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Asymmetrical Bilateral Tibial Dysplasia in a Pediatric Patient: A Rare and Complex Presentation

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.278

Open Access License: CC BY-NC 4.0

Submitted: 03/02/2026; Reviewed: 01/03/2026; Accepted: 16/05/2026; Published: 10/08/2026

Authors: Tariq Altaf Mir [1], Haseeb Gani [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

Bilateral tibial dysplasia is a very rare condition and has only been reported infrequently. We report a rare case of idiopathic bilateral tibial dysplasia in a 15-month-old child with asymmetric presentation. We managed the two sides differently and achieved a satisfactory union. Bilateral tibial dysplasia can be very challenging to manage, and the two sides may not behave similarly. Anterolateral bowing without fracture can have a better prognosis for union.
Keywords: Congenital pseudoarthrosis of the tibia, tibial dysplasia, congenital pseudoarthrosis of tibia.

References

1. Hefti F, Bollini G, Dungl P, Fixsen J, Grill F, Ippolito E, et al. Congenital pseudarthrosis of the tibia: History, etiology, classification, and epidemiologic data. J Pediatr Orthop B 2000;9:11-5.
2. Kesireddy N, Kheireldin RK, Lu A, Cooper J, Liu J, Ebraheim NA. Current treatment of congenital pseudarthrosis of the tibia: A systematic review and meta-analysis. J Pediatr Orthop B 2018;27:541-50.
3. Herring JA, editor. Disorders of the leg. In: Tachdjian’s Pediatric Orthopaedics. 5th ed. Amsterdam, The Netherlands: Elsevier; 2013. p. 713-58.
4. Chand S, Afaque SF, Singh RK. Bilateral congenital pseudoarthrosis of the tibia: A case report and literature review. J Clin Orthop Trauma 2024;58:102769.
5. Laine JC, Novotny SA, Weber EW, Georgiadis AG, Dahl MT. Distal tibial guided growth for anterolateral bowing of the tibia: Fracture may be prevented. J Bone J Surg Am 2020;102:2077-86.

How to Cite this Article: Mir TA, Gani H | Asymmetrical Bilateral Tibial Dysplasia in a Pediatric Patient: A Rare and Complex Presentation | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 36-39.

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Efficacy of Non-Vascularized Fibular Grafts in the Reconstruction of Large Long Bone Defects in the Pediatric Population

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.274

Open Access License: CC BY-NC 4.0

Submitted: 17/01/2026; Reviewed: 12/02/2026; Accepted: 09/05/2025; Published: 10/08/2026

Authors: Rajashree Paidipati [1], Rudraprasad M S [1], Kiran Rajappa [1], Abhishek S Bhasme [1], Nandini Sanjay [1], Mohammed Yaqub [1]

[1] Department of Paediatric Orthopaedics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India.

Address of Correspondence

Dr. Abhishek S. Bhasme
Department of Paediatric Orthopaedics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India.
E-mail: dr.bhasme@gmail.com

Abstract

Background: Management of large long bone defects in the pediatric population remains a significant challenge in orthopedic surgery. These defects often arise secondary to chronic osteomyelitis, high-energy open fractures, or resection of benign and malignant bone tumors. Various reconstructive strategies have been employed, including cancellous bone grafting, free vascularized fibular grafting, and bone transport using external ring fixators. Although non-vascularized fibular grafts (NVFG) have demonstrated promising outcomes in adults, their utility in children is less clearly defined due to limited data on safety, efficacy, and long-term outcomes.
Objectives: This study aims to evaluate the clinical and radiological outcomes of non-vascularized autologous fibular grafts in the management of large long bone defects (>4 cm) in children, with specific focus on graft incorporation, time to union, preservation of the physis, and functional recovery.
Materials and Methods: An observational study was conducted on 20 children presenting with large long bone defects exceeding 4 cm. All patients underwent reconstruction using autologous non-vascularized fibular strut grafts. Grafts were fixed via internal fixation (plates or nails) or external fixation based on the bone affected, soft-tissue condition, and stability needs. Patients were followed for a minimum period of 6 months. Outcome measured included radiological union, graft resorption or remodeling, limb-length discrepancy, joint range of motion, and complications (graft fracture, non-union, and physeal injury).
Results: Of the twenty children, radiographic union was achieved in 18 by a mean of 9.4 ± 2.1 weeks (range: 7–13 weeks). Two cases demonstrated delayed union; one of which required an additional surgical procedure (revision grafting and fixation) to achieve union. At final follow-up, most patients regained full joint function; minor complications included one graft fracture, one physeal separation, and one implant failure. All patients were ambulatory and pain-free, with no recurrence of infection or graft failure.
Conclusion: NVFG, when employed in conjunction with rigorous infection control and suitable fixation, is a safe, effective, and technically feasible reconstructive option for large bone defects in children. There is relatively rapid incorporation of the graft with high union rates and low donor-site morbidity. Special caution is needed in larger defects and some cases may require revision.
Keywords: Non-vascularised fibular graft, pediatric gap non-union.

