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Fractured Aneurysmal Bone Cyst in Children – Is Conservative Treatment an Option?

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.268

Open Access License: CC BY-NC 4.0

Submitted: 13/01/2026; Reviewed: 11/02/2026; Accepted: 03/06/2026; Published: 10/08/2026

Authors: Varun Garg [1], Anil Agarwal [2], Sunny Bhalla [2], Md Zafar Iqbal [2]

[1] Department of Orthopedics, All India Institute of Medical Sciences, Guwahati, Assam, India,
[2] Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalya, New Delhi, India.

Address of Correspondence

Dr. Varun Garg,
Department of Orthopedics, All India Institute of Medical Sciences, Assam, Guwahati, India.
E-mail: varungarg9@gmail.com

Abstract

Objective: The objectives are to evaluate the outcomes of conservatively managed pathological fractures through aneurysmal bone cysts (ABCs) in children and to assess the potential for spontaneous cyst healing post-fracture.
Methods: A retrospective review was conducted of hospital records between January 2014 and October 2024. Children aged ≤14 years with fractured long bone ABCs and managed conservatively with at least 6 months of radiographic follow-up were included. Cases treated surgically or with recurrent/previously treated lesions were excluded. Radiographs were reviewed for lesion characteristics, Enneking staging, and radiographic features (loculation, cortical rim, tubulation, and bone scalloping). Outcomes were assessed using fracture union and cyst healing according to Rastogi’s criteria.
Results: Eight patients (6 males, 2 females; mean age 7.3 ± 3.2 years) met the inclusion criteria. The proximal humerus (n = 5) was the most frequently affected site, followed by the proximal femur (n = 2) and distal radius (n = 1). All lesions were metaphyseal and classified as Enneking stage II. At a mean follow-up of 7 ± 1.1 months, all fractures united radiologically. Partial cyst healing occurred in 3 patients (37.5%), while 5 patients (62.5%) showed no significant healing. No deformities or complications were reported.
Conclusion: Conservative management of pathological fractures through ABCs in children achieves fracture union and may induce partial cyst healing. Larger, multi-center studies are required to better define the predictors of healing after a fracture through the cyst.
Keywords: Aneurysmal bone cyst, pathological fracture, benign bone tumor, spontaneous healing, pediatric.

References

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How to Cite this Article: Garg V, Agarwal A, Bhalla S, Iqbal MZ | Fractured Aneurysmal Bone Cyst in Children – Is Conservative Treatment an Option? | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 03-07.

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The Correlation between Vitamin D Deficiency and Orthopedic Manifestations in Children during the COVID-19 Pandemic

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.276

Open Access License: CC BY-NC 4.0

Submitted: 19/01/2026; Reviewed: 14/02/2026; Accepted: 21/06/2026; Published: 10/08/2026

Authors: Premal Naik [1], Mugdha M Mehta [2]

[1] Rainbow Superspeciality Hospital & Children’s Orthopaedic Centre, Ahmedabad, Gujarat, India.
[2] Department of Neurology, UTMB, Galveston, Texas

Address of Correspondence

Dr. Premal Naik,
Director, Rainbow Superspeciality Hospital & Children’s Orthopaedic Centre, Ahmedabad, Gujarat, India
E-mail: premalnaik@gmail.com

Abstract

Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, Vitamin D (Vit-D) deficiency in children was reported from many parts of the world, but no such study exists for Indian children. Vit-D deficiency leading to orthopedic manifestations during the COVID-19 pandemic has not been reported to date. We studied the correlation between Vit-D deficiency and orthopedic manifestations during the COVID-19 pandemic in otherwise healthy children.

Materials and Methods: The study group included children aged 5–18 years who had prolonged home confinement during the COVID-19 pandemic and exhibited signs of Vit-D deficiency, such as proximal myopathy, deformity, and pathological fractures. The study group was compared to a similar group from the preceding 2 years (control group).

Results: Thirty-six children (9 pre-adolescents and 27 adolescents) were enrolled in the study group. Twenty-five children presented with genu varum or valgum, six had insufficiency fractures of the femoral neck, and five had proximal myopathy. After medical treatment, 21 children with deformities were either treated or advised growth modulation or osteotomy, and fractures were stabilized. All children with myopathy recovered with medical treatment, and all fractures united without complications.

Conclusion: There was a sudden increase in the incidence of children with Vitamin-D deficiency due to prolonged home confinement during the COVID-19 pandemic. We could not find any correlation between Vit-D levels, the amount of delay, and the mode of presentation. Many children presented late with orthopedic problems requiring surgical interventions, which could have been prevented with timely diagnosis.

Keywords: Vitamin D deficiency, COVID-19 pandemic, orthopedic manifestation of Vitamin D deficiency, children, case series.

