present.
Intervention: Surgical management involved curettage of the fibrocartilaginous lesion and a corrective osteotomy using the LRS (Limb Reconstruction System) assisted technique, combined with the Roux-Goldwaith procedure to address the patellar dislocation.
Outcome: Postoperative follow-up over seven months showed satisfactory alignment of the femur, normal patellar tracking, and correction of the limb length discrepancy. Histological analysis confirmed the diagnosis of FFCD.
Conclusion: The combined approach of curettage and corrective osteotomy, along with soft tissue procedures, effectively managed the angular deformity and patellar dislocation in this case of FFCD. This case underscores the importance of early surgical intervention in managing progressive deformities associated with patellar dislocation due to FFCD.
Keywords: Focal fibrocartilaginous dysplasia, FFCD, Genu valgum, Femur deformity, Roux Goldwaith procedure, Curettage, Case report.

References

1. Kyriakos M., McDonald D. J., & Sundaram M. (2004). Fibrous dysplasia with cartilaginous differentiation (“fibrocartilaginous dysplasia”): a review, with an illustrative case followed for 18 years. Skeletal Radiology, 33(1), 51-62. https://doi.org/10.1007/s00256-003-0718-x
2. Muezzinoglu B., & Oztop F. (2001). Fibrocartilaginous dysplasia: a variant of fibrous dysplasia. The Malaysian Journal of Pathology, 23(1), 35-39.
3. Choi I. H., Kim C. J., Cho T. J., Chung C. Y., Song K. S., Hwang J. K., et al. (2000). Focal fibrocartilaginous dysplasia of long bones: report of eight additional cases and literature review. Journal of Pediatric Orthopedics, 20(4), 421-427.
4. Bian Z., Lyu X., Guo Y., Zhu Z., Feng C., Yang J., et al. (2020). Focal fibrocartilaginous dysplasia of the distal femur. Journal of Pediatric Orthopaedics B, 29(5), 466-471. https://doi.org/10.1097/BPB.0000000000000742
5. Jouve J.-L., Dohin B., & Bollini G. (2007). Focal Fibrocartilaginous Dysplasia (BFibrous Periosteal Inclusion^). J Pediatr Orthop, 27(1).
6. Thabet A. M., Belthur M. V., & Herzenberg J. E. (2010). Spontaneous resolution of angular deformity of the distal femur in focal fibrocartilaginous dysplasia: a case report. Journal of Pediatric Orthopaedics B, 19(2), 161-163. https://doi.org/10.1097/BPB.0b013e3283361b11
7. Johari A., & Anjum R. (2019). Spontaneous resolution of focal fibrocartilaginous dysplasia of femur on long-term follow-up: case report and review of literature. Journal of Pediatric Orthopaedics B, 28(2), 127-131. https://doi.org/10.1097/BPB.0000000000000570
8. Ruchelsman D. E., Madan S. S., & Feldman D. S. (2004). Genu Valgum Secondary to Focal Fibrocartilaginous Dysplasia of the Distal Femur. J Pediatr Orthop, 24(4).
9. Langenskiöld A. (1989). Tibia vara. A critical review. Clinical Orthopaedics and Related Research, (246), 195-207.
10. Bell S. N., Campbell P. E., Cole W. G., & Menelaus M. B. (1985). Tibia vara caused by focal fibrocartilaginous dysplasia. Three case reports. The Journal of Bone and Joint Surgery. British Volume, 67(5), 780-784. https://doi.org/10.1302/0301-620X.67B5.4055881
11. Beaty J. H., & Barrett I. R. (1989). Unilateral angular deformity of the distal end of the femur secondary to a focal fibrous tether. A report of four cases. The Journal of Bone and Joint Surgery. American Volume, 71(3), 440-445.
12. Zayer M. (1992). Tibia vara in focal fibrocartilaginous dysplasia. A report of 2 cases. Acta Orthopaedica Scandinavica, 63(3), 353-355. https://doi.org/10.3109/17453679209154802
13. Albiñana J., Cuervo M., Certucha J. A., Gonzalez-Mediero I., & Abril J. C. (1997). Five additional cases of local fibrocartilaginous dysplasia. Journal of Pediatric Orthopedics. Part B, 6(1), 52-55. https://doi.org/10.1097/01202412-199701000-00011
14. Macnicol M. F. (1999). Focal fibrocartilaginous dysplasia of the femur. Journal of Pediatric Orthopedics. Part B, 8(1), 61-63.
15. Welborn M. C., & Stevens P. (2017). Correction of Angular Deformities Due to Focal Fibrocartilaginous Dysplasia Using Guided Growth: A Preliminary Report. Journal of Pediatric Orthopaedics, 37(3), e183-e187. https://doi.org/10.1097/BPO.0000000000000785

How to Cite this Article: Kumar R, Venkatadass K, Rajasekaran S. Focal Fibrocartilaginous Dysplasia of the Distal Femur with Secondary Genu Valgum and Patellar Dislocation: Case Report and Literature Review. International Journal of Paediatric Orthopaedics . May-August 2025; 11(2):21-26 .

Abstract

Abstract

Abstract

Abstract

Abstract

(Article Text HTML) (Full Text PDF)

Abstract

License

Publisher