References

1. Kaewpornsawan K, Eamsobhana P. Free non-vascularized fibular graft for treatment of large bone defect around the elbow in pediatric patients. Eur J Orthop Surg Traumatol 2017;27:895-900.
2. Lenze U, Kasal S, Hefti F, Krieg AH. Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities. BMC Musculoskelet Disord 2017;18:289.
3. Swamy MK, Rathi A, Gupta V. Results of non-vascularised fibular grafting in gap non-union of long bones in paediatric age group. J Clin Orthop Trauma 2013;4:180-4.
4. Loro A, Franceschi F, Fisha MM, Ewochu E, Mwanje G, Dal Lago A, et al. Autogenous bone graft in the management of post-osteomyelitis bone defects in children in a limited-resource setting – a retrospective cohort study with a minimum follow-up of 7 years. J Bone Jt Infect 2025;10:155-63.
5. Sheridan GA, Cassidy JT, Donnelly A, Noonan M, Kelly PM, Moore DP. Non-vascularised fibular autograft for reconstruction of paediatric bone defects: An analysis of 10 cases. Strategies Trauma Limb Reconstr 2020;15:84-90.
6. Taqi M, Llewellyn CM, Estefan M. Fibula tissue transfer. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2023.
7. Rodriguez-Buitrago AF, Mabrouk A, Jahangir A. Tibia nonunion. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2025.
8. Glatt V, Evans CH, Tetsworth K. A concert between biology and biomechanics: The influence of the mechanical environment on bone healing. Front Physiol 2017;7:678.
9. Panteli M, Pountos I, Jones E, Giannoudis PV. Biological and molecular profile of fracture non-union tissue: Current insights. J Cell Mol Med 2015;19:685-713.
10. Siddiqui YS, Abbas M, Julfiqar M, Sherwani MK. Non-vascularized fibular strut grafting in infected gap non-union of long bones in paediatric population. Recent Adv Biol Med 2021;7:9800007.
11. Cluett J. Broken Bones in Children: Information about Fractures in Young Patients; 2005. Available from: https://www.com/about
12. Tarng YW, Lin KC. Management of bone defects due to infected non-union or chronic osteomyelitis with autologous non-vascularized free fibular grafts. Injury 2019;51:294-300.
13. Patwardhan S, Shyam AK, Mody RA, Sancheti PK, Mehta R, Agrawat H. Reconstruction of bone defects after osteomyelitis with nonvascularized fibular graft: A retrospective study in twenty-six children. J Bone Joint Surg Am 2013;95:e56, S1.
14. Thakkar CV, Sangada D. Non-vascularized fibular graft in management of segmental bone defects: Study of twelve cases. Int J Orthop Sci 2018;4:807-10.
15. González Del Pino J, Bartolomé Del Valle E, Graña GL, Villanova JF. Free vascularized fibular grafts have a high union rate in atrophic nonunions. Clin Orthop Relat Res 2004;419:38-45.
16. Al-Zahrani S, Harding MG, Kremli M, Khan FA, Ikram A, Takroni T. Free fibular graft still has a place in the treatment of bone defects. Injury 1993;24:551-4.
17. Enneking WF, Eady JL, Burchardt H. Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg Am 1980;62:1039-58.
18. Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am 2002;84-A:454-64.
19. Chilbule S, Dutt V, Gahukambale A, Madhuri V. Gap non-unions in paediatric upper limb long bone diaphyseal defect: Role of fibular grafting. Orthop Procs 2013;95-B Suppl 23:25.
20. Ruggieri P, Mavrogenis AF, Bianchi G, Sakellariou VI, Mercuri M, Papagelopoulos PJ. Outcome of the intramedullary diaphyseal segmental defect fixation system for bone tumors. J Surg Oncol 2011;104:83-90.
21. Giannoudis PV, Einhorn TA, Marsh D. Fracture healing: The diamond concept. Injury 2007;38:S3-6.

