Blog Single Author Big - International Journal of Paediatric Orthopaedics

Varus Derotation Osteotomy of the Proximal Femur in Neuromuscular Children Using a Locking Plate-Surgical Technique and Initial Results

DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.232

Open Access License: CC BY-NC 4.0

Submitted: 21/06/2024; Reviewed: 18/07/2024; Accepted: 27/05/2025; Published: 10/08/2025

Authors: Njalalle Baraza FRCS (Tr & Orth) [1], Mordicai Ating’a FRCS (Tr & Orth) [1]
[1] Department of Trauma and Orthopaedics, Aga Khan University, 3rd Parklands Avenue, P.O. Box 30270, GPO 00100, Nairobi, Kenya

Address of Correspondence
Dr. Njalalle Baraza,
Department of Trauma and Orthopaedics, Aga Khan University, 3rd Parklands Avenue, P.O. Box 30270, GPO 00100, Nairobi, Kenya
E-mail: njaleb@doctors.org.uk

Abstract

Introduction: Hip dysplasia affects up to 33% of children with neuromuscular disease. The main objective of treatment is improvement of femoral head coverage. Depending on the severity of dysplasia, treatment required may range from casting in abduction to salvage procedures including excision arthroplasty. The most commonly employed surgical procedure is a varus derotation osteotomy (VDRO) which is usually undertaken using a fixed angle blade plate, with or without a pelvic osteotomy. Unfortunately these implants are not always available. We therefore developed a novel technique using a locally available locking reconstruction plate to perform VDRO surgery, and present our initial results following the use of this technique.
Methods: Six hip in four patients of GMFCS IV or V suffering from hip dysplasia were included in the study. Pre and postoperative Reimers migration percentage (MP) was measured. In the three hips that underwent pelvic (Dega) osteotomy, the acetabular index (AI) was also measured. A paired t-test for non-parametric data was used to determine statistical significance.
Results: At an average of 8 months follow up, the pre-op MP had reduced from 64% to 23.3% (p=0.026). In the hips who had Dega osteotomy, the AI went down from 33.3 degrees to 23.3 degrees (p=0.013) at an average of 5 months follow up.
Conclusion: In the absence of a blade plate, the novel technique described is an effective alternative in performing VDRO surgery.
Keywords: Varus derotation osteotomy, VDRO, Neuromuscular hip, Hip dysplasia, Cerebral palsy, Hip surgery

References

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How to Cite this Article: Baraza N, Ating’a M. Varus Derotation Osteotomy of the Proximal Femur in Neuromuscular Children Using a Locking Plate-Surgical Technique and Initial Results. International Journal of Paediatric Orthopaedics . May-August 2025; 11(2):16-20.

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“Rachitomalacia” – Radiological Findings of a “New” Intermediate Entity in Adolescents

DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.230

Open Access License: CC BY-NC 4.0

Submitted: 21/06/2025; Reviewed: 02/07/2025; Accepted: 23/07/2025; Published: 10/08/2025

Authors: Anil Agarwal MS Ortho [1], Sitanshu Barik MS Ortho [2], Eknoor Kaur MS Ortho [3]

[1] Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
[2] Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, India.
[3] Department of Hand Surgery, Christian Medical College, Vellore, Tamil Nadu, India.

Address of Correspondence

Dr. Anil Agarwal,
Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Delhi, India
E-mail: anilrachna@gmail.com

Abstract

Background: This study proposes an intermediate radiological entity in adolescents with calcium/vitamin D deficiency, exhibiting features of both rickets and osteomalacia but lacking classical signs of either. We have used the term “Rachitomalacia” to describe this unique radiographic presentation. The report describes the atypical radiological findings of rachitomalacia in adolescents and highlights its distinction from classical rickets and osteomalacia. The study will aid in the early diagnosis and appropriate management of this previously unrecognized clinical and radiographic entity.
Material and Methods: A retrospective analysis of 10 adolescents (8 females, 2 males; mean age 11.1±0.6 years) presenting to a tertiary pediatric hospital (2020–2021) with knee deformities or pain. Inclusion criteria: (1) radiographs showing metaphyseal lucency with vertical striations or widened physis without cupping/splaying; (2) biochemical evidence of vitamin D deficiency (25(OH)D <20 ng/mL) and/or elevated alkaline phosphatase; (3) exclusion of non-nutritional metabolic disorders (e.g., hypophosphatemic rickets). Biochemical and radiographic assessments were performed, followed by calcium/vitamin D therapy.
Results: All patients demonstrated hypovitaminosis D (18.9±4.8 ng/mL) and elevated alkaline phosphatase (1196.7±689.9 IU/L), with normal serum calcium/phosphorus. Radiographs revealed: (1) loss of metaphyseal architecture with vertical striations, (2) widened physis with osteopenia, and (3) incomplete metaphyseal fractures. Treatment normalized biochemical/radiological parameters.
Conclusion: Rachitomalacia presents with subtle, atypical radiographic features in adolescents, distinct from classical rickets or osteomalacia. Recognizing these signs—particularly metaphyseal striations and physeal widening—is critical to prompt diagnosis and treatment, preventing deformities during rapid pubertal growth. Clinicians should consider rachitomalacia in adolescents with nonspecific musculoskeletal complaints and suboptimal vitamin D levels.
Keywords: Rickets, Osteomalacia, Adolescent, Radiograph

