Online Journals : the good, the bad and the ugly

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 1 | Sandeep Patwardhan, Taral Nagda, Ashok Shyam

Authors : Sandeep Patwardhan [1], Taral Nagda [2], Ashok Shyam [1], [3].

[1]  Sancheti Instittue for orthopaedics and Rehabilitation, Pune, India.
[2] Institute of Pediatric Orthopedic Disorders Mumbai India.
[3] Indian Orthopaedic Research Group, Thane, India

Address of Correspondence
Dr Ashok Shyam
IORG House, Mantahn Apts, shreesh CHS, Hajuri Road, Thane
Email: dr

Online Journals : the good, the bad and the ugly

In last few years, technology has impacted academics and education in a big way. Journals and publications are affected the most with this. The technology has made it easy to host a journal and publish an e-journal. This has both advantages and disadvantages. The advantage is that now even small societies can start their own Journal at low cost and maintain it without crippling cost that is part of agreement with big publishers. It is like academics has been allowed to slip through the tight claws of big publishers. Many established journals were getting too much content and would often reject without review. With new journals coming up the authors have avenues to submit their work and get timely publication of their articles. Many new journals also provided a lot of assistance to authors to write articles and this has again helped new academicians. Again different kind of journals are being started including journals dedicated to reviews and surgical techniques and case reports. This has definitely increased the forum available to young researcher. IJPO too is a product of this technological advancement. At times where only three paediatric orthopaedic journals existed in world, IJPO was started with help of Orthopaedic Research Group and has received great response in last three years.

However, this technological advancement is not without disadvantage which has allowed mushrooming of predatory publishers. The predatory publishers have grown in recent years and have grown bolder. Not a week goes by where we editors do not receive invitation from these journals soliciting articles from us and promising fast and rapid publication within days. We are sure many gullible young academicians are falling prey to these journals. This is an alarming trend and something needs to be done urgently to counter this. One of the most important part of this will be to inform and educate the academic community about these journals and their practices. Bealle’s List was an important list of predatory journals but we can ourselves use simple set of rules to identify these journals. Firstly only predatory journals will solicit your articles and ask for you submit to them. Its only these journals that will promise to publish articles within days of submission. There will hardly be any peer review. Also when you read published articles in these journals, there are lot of spelling error, poor formats, content published as in raw files. Also most of these journals will have weird names that would make them eligible to accept any article in medical field. One of the major hurdles with these journals is that once you have submitted your article to these journals, you cant retract your article. If you wish to retract, you have to pay money to them to retract your own article. This is the ugliest aspect of these publishers and something every researcher will be afraid of. However, if you face such problem, please let us know and we can help you with that

As more and more of us become aware of advantages and disadvantages of online publishing we will be well equipped to deal with these issue and will be able to make best use of these opportunities


1. Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004;364(9431):369-379.
2. Krogstad P. Osteomyelitis. In: Feigin RD, Cherry JD, Demmler-Harrison GD, Kaplan SL, editors. Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA, USA: Saunders Elsevier; 2009. p. 725-742

How to Cite this Article: Patwardhan S, Nagda T, Shyam AK. Online Journals : the good, the bad and the ugly. International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):1.

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Primary Subacute Osteomyelitis of Talus: An Unusual Presentation of a Limping Child

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 24-25 | Rajib Naskar, Balgovind S. Raja, Dhanish V. Mehendiratta, Pravin Jadhav, Harshad G. Argekar

Authors : Rajib Naskar [1], Balgovind S. Raja [2], Dhanish V. Mehendiratta [1], Pravin Jadhav [1], Harshad G. Argekar [1].