How to Cite this Article: Paidipati R, Rudraprasad M S, Rajappa K, Bhasme AS, Sanjay N, Yaqub M | Efficacy of Non- Vascularized Fibular Grafts in the Reconstruction of Large Long Bone Defects in the Paediatric Population | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 19-25.

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Ponseti Casting in Obtaining Correction of Non-idiopathic Clubfoot: Where do we Stand? A Tertiary Care Institution-Based Prospective Observational Study

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.270

Open Access License: CC BY-NC 4.0

Submitted: 24/04/2026; Reviewed: 19/05/2026; Accepted: 20/06/2026; Published: 10/08/2026

Authors: Prashant Adhikari [1,2], Jeevan Kumar Sharma [3], Gaurav Bir Bajracharya [1, 2], Tarun Rajbhandari [4, 5], Bibek Banskota [4, 5], Saurav Neupane [6], Isha Amatya [7], Ashok Kumar Baskota [4, 5]

[1] Department of Orthopaedics, Hospital for Advanced Medicine and Surgery, Kathmandu, Nepal.
[2] AaRuS Lifestyle Hospital, Kathmandu, Nepal,
[3] Indian Spinal Injuries Center, New Delhi, India,
[4] Department of Orthopaedics, Baidya and Banskota Hospital Pvt Ltd., Patan, Central Development Region, Nepal,
[5] Hospital and Rehabilitation Centre for Disabled Children, Orthopaedics, Banepa, Central Development Region, Nepal,
[6] Tribhuvan University Central Department of Rural Development, Kirtipur, Central Development Region, Nepal,
[7] Department of Orthopaedics, Patan Academy of Health Sciences, Lalitpur, Nepal.

Address of Correspondence

Dr. Prashant Adhikari,
Department of Orthopaedics, Hospital for Advanced Medicine and Surgery, Kathmandu, Nepal.
E-mail: adhikariprashant@hotmail.com

Abstract

Background: Clubfoot is a common congenital deformity, with idiopathic cases well managed by the Ponseti method. However, non‑idiopathic clubfoot (NICF), often associated with syndromic or neuromuscular conditions, remains challenging. Evidence on Ponseti casting in NICF is limited, and outcomes vary across etiologies.
Methods: This prospective observational study was conducted at a tertiary care center between September 2011 and September 2013. Out of 739 patients with clubfoot, 38 patients (59 feet) were diagnosed with NICF. Severity was assessed using Pirani and Diméglio scores. Ponseti casting was performed with weekly or accelerated cast changes, followed by Denis‑Browne splinting. Relapse and non-compliance were documented, and surgical interventions were tailored when casting failed.
Results: The majority of cases were due to Streeter’s dysplasia (36.9%) and arthrogryposis multiplex congenita (23.7%). All feet were rigid (Diméglio >5). Significant improvement in Pirani scores was observed across age groups (mean reduction from 5.2 ±1 to 2.9 ±1.4, P < 0.001). The mean number of casts required was 6.84, with Charcot‑Marie‑Tooth disease requiring the highest (13 casts). Correction was achieved in 61.7% of feet with casting ± heel cord release, while 38.3% required surgery. Relapse occurred in 18.9% of feet, mostly linked to splint non-compliance (31.6%). Parent‑reported satisfaction was high (78.9%).
Conclusion: Ponseti casting provides a reasonable success rate (61%) in NICF, particularly in younger age groups, and should be considered a first‑line treatment before surgical intervention. Despite higher rigidity and relapse rates compared to idiopathic cases, functional and cosmetic outcomes were satisfactory, with minimal complications.
Keywords: Dimeglio grading, non-idiopathic clubfoot, ponseti casting, pirani score, secondary clubfoot.