References

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5. Naik A, Naik H, Naik P, Vora K. Clinical profile and outcome of pediatric covid-19 during second wave in Gujarat, India; a cross-sectional study. Glob J Res Anal 2022;???:28-31.
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8. Sodri NI, Mohamed-Yassin MS, Nor NS, Ismail IA. Rickets due to severe vitamin d and calcium deficiency during the COVID-19 pandemic in Malaysia. Am J Case Rep 2021;22:e934216.
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12. Wagner CL, Greer FR. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008;122:1142-52.
13. Holick MF. Vitamin D: A d-lightful solution for health. J Investig Med 2011;59:872-80.
14. Chabra T, Tahbildar P, Sharma A, Boruah S, Mahajan R, Raje A. Prevalence of skeletal deformity due to nutritional rickets in children between 1 and 18 years in tea garden community. J Clin Orthop Trauma 2016;7:86-9.
15. Shore RM, Chesney RW. Rickets: Part I. Pediatr Radiol 2013;43:140-51.
16. Soliman A, De Sanctis V, Elalaily R, Bedair S, Kassem I. Vitamin D deficiency in adolescents. Indian J Endocrinol Metab 2014;18:S9-16.
17. Sahni S, Kakkar S, Kumar R, Goraya J. Osteomalacic myopathy in children and adolescents with vitamin-D deficiency. Neurol India 2021;69:1650-4.
18. Hazzazi M, Alzeer I, Tamimi W, Al Atawi M, Al Alwan I. Clinical presentation and etiology of osteomalacia/rickets in adolescents. Saudi J Kidney Dis Transplant 2013;24:938.
19. Cabarrus MC, Ambekar A, Lu Y, Link TM. MRI and CT of insufficiency fractures of the pelvis and the proximal femur. Am J Roentgenol 2008;191:995-1001.
20. Stevens PM. Guided growth for angular correction: A preliminary series using a tension band plate. J Pediatr Orthop 2007;27:253-9.
21. Naik P, Ganjwala D, Bhatt C, Vora KS. Usefulness of the sauvegrain method of bone age assessment in Indian children. Indian J Orthop 2021;55:116-24.
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How to Cite this Article: Naik P, Mehta MM | The correlation between Vitamin D deficiency and orthopaedic manifestations in children during the COVID-19 pandemic | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 26-35.

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Adapting Joshi External Stabilization System for Congenital Talipes Equinovarus Correction: A Practical Solution for Unavailable Distractor Sizes

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.282

Open Access License: CC BY-NC 4.0

Submitted: 17/01/2026; Reviewed: 10/02/2026; Accepted: 25/05/2026; Published: 10/08/2026

Authors: Md Zafar Iqbal [1], Anil Agarwal [1], Shivank Khurana [1]

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India.

Address of Correspondence

Md Zafar Iqbal,
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi – 110031, India.
E-mail: docmdzafariqbal@gmail.com

Abstract

Congenital talipes equinovarus is a complex foot deformity that is principally corrected by gradual manipulation. The Joshi external stabilization system (JESS) fixator uses this principle of gradual correction by ligamentotaxis. The principal component of the JESS system is the distractor applied at multiple planes to achieve soft-tissue stretching, enabling gradual correction of the deformity. As recommended, the size of the JESS should be at least 2/3rd of the limb to get maximum outcome. However, situations may arise where the exact size of the distractor is unavailable, posing a challenge to achieving optimal correction. This article describes a practical solution involving the use of an additional Z-rod or L-rod, allowing the application of a smaller size distractor. This adaptation ensures continued correction of the deformity, ultimately benefiting patients with optimal outcomes.
Keywords: Clubfoot, Joshi external stabilization system fixator, distractor, adaptation, surgical tip, children.

References

1. Ponseti IV, Smoley EN. The classic: Congenital club foot: The results of treatment. Clin Orthop Relat Res 2009;467:1133-45.
2. Joshi BB, Prabhoo R, Kanaji BG, Kaushik. Management of Clubfoot by Joshi’s External Stabilization System (JESS). Uttar Pradesh: Jaypee; 2010.
3. Singh A. Evaluation of neglected idiopathic ctev managed by ligamentotaxis using jess: A long-term followup. Adv Orthop 2011;2011:218489.
4. Altaf KA, Shah SB, Ahmad S, Mumtaz U, Mantoo SA. Results of JESS (Joshi’s external stabilizing system) in relapsed, neglected and neurogenic clubfoot in an age group of 2-10 years. Ortop Traumatol Rehabil 2020;22:121-9.
5. Suresh S, Ahmed A, Sharma VK. Role of Joshi’s External Stabilisation System Fixator in the Management of Idiopathic Clubfoot. J Orthop Surg 2003;11:194-201.