[1] Department of Orthopaedics, LTMC &Sion Hospital, Sion, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, K B Bhabha Municipal Hospital, Bandra, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Rajib Naskar,
Suite no.115, College building, Sion hospital, Dr. Ambedkar Road Mumbai 400022


A 9-year-old female presented with symptoms of limp and pain in the right ankle region along with swelling. Prominent systemic features of osteomyelitis were lacking. The delay in diagnosis from limping to diagnosis confirmation and hospital admission was 6 days. The final diagnosiswas made after adetailed radiological investigation and open sampling and curettage. It was the treated conservatively, and after 6 weeks of treatment, radiological improvement was noted. We conclude that, in a limping child with ankle pain, subacute osteomyelitis of talus should be kept in mind as a differential and it can be successfully treated in outpatient basis with conservative management.
Keywords: Osteomyelitis, Talus, Children, Ankle pain.


1. Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004;364(9431):369-379.
2. Krogstad P. Osteomyelitis. In: Feigin RD, Cherry JD, Demmler-Harrison GD, Kaplan SL, editors. Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA, USA: Saunders Elsevier; 2009. p. 725-742

How to Cite this Article: Naskar R, Raja B S, Mehendiratta D V, Jadhav P, Argekar H G. Primary Subacute Osteomyelitis of Talus: An Unusual Presentation of a Limping Child. International Journal of Paediatric Orthopaedics Jan-Jun 2017;3(1):24-25.

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Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 12-15 | Samuel K. Van de Velde, Jack Pang, Lachlan Milne, Jitendra Balakumar

Authors : Samuel K. Van de Velde [1], Jack Pang [1], Lachlan Milne [1], Jitendra Balakumar [1].

[1] Department of Orthopaedics, The Royal Children’s Hospital Melbourne, Parkville (VIC) 3052, Australia

Address of Correspondence
Dr. Samuel K. Van de Velde,
Department of Orthopaedics, The Royal Children’s Hospital Melbourne
50 Flemington Road, Parkville (VIC) 3052, Australia
Email :


Purpose: Femoral neck fractures in children are rare injuries which are associated with a high incidence of osteonecrosis of the femoral head. We aimed to determine the predictive accuracy of bone scintigraphy for femoral head osteonecrosis after pediatric femoral neck fractures.
Materials and Methods: Thirteen scintigrams were performed in 10 children (6–15 years) at diverse moments after fixation of a femoral neck fracture.The results of the bone scintigrams were compared with the hip radiographs at final follow-up.
Results: Eight of the 10 femoral heads eventually developed osteonecrosis. Scintigrams performed within 2 weeks showed decreased uptake for these heads. However,four of the five scans that were performed more than 1 month after surgery showed normal uptake despite the subsequent collapse of these femoral heads.
Conclusions: Bone scintigraphy has a very low accuracy in predicting compromised vascularity of the femoral head when performed more than 1month after surgery of a femoral neck fracture in children. This findingquestions the value of scintigraphy performed late in the follow-up of pediatric femoral neck fractures.
Level of Evidence: Level IV.
Keywords: Pediatric Hip Fracture; Bone Scan; Outcome