References

1. Ponseti IV, Campos J. The classic: Observations on pathogenesis and treatment of congenital clubfoot. Clin Orthop Relat Res 2009;467:1124-32.
2. Heck K, Heck A, Placzek R. [Ponseti method for treatment of idiopathic clubfoot]. Oper Orthop Traumatol 2016;28:449-71.
3. Shah A, Aroojis A, Mehta R. The Ponseti method of treatment for neuromuscular and syndromic (non-idiopathic) clubfeet: Evaluation of a programme-based approach at a mean follow-up of 5.8 years. Int Orthop 2021;45:155-63.
4. Ponseti IV, Smoley EN. Congenital club foot: The results of treatment. J Bone Joint Surg 1963;45:261-344.
5. De Mulder T, Prinsen S, Van Campenhout A. Treatment of non-idiopathic clubfeet with the Ponseti method: A systematic review. J Child Orthop 2018;12:575-81.
6. Kowalczyk B, Lejman T. Short-term experience with Ponseti casting and the Achilles tenotomy method for clubfeet treatment in arthrogryposis multiplex congenita. J Child Orthop 2008;2:365-71.
7. Matar HE, Beirne P, Garg N. The effectiveness of the Ponseti method for treating clubfoot associated with arthrogryposis: Up to 8 years follow-up. J Child Orthop 2016;10:15-8.
8. Kowalczyk B, Felus J. Ponseti casting and Achilles release versus classic casting and soft tissue releases for the initial treatment of arthrogrypotic clubfeet. Foot Ankle Int 2015;36:1072-7.
9. Boehm S, Limpaphayom N, Alaee F, Sinclair MF, Dobbs MB. Early results of the ponseti method for the treatment of clubfoot in distal arthrogryposis. J Bone Joint Surg 2008;90:1501-7.
10. Matar HE, Beirne P, Garg NK. Effectiveness of the Ponseti method for treating clubfoot associated with myelomeningocele: 3-9 years follow-up. J Pediatr Orthop Part B 2017;26:133-6.
11. El-Fadl SA, Sallam A, Abdelbadie A. Early management of neurologic clubfoot using Ponseti casting with minor posterior release in myelomeningocele: A preliminary report. J Pediatr Orthop Part B 2016;25:104-7.
12. Gerlach DJ, Gurnett CA, Limpaphayom N, Alaee F, Zhang Z, Porter K, et al. Early results of the Ponseti method for the treatment of clubfoot associated with myelomeningocele. J Bone Joint Surg 2009;91:1350-9.
13. Jackson T, Jones A, Miller N, Georgopoulos G. Clubfoot and tethered cord syndrome: Results of treatment with the Ponseti method. J Pediatr Orthop 2019;39:318-21.
14. Ishizuka T, Hung YY, Weintraub MR, Kaiser SP, Williams ML. Ponseti idiopathic and nonidiopathic clubfoot correction with secondary surgeries. J Foot Ankle Surg 2021;60:742-6.
15. Abraham J, Wall JC, Diab M, Beaver C. Ponseti casting vs. Soft tissue release for the initial treatment of non-idiopathic clubfoot. Front Surg 2021;8:668334.
16. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg Br 2006;88:1082-4.
17. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B 1995;4:129-36.
18. Ponseti IV, Smoley EN, Brand RA. The classic congenital club foot: The results of treatment. J Bone Joint Surg Am 1963;45:261-344.
19. Islam MS, Masood QM, Bashir A, Shah FY, Halwai MA. Results of a standard versus an accelerated Ponseti protocol for clubfoot: A prospective randomized study. Clin Orthop Surg 2020;12:100-6.
20. Sollod AJ. A modified Dennis Browne splint. J Am Podiatry Assoc 1963;53:206.
21. Moroney PJ, Noël J, Fogarty EE, Kelly PM. A single-center prospective evaluation of the ponseti method in nonidiopathic congenital talipes equinovarus. J Pediatr Orthop 2012;32:636-40.
22. Sharma PK, Verma V, Meena S, Singh R, Km P. Comparative evaluation and analysis of outcomes in non-idiopathic and idiopathic clubfeet with Ponseti method at a tertiary care centre of a developing country. Foot (Edinb) 2021;49:101841.
23. Janicki JA, Narayanan UG, Harvey B, Roy A, Ramseier LE, Wright JG. Treatment of neuromuscular and syndrome-associated (nonidiopathic) clubfeet using the Ponseti method. J Pediatr Orthop 2009;29:393-7.
24. Dunkley M, Gelfer Y, Jackson D, Parnell E, Armstong J, Rafter C, et al. Mid-term results of a physiotherapist-led Ponseti service for the management of non-idiopathic and idiopathic clubfoot. J Child Orthop 2015;9:183-9.
25. Gelfer Y, Dunkley M, Jackson D, Armstrong J, Rafter C, Parnell E, et al. Evertor muscle activity as a predictor of the mid-term outcome following treatment of the idiopathic and non-idiopathic clubfoot. Bone Joint J 2014;96-B:1264-8.