How to Cite this Article: Iqbal MZ, Agarwal A, Khurana S | Adapting Joshi External Stabilization System for Congenital Talipes Equinovarus Correction: A Practical Solution for Unavailable Distractor Sizes | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 44-46.

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Age Pattern and Bone Predilection in Pediatric Septic Arthritis and Osteomyelitis: A Retrospective Analysis at a Tertiary Care Center

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.272

Open Access License: CC BY-NC 4.0

Submitted: 03/05/2026; Reviewed: 22/05/2026; Accepted: 16/06/2026; Published: 10/08/2026

Authors: Rupika T [1]

[1] Department of Paediatrics, Apollo Hospitals Chennai, Tamil Nadu, India.

Address of Correspondence

Dr. Rupika T
Department of Paediatrics, Apollo Hospitals Chennai, Tamil Nadu, India.
E-mail: rupithiru@gmail.com

Abstract

Background: Pediatric musculoskeletal infections, specifically septic arthritis (SA) and osteomyelitis (OM), are significant causes of morbidity. Understanding local epidemiological trends is vital for early diagnosis and empirical management.
Objectives: To analyze age-specific patterns and the anatomical predilection of bones and joints affected by SA and OM in a tertiary hospital setting.
Methods: This retrospective study reviewed pediatric patients (0–18 years) diagnosed with SA or OM over 8 years. Data on age, gender, infection site, and microbiology were analyzed.
Results: A retrospective analysis of 210 pediatric cases revealed a male preponderance (58%). The mean age was 10.8 years. The tibia (21%) and femur (20%) were the most common bones involved in OM. A significant portion of the cohort (29%) presented with SA, with the hip (18%) and knee (14%) being the most frequently affected joints. Chronic presentations and post-infectious sequelae, such as joint dislocations and pathological fractures, were prevalent, particularly in cases involving the proximal femur and hip joint.
Conclusion: Long bones of the lower limb and the major weight-bearing joints (hip and knee) are the primary sites of pediatric musculoskeletal infections at our center. The significant incidence of joint-related sequelae highlights the critical importance of early surgical debridement and long-term follow-up in managing these infections to preserve joint function and limb alignment.
Keywords: Pediatric orthopedics, septic arthritis, osteomyelitis, bone predilection, epidemiology.

References

1. Trueta J. The three-dimensional vascularity of the metaphysis. J Bone Joint Surg Br 1959;41-B:392-400.
2. Peltola H, Pääkkönen M. Acute osteomyelitis in children. N Engl J Med 2014;370:352-60.
3. Gafur OA, Copley LA, Hollmig ST, Browne RH, Thornton LA, Crawford SE. The impact of the current epidemiology of pediatric musculoskeletal infection on evaluation and treatment guidelines. J Pediatr Orthop 2008;28:777-85.
4. Dartnell J, Ramachandran M, Katchburian L. Haematogenous acute and subacute paediatric osteomyelitis: A systematic review of the literature. J Bone Joint Surg Br 2012;94:584-95.
5. Ilharreborde B. Sequelae of pediatric osteoarticular infection. Orthop Traumatol Surg Res 2015;101 Suppl 1:S129-37.
6. Dodwell ER. Osteomyelitis and septic arthritis in children: Current concepts. Curr Opin Pediatr 2013;25:58-63.
7. Montgomery CO, Siegel E, Blasier RD, Suva LJ. Concurrent septic arthritis and osteomyelitis in children. J Pediatr Orthop 2013;33:464-7.
8. Safdieh G, Silberman J, Nguyen J, Doyle SM, Blanco JS, Scher DM, et al. Pediatric septic arthritis and osteomyelitis in the USA: A national KID database analysis. HSS J 2019;15:159-66.

How to Cite this Article: Rupika T | Age Pattern and Bone Predilection in Paediatric Septic Arthritis and Osteomyelitis: A Retrospective Analysis at a Tertiary Care Center | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 15-18.

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Removal of Broken Retrograde Rush Rod from Tibia: A Technical Tip

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.284

Open Access License: CC BY-NC 4.0

Submitted: 14/04/2026; Reviewed: 07/05/2026; Accepted: 11/06/2026; Published: 10/08/2026

Authors: Tariq Mir [1], Anoop Mavila [1]

[1] Department of Paediatric Orthopaedics Unit, Paras Health, Durganag, Dalgate, Srinagar, Jammu and Kashmir, India.