1. Yeranosian M, Horneff JG, Baldwin K, Hosalkar HS. Factors affecting the outcome of fractures of the femoral neck in children and adolescents: A systematic review. Bone Joint J 2013;95-B:135-42.
2. Moon ES, Mehlman CT. Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma 2006;20:323-9.
3. Kim HK, Aruwajoye O, Stetler J, Stall A. Effects of non-weight-bearing on the immature femoral head following ischemic osteonecrosis: An experimental investigation in immature pigs. J Bone Joint Surg Am 2012;94:2228-37.
4. Kim HK, Randall TS, Bian H, Jenkins J, Garces A, Bauss F. Ibandronate for prevention of femoral head deformity after ischemic necrosis of the capital femoral epiphysis in immature pigs. J Bone Joint Surg Am 2005;87:550-7.
5. Arora A, Agarwal A, Sharma J. Outcomes in pediatric femoral neck fractures. Delhi J Orthop 2004;1:25-49.
6. Hajdu S, Oberleitner G, Schwendenwein E, Ringl H, Vécsei V. Fractures of the head and neck of the femur in children: An outcome study. Int Orthop 2011;35:883-8.
7. Bali K, Sudesh P, Patel S, Kumar V, Saini U, Dhillon MS. Pediatric femoral neck fractures: Our 10 years of experience. Clin Orthop Surg 2011;3:302-8.
8. Shrader MW, Jacofsky DJ, Stans AA, Shaughnessy WJ, Haidukewych GJ. Femoral neck fractures in pediatric patients: 30 years experience at a level 1 trauma center. Clin Orthop Relat Res 2007;454:169-73.
9. Kaushik A, Sankaran B, Varghese M. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures. Eur J Radiol 2010;75:364-75.
10. Pierce TP, Jauregui JJ, Cherian JJ, Elmallah RK, Mont MA. Imaging evaluation of patients with osteonecrosis of the femoral head. Curr Rev Musculoskelet Med 2015;8:221-7.
11. Bauer G, Weber DA, Ceder L, Darte L, Egund N, Hansson LI, et al. Dynamics of Technetium-99m methylenediphosphonate imaging of the femoral head after hip fracture. Clin Orthop Relat Res 1980;152:85-92.
12. D’Ambrosia RD, Shoji H, Riggins RS, Stadalnik RC, DeNardo GL. Scintigraphy in the diagnosis of osteonecrosis. Clin Orthop Relat Res 1978;130:139-43.
13. Alberts KA, Dahlborn M, Ringertz H. Sequential scintimetry after femoral neck fracture. Methodologic aspects and prediction of healing complications. Acta Orthop Scand 1987;58:217-22.
14. Strömqvist B, Brismar J, Hansson LI, Palmer J. Technetium-99m-methylenediphosphonate scintimetry after femoral neck fracture. A three-year follow-up study. Clin Orthop Relat Res 1984;182:177-89.
15. Broeng L, Bergholdt Hansen L, Sperling K, Kanstrup IL. Postoperative Tc-scintimetry in femoral neck fracture. A prospective study of 46 cases. Acta Orthop Scand 1994;65:171-4.
16. Juréus J, Geijer M, Tiderius CJ, Tägil M. Vascular evaluation after cervical hip fractures in children: A case series of eight children examined by scintigraphy after surgery for cervical hip fracture and evaluated for development of secondary radiological changes. J Pediatr Orthop B 2016;25:17-23.
17. Mortensson W, Rosenborg M, Gretzer H. The role of bone scintigraphy in predicting femoral head collapse following cervical fractures in children. Acta Radiol 1990;31:291-2.
18. Minikel J, Sty J, Simons G. Sequential radionuclide bone imaging in avascular pediatric hip conditions. Clin Orthop Relat Res 1983;175:202-8.
19. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 1985;67:3-9.
20. Turner JH. Post-traumatic avascular necrosis of the femoral head predicted by preoperative technetium-99m antimony-colloid scan. An experimental and clinical study. J Bone Joint Surg Am 1983;65:786-96.
21. Meyers MH, Telfer N, Moore TM. Determination of the vascularity of the femoral head with technetium 99m-sulphur-colloid. J Bone Joint Surg Am 1977;59:658-64.
22. Alberts KA. Prognostic accuracy of preoperative and postoperative scintimetry after femoral neck fracture. Clin Orthop Relat Res 1990;250:221-5.
23. Strömqvist B, Hansson LI, Nilsson LT, Thorngren KG. Prognostic precision in postoperative 99mTc-MDP scintimetry after femoral neck fracture. Acta Orthop Scand 1987;58:494-8.
24. Yoon BH, Kim YW, Yoon HK. Patterns of isotope uptake in sequential postoperative bone scan in undisplaced femoral-neck fractures. Int Orthop 2013;37:1541-5.
25. Love C, Din AS, Tomas MB, Kalapparambath TP, Palestro CJ. Radionuclide bone imaging: An illustrative review. Radiographics 2003;23:341-58.

How to Cite this Article: Van de Velde SK, Pang J, Milne L, Balakumar J.Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures. International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):12-15.

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Reliability of Beighton’s Score in a Pediatric Population

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 9-11 | Nimesh G Patel, Peter Riddlestone, Roshan Gunalan, Anthony Gough, James Metcalfe, Ben Holroyd

Authors : Nimesh G Patel [1], Peter Riddlestone [1], Roshan Gunalan [1], Anthony Gough [1], James Metcalfe [1], Ben Holroyd [1].