References

[1] Moncrieff MW, Lunt HR, Arthur LJ. Nutritional rickets at puberty. Arch Dis Child 1973;48:221–4. https://doi.org/10.1136/adc.48.3.221.
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[4] Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. Horm Res Paediatr 2016;85:83–106. https://doi.org/10.1159/000443136.
[5] Frush TJ, Lindenfeld TN. Peri-epiphyseal and Overuse Injuries in Adolescent Athletes. Sports Health 2009;1:201–11. https://doi.org/10.1177/1941738109334214.
[6] Cianferotti L. Osteomalacia Is Not a Single Disease. Int J Mol Sci 2022;23:14896. https://doi.org/10.3390/ijms232314896.

How to Cite this Article: Agarwal A, Barik A, Kaur E. “Rachitomalacia” – Radiological findings of a “New” Intermediate Entity in Adolescents. International Journal of Paediatric Orthopaedics. May-August 2025; 11(2): 11-15.

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Pediatric Anterior Cruciate Ligament Tears: Epidemiology, Evaluation, and Evolving Treatment Strategies

DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.226

Open Access License: CC BY-NC 4.0

Submitted: 01/06/2025; Reviewed: 30/06/2025; Accepted: 06/07/2025; Published: 10/08/2025

Authors: Doria L. Weiss BS [1] , Alexis Carr BS [1], Kevin Berardino MD [1], Kevin Quindlen MD [1], Rachel Talley-Bruns MD [1]

[1] Westchester Medical Center, Department of Orthopaedic Surgery, Valhalla, NY

Address of Correspondence

Dr. Doria L. Weiss,
Westchester Medical Center, Department of Orthopaedic Surgery, Valhalla, NY.
E-mail: dweiss23@student.nymc.edu

Abstract

Introduction: Anterior cruciate ligament (ACL) tears in pediatric patients are increasingly recognized due to rising sports participation and improved imaging. Given the presence of open physes, treatment decisions must balance the need for knee stability with the risk of growth disturbance. This review outlines current approaches to diagnosis, surgical techniques, graft selection, postoperative rehabilitation, and complications in skeletally immature patients.
Methods: This review summarizes recent literature on pediatric ACL injuries, including epidemiology, injury patterns, surgical management strategies, graft options, rehabilitation protocols, and complication rates. Emphasis is placed on the rationale behind technique selection based on skeletal maturity and long-term outcomes.
Results: Surgical reconstruction has become the preferred treatment for most pediatric ACL injuries to prevent secondary damage and restore knee stability. Several physeal-sparing and transphyseal techniques are available, with selection guided by skeletal age and growth remaining. All-epiphyseal and extraphyseal techniques avoid crossing the physis, while transphyseal reconstruction is safe in adolescents nearing skeletal maturity. Hamstring and quadriceps tendon autografts are most commonly used, while bone–patellar tendon–bone grafts and allografts are generally avoided in younger patients. Graft failure and growth disturbance remain key concerns, with retear rates reaching up to 20% and growth abnormalities occurring in 1–5% of cases. Rehabilitation protocols are evolving toward milestone-based progression, with return to sport typically delayed at least 12 months. However, re-injury rates remain high in this population.
Conclusions: ACL injuries in pediatric patients require a nuanced, age-specific approach. Surgical reconstruction using physeal-respecting or transphyseal techniques offers favorable outcomes when matched to skeletal maturity. Careful graft selection, individualized rehabilitation, and delayed return to sport are essential to optimize results and reduce complications. Ongoing research is needed to refine surgical strategies, compare graft types, and establish evidence-based rehabilitation and return-to-sport guidelines.
Keywords: Paediatrics, Anterior Cruciate Ligament Tears, Epidemiology, Evaluation, Evolving Treatment Strategies