How to Cite this Article: Adhikari P, Sharma JK, Bajracharya GB, Rajbhandari T, Banskota B, Neupane S, Amatya I, Baskota AK Ponseti Casting in Obtaining Correction of | Non-idiopathic Clubfoot: Where do we Stand? A Tertiary Care Institution-Based Prospective Observational Study | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 08-14.

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Charting the Next Chapter: The Road Ahead for the International Journal of Paediatric Orthopaedics

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.266

Open Access License: CC BY-NC 4.0

Authors: Mandar Agashe [1]

[1] Department of Paediatric Orthopaedics, Director, Agashe Paediatric Superspeciality Clinic, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Mandar Agashe
Department of Paediatric Orthopaedics, Director, Agashe Paediatric Superspeciality Clinic, Mumbai, Maharashtra, India.
E-mail: mandarortho@gmail.com

Editorial

It is both a privilege and a responsibility to take over as Editor-in-Chief of the International Journal of Paediatric Orthopaedics (IJPO). I would like to begin by placing on record my deep gratitude to Dr. Jayanth Sampath, whose six years of dedicated stewardship gave this journal its identity, credibility, and steady growth. The strong editorial foundation he leaves behind is the platform on which we now build.
As I look ahead to the next three years, three themes will define our journey: relevance in the age of artificial intelligence, competitiveness amid a rapidly expanding field of specialty journals, and a structured push toward international indexing.
Staying relevant in the age of AI. Artificial intelligence is transforming how research is conceived, written, reviewed, and consumed. Rather than viewing this as a threat, IJPO must position itself as a thoughtful adopter — using AI-assisted tools to strengthen peer review quality, detect plagiarism and data manipulation, and speed up manuscript handling, while firmly safeguarding the human judgement and ethical oversight that no algorithm can replace. We will also encourage authors to engage critically with AI’s growing role in paediatric orthopaedic research and practice, through invited reviews and structured debates on the subject.
Standing out among emerging journals. The paediatric orthopaedic literature landscape is more crowded than ever, with new regional and subspecialty journals competing for the same pool of quality manuscripts. Our response will not be to chase volume, but to sharpen identity — prioritising manuscripts with genuine clinical relevance to low- and middle-income settings, encouraging multicentre Indian and South Asian collaborative studies, and building thematic issues around underrepresented areas such as neuromuscular disorders, limb deformity correction, and untreated or neglected paediatric trauma. A journal’s relevance is ultimately earned through the quality and originality of what it publishes, not merely its frequency.
The path to indexing. Perhaps the most tangible goal of my tenure will be to work systematically toward indexing in Scopus, DOAJ, and ultimately PubMed. This is not a matter of a single application, but of consistent, verifiable quality over time: timely publication schedules, rigorous peer review, complete ethical documentation, robust editorial governance, and full compliance with international publishing standards. I intend to work closely with the editorial board, reviewers, and the Paediatric Orthopaedic Society of India to ensure every issue reflects the standards these indexing bodies expect, so that when we apply, our application reflects years of consistent practice rather than a last-minute effort.
It is fitting that my first issue as Editor-in-Chief already reflects much of what I hope the journal will stand for. This edition brings together ten articles spanning the breadth of our subspecialty — from musculoskeletal infections and clubfoot to tumours and non-unions — offering readers a genuinely comprehensive snapshot of contemporary paediatric orthopaedic practice. Equally significant is the geographic spread of contributions, with authors writing from Africa and Nepal alongside India, a reminder that the challenges and innovations in our field are not confined by borders. This diversity of both content and contributors is exactly the direction in which I hope to steer IJPO — a journal that is international not merely in name, but in the voices it publishes.
None of this is achievable without the continued trust of our authors, the rigour of our reviewers, and the guidance of our editorial board. I look forward to working with this community over the next three years, and I invite members, authors, and readers to share their ideas as we shape this journey together.
The story of IJPO’s next chapter is one we will write collectively.