[1] Department of Paediatric Orthopaedics Derriford Hospital, Plymouth, UK

Address of Correspondence
Dr. Nimesh Patel,
Department of Paediatric Orthopaedics Derriford Hospital Plymouth, UK


Introduction: Beighton’s score (BS) is a valid screening tool in an adult population, but its use in pediatrics to assess generalized joint mobility is not fully validated. The correlation of hypermobility and joint pain in children is also not fully understood. We, therefore, aim to investigate the reliability of BS in the pediatric population.
Materials and Methods: Over a 3-month period, children presenting to our pediatric orthopedic unit had their BS measured by a trained orthopedic surgeon. Non-ambulatory children were excluded, as were those with known hypermobility syndrome or neuromuscular disorders.We also screened them for joint pain and measured their lower limb rotational profile.
Results: A total of 200 patients (92 males and 108 females) were assessed, aged between 3 and 15 years (mean 10.1). Mean standard deviation (SD) BS was 2.06 (2.2), and the range was 0–8. Comparing males versus females, mean BS SD was 1.71 (2.25) versus 2.36 (2.14); p=0.0378, age was 9.75 versus 10.13, and BS range was 0–7 versus 0–8.64 children (32%) complained of pain in at least one joint, though the mean SD BS in these patients was 1.71 (1.86).
Discussion: We found that the average BS was just over 2 in all of our children, though significantly lower in males.In adults, a score of 4 or higher has been attributed to generalized hypermobility, though a true diagnostic cutoff has not been defined in children.Since there is already an innate tendency to have an increased BS in normal children, it makes interpretation of the score in a pediatric population difficult and less meaningful.Of note, there was no correlation between arthralgia and a high BS or abnormal lower limb rotational profile. We therefore do not recommend routine measurement of BS to diagnose hypermobility in a pediatric population.
Keywords: Beighton’s score, hypermobility, joint laxity, pediatric population


1. Beighton P, Horan F. Orthopaedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg Br 1969;51:444-53.
2. Hakim AJ, Sahota A. Joint hypermobility and skin elasticity: The hereditary disorders of connective tissue. ClinDermatol 2006;24:521-33.
3. Kirk JA, Ansell BM, BywatersEG.The hypermobility syndrome, Musculoskeletal complaints associated with generalized joint hypermobility.Ann Rheum Dis 1967;26:419-25.
4. Cattalini M,Khubchandani R,CimazR.When flexibility is not necessarily a virtue: A review of hypermobility syndromes and chronic or recurrent musculoskeletal pain in children.PediatrRheumatol Online J2015;13:40.
5. Palmer S, Bailey S, Barker L, Barney L, ElliottA.The effectiveness of therapeutic exercise for joint hypermobility syndrome: A systematic review.Physiotherapy2014;100:220-7.
6. Guidelines for Management of Joint Hypermobility Syndrome in Children and Young People. A Guide for professionals managing young people with this condition.
7. Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis 1973;32:413-8.
8. Junge T, Jespersen E,Wedderkopp N,Juul-KristensenB.Inter-tester reproducibility and inter-method agreement of two variations of the Beighton test for determining Generalised Joint Hypermobility in primary school children.BMC Pediatr2013;13:214.
9. van Trijffel E, van de Pol RJ,Oostendorp RA, LucasC.Inter-rater reliability for measurement of passive physiological movements in lower extremity joints is generally low: A systematic review.JPhysiother2010;56:223-35.
10. Carter C, wilkinson J.Persistent joint laxity and congenital dislocation of the hip.J Bone Joint Surg Br1964;46:40-5.
11. Wynne-Davies R. Acetabular dysplasia and familial joint laxity: Two etiological factors in congenital dislocation of the hip. A review of 589 patients and their families. J Bone Joint Surg Br 1970;52:704-16.
12. Grahame R, Bird HA, ChildA.The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS).JRheumatol 2000;27:1777-9.