Address of Correspondence

Dr. Tariq Altaf Mir,
Department of Paediatric Orthopaedics Unit, Paras Health, Durganag, Dalgate, Srinagar, Jammu and Kashmir, India.
E-mail: mirtariqaltaf@gmail.com

Abstract

Broken rush rods within the tibia present a challenging scenario for orthopedic surgeons, particularly when the retrograde inserted nails break at the ankle or distal tibial level, and the distal fragment remains embedded with the tibial canal. This technical tip outlines a practical and reproducible method for the removal of a broken rush rod using minimally invasive principles and avoiding iatrogenic complications.

Keywords: Broken rush rod, tibia.

References

1. Joseph B, Mathew G. Management of congenital pseudarthrosis of the tibia by excision of the pseudarthrosis, onlay grafting, and intramedullary nailing. J Pediatr Orthop 2000;9:16-23.
2. Joseph B, Rebello G, Kant BC. The choice of intramedullary devices for the femur and the tibia in osteogenesis imperfecta. J Pediatr Orthop B 2005;14:311-9.
3. Shah H, Rousset M, Canavese F. Congenital pseudarthrosis of the tibia: Management and complications. Indian J Orthop 2012;46:616-26.
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How to Cite this Article: Mir T, Mavila A | Removal of Broken Retrograde Rush Rod from Tibia: A Technical Tip | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 47-49.

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A Rare but Preventable Injury: Surgical Management of Traumatic Achilles Tendon Tear Caused by Glass-coated Kite String (Chinese Manja) in a Child – A Case Report

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.280

Open Access License: CC BY-NC 4.0

Submitted: 27/03/2026; Reviewed: 21/04/2026; Accepted: 09/06/2026; Published: 10/08/2026

Authors: Amandeep [1], Umesh Meena [1], Varun Goyal [1], Ranadeep Ghosh [1]

[1] Department of Orthopaedics, Government Medical College, RK Puram, Kota, Rajasthan, India.

Address of Correspondence

Dr. Ranadeep Ghosh,
Department of Orthopaedics, Government Medical College, RK Puram, Kota Rajasthan, India.
E-mail: ranadeepghosh9@gmail.com

Abstract

Introduction: Acute traumatic Achilles tendon tear is very uncommon in the pediatric population. This injury is particularly important in the current era due to the increasing and widespread use of glass-coated kite strings (manja). The Achilles tendon lies superficially with minimal soft-tissue protection, making it particularly vulnerable to sharp kite string injuries. This case highlights the rarity of this injury pattern, an emerging and preventable cause of trauma in developing countries, and its effective surgical management.
Case Report: We report the case of a 12-year-old male who sustained a traumatic distal Achilles tendon laceration near its insertion after a glass-coated kite string became entangled around his ankle while running. This resulted in a deep wound over the Achilles tendon with complete transection. The patient was successfully treated with primary tendon repair using non-absorbable sutures with the Krackow technique following thorough wound irrigation and debridement.
Conclusion: Traumatic Achilles tendon laceration caused by kite string injury is a rare but preventable serious condition. Early recognition and timely surgical intervention are crucial. Primary repair using non-absorbable sutures with the Krackow technique provides strong tendon approximation, promotes early healing, and effectively restores tendon continuity when combined with meticulous wound irrigation and debridement.
Keywords: Traumatic tendoachilles, paediatrics.

References

1. Ashebo LB, Stevens AC, MacAlpine EM, Wittstein JR, Bradley KE, Lawrence JT. Achilles tendon injuries in the pediatric population. J Pediatr Orthop 2023;43:e513-8.
2. Singh D, Aryala S. Kite string injury: An unusual cause of extensive ankle trauma with vascular injury. Indian J Vasc Endovasc Surg 2022;9:319-21.
3. Singh RK, Kumar V, Mishra B, Halagiri SM, Singh A. Kite string (manja) injury: Rare presentations of common entity leading to disability. Acta Sci Surg Res 2022;1:10-2.
4. Bansal A, Goyal S, Kumar A. Kite string (manjha) injuries in children: An ongoing and preventable public health problem. Injury 2022;53:3550-6.
5. Sharma R, Sodhi KS, Khandelwal N. Pattern and severity of kite string injuries during festive seasons: A recent trauma center experience. Indian J Pediatr 2023;90:356-61.
6. Patel NM, Ganley TJ. Evaluation and management of acute Achilles tendon injuries in children and adolescents. J Pediatr Orthop 2022;42:e820-6.
7. Verma A, Singh V, Gupta P. Kite string injuries as a preventable cause of pediatric trauma: Need for stricter regulation and awareness. J Fam Med Prim Care 2024;13:890-5.

How to Cite this Article: Amandeep, Meena U, Goyal V, Ghosh R | A Rare but Preventable Injury: Surgical Management of Traumatic Achilles Tendon Tear Caused by Glass-coated Kite String (Chinese Manja) in a Child – A Case Report | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 40-43.

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