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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

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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

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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

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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

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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.

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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

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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 .

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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

1. Hagglund G, Lauge-Pedersen H and Wagner P. Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskelet Disord 2007; 8: 101.
2. Soo B, Howard JJ, Boyd RN, et al. Hip displacement in cerebral palsy. J Bone Joint Surg Am 2006; 88: 121–129.
3. Connelly A, Flett P, Graham HK, et al. Hip surveillance in Tasmanian children with cerebral palsy. J Paediatr Child Health 2009; 45(7–8): 437–443.
4. Reimers J. The stability of the hip in children: a radiological study of results of muscle surgery in cerebral palsy. Acta Orthop Scand 1980; 184: 1–100.
5. Miller F and Bagg MR. Age and migration percentage as risk factors for progression in spastic hip disease. Dev Med Child Neurol 1995; 37(5): 449–455.
6. Flynn JM and Miller F. Management of hip disorders in patients with cerebral palsy. J Am Acad Orthop Surg 2002;10: 198–209.
7. Bouwhuis CB, van der Heijden-Maessen HC, Boldingh EJ,et al. Effectiveness of preventive and corrective surgical intervention on hip disorders in severe cerebral palsy: a systematic review. Disabil Rehabil 2015; 37(2): 97–105.
8. Alibhai A, Hendrikse C, Bruijns SR. Poor access to acute care resources to treat major trauma in low- and middle-income settings: a self-reported survey of acute care providers. Afr J Emerg Med. 2019;9:S38–S42. doi: 10.1016/j.afjem.2019.01.004.
9. Larsson M, Hägglund G and Wagner P. Unilateral varus osteotomy of the proximal femur in children with cerebral palsy: a five-year follow-up of the development of both hips. J Child Orthop 2012; 6(2): 145–151.

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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[3] Wheeler BJ, Snoddy AME, Munns C, Simm P, Siafarikas A, Jefferies C. A Brief History of Nutritional Rickets. Front Endocrinol 2019;10:795. https://doi.org/10.3389/fendo.2019.00795.
[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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