How to Cite this Article: Patel N G, Riddlestone P, Gunalan R, Gough A, Metcalfe J, Holroyd B.Reliability of Beighton’s Score in a Pediatric Population. International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):9-11.

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Analysis of Dimeglio Score with Modified Pirani Score for Assessment of Idiopathic Clubfoot Deformity in Infants: A Comparative Study!

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 2-5| Vasu sharma, Vikas Gupta, Daipayan chatterjee, Akshat Sharma

Authors : Vasu sharma [1], Vikas Gupta [2], Daipayan chatterjee [1], Akshat Sharma [1].

[1] Senior Resident, Central Institute of orthopaedics, VMMC & Safdarjung Hospital, New Delhi. India.

[2] Professor, Central Institute of orthopaedics, VMMC & Safdarjung Hospital, New Delhi. India.

Address of Correspondence
Dr. Vasu Sharma

Central Institute of orthopaedics,

VMMC & Safdarjung Hospital,

New Delhi 110029, India.



Background: To evaluate Idiopathic clubfoot deformity of foot, several scoring systems have been proposed and modified Pirani score and Dimeglio score have stood the test of time. There is scarcity of literature comparing the two systems in depth. We tried to compare the scoring systems on user friendliness and predictability to find out whether any superiority exists, if any. We also tried out if Dimeglio score could be used as a guideline for performing tenotomy.
Methods: 82 feet of idiopathic clubfoot deformity were treated by Ponseti’s Plaster technique and evaluated by both modified Pirani and Dimeglio score simultaneously with each cast until full correction was achieved. The scores were compared using standard statistical techniques comparing predictability and user friendliness. Tenotomy was done as per guidelines given by Pirani and corresponding Dimeglio score was assessed and evaluated.
Results: Dimeglio score took longer time as compared to Modified Pirani score. Strong positive correlation was found between corresponding Modified Pirani and Dimeglio Score. Pirani score had statistical significant Plateauing just prior to tenotomy. Dimeglio score of 5 or 6 was found in all cases where tenotomy was done with Equinus score 3 or 2, Curvature of lateral border and Derotation of carpopedal block and Forefoot adduction score 0 or 1, with Cavus, Medial, Posterior crease, Muscle status score 0.
Conclusion: Both Dimeglio and Modified Pirani score have their advantages and shortcomings but most of the scoring correlate well. Dimeglio score can also be used to decide when to do tenotomy.


1. Turco VJ. Clubfoot: Current Problems in Orthopaedics. New York: Churchill Livingstone; 1981.
2. Ponseti IV. Introduction Congenital Clubfoot: Fundamentals of Treatment. Ch. 1. Oxford: Oxford University Press; 1996. p. 1-8.
3. Stern C. Anomalies of genetic origin. Pediatrics 1950;5(2):324-328.
4. Shabtai L, Specht SC, Herzenberg JE. Worldwide spread of the Ponseti method for clubfoot. World J Orthop 2014;5(5):585-590.
5. Göksan SB. Treatment of congenital clubfoot with the Ponseti method. Acta Orthop Traumatol Turc 2002;36(4):281-287.
6. Lehman WB, Mohaideen A, Madan S, Scher DM, Van Bosse HJ, Iannacone M, et al. A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop B 2003;12(2):133-140.
7. Ponseti IV, Smoley EN. Congenital club foot: The results of treatment. J Bone Joint Surg Am 1963;45-A:261-344.
8. Catterall A. A method of assessment of the clubfoot deformity. Clin Orthop Relat Res 1991;264:48-53.
9. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B 1995;4(2):129-136.
10. Harrold AJ, Walker CJ. Treatment and prognosis in congenital club foot. J Bone Joint Surg Br 1983;65(1):8-11.
11. Canale ST, beaty JJH, Campbell’s Operative orthopedics. 12th edition. 2013. Elseviers Mosby; . Ch 29: p. 997-1001.
12. Flynn JM, Donohoe M, Mackenzie WG. An independent assessment of two clubfoot-classification systems. J Pediatr Orthop 1998;18(3):323-327.
13. Chu A, Labar AS, Sala DA, van Bosse HJ, Lehman WB. Clubfoot classification: correlation with Ponseti cast treatment. J Pediatr Orthop 2010;30(7):695-699.
14. Wainwright AM, Auld T, Benson MK, Theologis TN. The classification of congenital talipes equinovarus. J Bone Joint Surg Br 2002;84(7):1020-1024.
15. Cosma D, Vasilescu DE. A clinical evaluation of the pirani and dimeglio idiopathic clubfoot classifications. J Foot Ankle Surg 2015;54(4):582-585.