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68. Wang B, Zhong JL, Xu XH, Shang J, Lin N, Lu HD. Incidence and risk factors of joint stiffness after Anterior Cruciate Ligament reconstruction. J Orthop Surg. 2020;15:175. doi:10.1186/s13018-020-01694-7
69. Kaeding CC, Pedroza AD, Reinke EK, Huston LJ, MOON Consortium, Spindler KP. Risk Factors and Predictors of Subsequent ACL Injury in Either Knee After ACL Reconstruction: Prospective Analysis of 2488 Primary ACL Reconstructions From the MOON Cohort. Am J Sports Med. 2015;43(7):1583-1590. doi:10.1177/0363546515578836
70. Nester JR, Torino D, Sylvestre D, et al. Risk of reoperation after primary anterior cruciate ligament reconstruction in children and adolescents. J Orthop Surg. 2022;30(2):10225536221122340. doi:10.1177/10225536221122340
71. Cordasco FA, Black SR, Price M, et al. Return to Sport and Reoperation Rates in Patients Under the Age of 20 After Primary Anterior Cruciate Ligament Reconstruction: Risk Profile Comparing 3 Patient Groups Predicated Upon Skeletal Age. Am J Sports Med. 2019;47(3):628-639. doi:10.1177/0363546518819217
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How to Cite this Article: Weiss DL, Carr A, Berardino K, Quindlen K, Bruns RT. Paediatric Anterior Cruciate Ligament Tears: Epidemiology, Evaluation, and Evolving Treatment Strategies. International Journal of Paediatric Orthopaedics . May-August 2025; 11(2): 02-10.

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Editorial

Volume 11 | Issue 1 | January-April 2025 | Page: 01 | Jayanth S. Sampath

DOI- https://doi.org/10.13107/ijpo.2025.v11.i01.210

Authors: Jayanth S. Sampath FRCSEd (Tr & Orth) [1]

[1] Department of Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India.

Address of Correspondence

Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: editor.posi.ijpo@gmail.com

Editorial

The management of skeletal dysplasias in children has transformed in recent years thanks to widespread availability of genetic studies in the developing world and a better understanding of the orthopaedic aspects of these complex multi-system problems. It has become a common experience for orthopaedic surgeons to be presented with a genetic report that lists an obscure skeletal dysplasia. This issue of IJPO is aimed to improve the awareness among orthopaedic surgeons of the common skeletal dysplasias, their typical clinical and radiological features, and management.
We present an overview of the principles and practice of orthopaedic surgery in skeletal dysplasias. The issue kicks off with an introduction by Dr Sukalyan Dey and colleagues regarding the definition and classification of skeletal dysplasias. Dr Sangeet Gangadharan follows with a comprehensive outline of the radiological diagnosis and the need for specialised investigations. Dr Arjun Dhawale and co-workers have provided a broad perspective to the assessment and treatment of spinal disorders. The role of growth modulation in deformities around the knee has been covered in detail with case examples by Dr Akash Kumar Ghosh. Our associate editor, Dr Gaurav Garg has pitched in with an excellent overview of hip problems in skeletal dysplasias. Dr Binu Kurian has detailed the management of limb deformities, an article co-authored by Dr James Fernandes from Sheffield Children’s Hospital, a world authority on the subject.
We are proud that the authors are from institutions across the world, each offering a unique perspective to the management of these difficult problems. Please share the articles with your trainees and fellows. IJPO issues are easily downloadable free of charge and in full-text format from our website www.ijpoonline.com
We invite your suggestions and comments for any improvements to the journal. Kindly write to us editor.ijpo@gmail.com or editor@posi.org.in
It is my pleasure to acknowledge the contributions of authors, reviewers, editors, and the backend team who have been instrumental in bringing out this issue. We acknowledge Dr Easwar T Ramani, POSI Webmaster for the cover page artwork which adds interest to the contents of this issue.