How to Cite this Article: Agashe M. Charting the Next Chapter: The Road Ahead for the International Journal of Paediatric Orthopaedics. International Journal of Paediatric Orthopaedics. May-August 2026; 12(2): 01-02.

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The Gliding Surgical Drapes Near the Periarticular Region: A Potential Source of Surgical Contamination

DOI- https://doi.org/10.13107/ijpo.2026.v12.i01.262

Open Access License: CC BY-NC 4.0

Submitted: 23/09/2025; Reviewed: 19/10/2025; Accepted: 14/01/2026; Published: 10/02/2026

Authors: Md Zafar Iqbal MS Ortho [1], Anil Agarwal MS Ortho [1], Sunny Bhalla MS Ortho [1]

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

Address of Correspondence

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

Abstract

In surgeries involving joints and the adjacent area, maintaining a sterile field is essential for preventing postoperative infections. The responsibilities are heightened when the joint is required to be exposed. An often-overlooked source of contamination is the gliding motion of the drapes from manipulation of the limb during surgery. We found the movement akin to the tendon glide in contaminated animal bites, where movement draws pathogens deep into the joint, increasing the infection risk. This article presents a practical tip: recognizing this gliding drape as a surgical contaminant and suggesting methods to prevent it.
Keywords: Surgical drapes, Human/animal bite, Contamination, Sterility

References

1. Noordin S, McEwen JA, Kragh CJ Jr, Eisen A, Masri BA. Surgical tourniquets in orthopaedics. J Bone Joint Surg Am. 2009;91:2958-67.
2. Armstrong M, Spencer R. Tourniquet use in orthopaedic surgery. J Perioper Pract. 2011;21:319-22.
3. Tintle SM, Forsberg JA, Keeling JJ, Shawen SB. Infectious complications of animal bites involving the upper extremity. J Hand Surg Am. 2010;35:476-9.
4. Walsh EF, Ben-David D, Ritter M, Mechrefe A, Mermel LA, DiGiovanni C. Microbial colonization of tourniquets used in orthopedic surgery. Orthopedics. 2006;29:709-13.
5. Ahmed SM, Ahmad R, Case R, Spencer RF. A study of microbial colonisation of orthopaedic tourniquets. Ann R Coll Surg Engl. 2009;91:131-4.
6. Mufarrih SH, Qureshi NQ, Rashid RH, Ahmed B, Irfan S, Zubairi AJ, Noordin S. Microbial colonization of pneumatic tourniquets in the orthopedic operating room. Cureus. 2019;11:e5308.

How to Cite this Article: Iqbal MZ, Agarwal A, Bhalla S. The Gliding Surgical Drapes Near the Periarticular Region: A Potential Source of Surgical Contamination. International Journal of Paediatric Orthopaedics. January-April 2026; 12(1): 19-21.

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Small Shoulders, Big Burden: Scapular Osteomyelitis in an Infant

DOI- https://doi.org/10.13107/ijpo.2026.v12.i01.260

Open Access License: CC BY-NC 4.0

Submitted: 31/10/2025; Reviewed: 24/11/2025; Accepted: 11/01/2026; Published: 10/02/2026

Authors: Dyan D’ Souza MS, MCh (Paed Surgery) [1], Karthik Shyam MD Rad [2], Binu T Kurian MS Ortho [3], Shubha A M MS, MCh (Paed Surgery) [1]

[1] Department of Paediatric Surgery, St Johns National Academy of Health Sciences Bangalore, Karnataka, India
[2] Department of Radiodiagnosis, St Johns National Academy of Health Sciences Bangalore, Karnataka, India
[3] Department of Orthopaedics, St Johns National Academy of Health Sciences Bangalore, Karnataka, India

Address of Correspondence

Dr. Shubha A M,
Department of Pediatric Surggery, St Johns National Academy of Health Sciences Bangalore, Karnataka, India
E-mail: dramshubha@yahoo.co.in