Sincerely

Dr Jayanth S Sampath
Editor,
International Journal of Paediatric Orthopaedics

How to Cite this Article: Sampat JS | Editorial | International Journal of Paediatric Orthopaedics | May-August 2025;11(1): 01. https://doi.org/10.13107/ijpo.2025.v11.i01.210

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Management of Deformities Around the Knee in Skeletal Dysplasia and a Review of Current Literature on Guided Growth in Skeletal Dysplasia

Volume 11 | Issue 1 | Januar-April 2025 | Page: 25-33 | Akash Kumar Ghosh, Puneeth K Pai, Vikas Ellur

DOI- https://doi.org/10.13107/ijpo.2025.v11.i01.218

Open Access License: CC BY-NC 4.0

Submitted: 14/02/2025; Reviewed: 26/02/2025; Accepted: 02/04/2025; Published: 10/04/2025

Authors: Akash Kumar Ghosh M.Ch (Paed. Ortho.) [1], Puneeth K Pai MS Ortho [1], Vikas Ellur MS Ortho [1]

[1] Department of Orthopaedics, Paediatric Orthopaedics Unit, Narayana Healthcity, Bengaluru, Karnataka, India.

Address of Correspondence

Dr. Akash Kumar Ghosh,
Department of Orthopaedics, Paediatric Orthopaedics Unit, Narayana Healthcity, Bengaluru, Karnataka, India.
E-mail: akashgh994@gmail.com

Abstract

Skeletal dysplasias are a heterogeneous group of disorders characterized by abnormal bone and cartilage formation, often presenting with complex lower limb deformities, particularly around the knee. This review provides a comprehensive overview of the current evidence regarding the management of knee deformities in skeletal dysplasias.
Deformities may arise due to asymmetric physeal. involvement, unequal growth of paired bones, or soft tissue contractures. A thorough history, comprehensive examination, and appropriate imaging are, essential for accurate assessment. Instrumented gait analysis provides valuable insights into the dynamic impact of deformities.
Treatment planning should consider the multifocal and multiplanar nature of deformities, unpredictable growth patterns, bone quality, and anesthetic risks. Guided growth is a safe and effective option for correcting coronal and sagittal plane deformities in children with at least two years of growth remaining. Acute correction using osteotomies and internal fixation is preferred when the center of rotation of angulation (CORA) is further from the physis. Gradual correction using external fixators is useful for multiplanar and multifocal deformities with limb length discrepancy. A multidisciplinary collaboration and astute planning are important for ensuring optimal outcomes in the management of knee deformities in skeletal dysplasias.
Keywords: Bone disease, Developmental, Osteotomy, Growth plate, Epiphysis, Guided growth

References

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How to Cite this Article: Ghosh A, Pai PK, Ellur V | Management of Deformities Around the Knee in Skeletal Dysplasia and a Review of Current Literature on Guided Growth in Skeletal Dysplasia | International Journal of Paediatric Orthopaedics | January-April 2025; 11(1): 25-33 .

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Management of Paediatric Spinal Pathologies in Skeletal Dysplasia

Volume 11 | Issue 1 | Januar-April 2025 | Page: 17-24 | Arjun Dhawale, Bhushan Sagade, Atif Naseem, Abhay Nene

DOI- https://doi.org/10.13107/ijpo.2025.v11.i01.216

Open Access License: CC BY-NC 4.0

Submitted: 29/01/2025; Reviewed: 13/02/2025; Accepted: 08/03/2025; Published: 10/04/2025

Authors: Arjun Dhawale MS Ortho [1, 2], Bhushan Sagade MS Ortho [1], Atif Naseem MS Ortho [1], Abhay Nene MS Ortho [1, 2]

[1] Department of Orthopaedics, B.J. Wadia Hospital for Children, Parel, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Girgaon, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Arjun Dhawale,
Department of Orthopaedics , B.J. Wadia Hospital For Children, Parel, Mumbai 400012, Maharashtra, India.
E-mail: arjundhawale@hotmail.com

Abstract

Treatment of spinal deformities in skeletal dysplasia is challenging. There should be a low threshold for imaging the cervical spine for instability at the craniovertebral junction. A thorough evaluation by a multidisciplinary is necessary before deciding upon any surgery. Deformity, spinal stenosis, and neurological deficit can occur. Medical optimization should be considered. Treatment should be tailored to each patient based on the symptoms, signs, the curve magnitude, and overall prognosis of survival in these patients. Implant failure, intraoperative neuromonitoring signal alerts, and junctional kyphosis are common complications . Most literature is based on expert consensus and small series, there are few long-term outcomes studies.
Keywords: Kyphosis, Scoliosis, Craniovertebral instability, Skeletal Dysplasia, Spinal Fusion, Achondroplasia, Mucopolysaccharidosis

References

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How to Cite this Article: Dhawale A, Sagade B, Naseem A, Abhay Nene A. Management of Paediatric Spinal Pathologies in Skeletal Dysplasia. International Journal of Paediatric Orthopaedics. January-April 2025; 11(1): 17-24.

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