Abstract

Background: A mass in relation to the scapula is rare in infancy, causing a diagnostic dilemma. We report a case in an infant presenting with scapular osteomyelitis and highlight the management of this condition.
Case report: A 2-month-old male child presented with an atraumatic swelling in the right scapular region with decreased movements of the upper arm for 15 days with no response to antibiotics. A diffuse firm to hard swelling in the right scapular region, with increased temperature and tenderness restricting both passive and active movements at the shoulder joint was noted on examination. Though total counts and C- reactive protein were raised, the blood culture was sterile. Plain X-ray and MRI revealed osteomyelitis of the right scapula. Biopsy further confirmed the diagnosis. Good response was noted to treatment with antibiotics and physiotherapy
Conclusion: A scapular mass without shoulder arthritis, longer duration of symptoms, negative cultures and the absence of sepsis are notable features in this case. Emphasis is on prompt diagnosis and treatment with antibiotics and appropriate physiotherapy to prevent long term complications.
Keywords: Infant, Scapula, Osteomyelitis, Antibiotics, Case report

References

1. Kennedy TL, Whitaker M, Pellitteri P, Wood WE. Cystic hygroma/lymphangioma: a rational approach to management. Laryngoscope. 2001 Nov;111(11 Pt 1):1929-37. doi: 10.1097/00005537-200111000-00011. PMID: 11801972.
2. Dich VQ, Nelson JD, Haltalin KC. Osteomyelitis in infants and children. A review of 163 cases. Am J Dis Child. 1975 Nov;129(11):1273-8. doi: 10.1001/archpedi.1975.02120480007004. PMID: 1190158.
3. Behnke NM, Patel M, Davidson T, Arkader A. Orthopaedic case of the month: Rapidly progressive shoulder soft tissue mass in an 8-week-old girl. Clin Orthop Relat Res. 2011 Feb;469(2):624-9. doi: 10.1007/s11999-010-1710-0. Epub 2010 Dec 3. PMID: 21128034; PMCID: PMC3018191.
4. De Boeck H. Osteomyelitis and septic arthritis in children. Acta Orthop Belg 2005;71:505–15.
5. Koubaa M, Mnif H, Zrig M, et al. Acute hematogenous osteomyelitis of the scapula in children. Orthop Traumatol Surg Res. 2009;95:632–635.
6. Cunningham DG. Hematogenous osteomyelitis of the scapula presenting as Erb’s palsy. Ill Med J. 1975;147:439–440.
7. Fardon DF. Osteomyelitis of the scapula in an infant. Case report. Mo Med. 1970 May;67(5):299-302. PMID: 5427692
8. Rose NK, Franck LG, Celestin B, Adoubs I, Jean Bertrand KA. Osteomyelitis of the scapula in a 2-month-old infant. J. Pediatr. Surg. Case Rep. 2021; 73: 101998.
9. Meena S, Ansari MT. Osteomyelitis of scapula with secondary septic arthritis of shoulder joint in a six-month-old child. Malays Orthop J. 2013 Mar;7(1):67-9. doi: 10.5704/MOJ.1303.001. PMID: 25722810; PMCID: PMC4341052
10. Obeidat MM, Omari A. Osteomyelitis of the scapula with secondary septic arthritis of the shoulder joint. Singapore Med J. 2010;51:1–2.
11. Dartnell J, Ramachandran M, Katchburian M. Haematogenous acute and subacute paediatric osteomyelitis: a systematic review of the literature. Bone Joint J. 2012;94-B:584–595.
12. Caffey J. Infantile cortical hyperostosis; a review of the clinical and radiographic features. Proceedings of the Royal Society of Medicine. 1957;50(5):347–354. doi: 10.1177/003591575705000516.
13. Unkila-Kallio L, Kallio MJ, Peltola H, Eskola J. Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children. Pediatrics. 1994;93(1):59–62.
14. Pratik Phansopkar, Priya tikhile, Radhika Sawal, et al. Early physiotherapy rehabilitation approach enhances recovery in rare acute tibial osteomyelitis post-operative in a 9year old child. Medical Science, 2020, 24(104), 2482-2486.

How to Cite this Article: D’ Souza D, Shyam K, Kurian BT, Shubha AM. Small Shoulders, Big Burden: Scapular Osteomyelitis in an Infant. International Journal of Paediatric Orthopaedics. January-April 2026; 12(1): 16-18.

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