How to Cite this Article: Sharma V, Gupta V, Chatterjee D, Sharma A: Analysis of Dimeglio Score with Modified Pirani Score for Assessment of Idiopathic Clubfoot Deformity in Infants: A Comparative Study! International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):2-5.

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Ipsilateral Supracondylar Humerus Fracture with Distal End Radius Fracture in Children: A Series of 10 Cases

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 6-8 | Chirag Borana, Naeem Jagani, Nadir Shah, Lokesh Sharoff, Sunirmal Mukherjee

Authors : Chirag Borana [1], Naeem Jagani [2], Nadir Shah [3], Lokesh Sharoff [4], Sunirmal Mukherjee [5].

[1,2,4] Consultant, Dept of Orthopaedics, Masina Hospital, Byculla, Mumbai.
[3] Asst. Professor, Dept of Orthopaedics, Sir JJ Group of Hospitals, Mumbai.
[5] Senior Resident, Dept of Orthopaedics, Sir JJ Group of Hospitals, Mumbai.

Address of Correspondence
Dr. Lokesh Sharoff,
42, Madhur Milan Society,14th B Road, Khar West, Mumbai 400052.


Background: Supracondylar humerus fracture with forearm fractures are rare with reported incidence ranging from 3% to 13%.
Materials and Methods: We have treated 10patients with ipsilateral supracondylar humerus fracture with distal radius fracture. One had a Gustilo-Anderson Grade 2 open supracondylar humerus fracture. All displaced fractures were treated with K-wire fixation by aclosed method except the open fracture which warranted wound debridement and subsequent open reduction. A follow-up of at least 6 months is available for all our patients.
Results: All fractures showed signs of union by 6 weeks when K-wires were removed. At6 months, 9 patients had excellent outcome while one patient with recovering radial nerve palsy had afair outcome. No cases of non-union or loss of reduction were seen in the post-operative period. Pin tract site infection was seen in one patient with anopen fracture which resolved after K-wire removal and antibiotic coverage.
Conclusion and Learning: This study recommends screening radiographs of forearm and wrist in patients with supracondylar humerus fractures to rule out any associated forearm/wrist injury. We also recommend closed reduction and K-wire fixation of the displaced supracondylar humerus as well as distal radius fractures.
Keywords: Pediatric fractures; Double fractures; Adolescent fractures; Immature skeletal fractures; upper-extremity fractures.


1. McLauchlan GJ, Walker CR, Cowan B, Robb JE, Prescott RJ. Extension of the elbow and supracondylar fractures in children. J Bone Joint Surg Br 1999;81(3):402-405.
2. Dhoju D, Shrestha D, Parajuli N, Dhakal G, Shrestha R. Ipsilateral supracondylar fracture and forearm bone injury in children: A retrospective review of thirty one cases. Kathmandu Univ Med J (KUMJ) 2011;9(34):11-16.
3. Siemers F, Obertacke U, Fernandez ED, Olivier LC, Neudeck F. Combination of ipsilateral supracondylar humeral-and forearm fractures in children. ZentralblChir 2002;127(3):212-217.
4. Tabak AY, Celebi L, Muratli HH, Yagmurlu MF, Aktekin CN, Biçimoglu A. Closed reduction and percutaneous fixation of supracondylar fracture of the homers and ipsilateral fracture of the forearm in children. J Bone Joint Surg Br 2003;85(8):1169-11672.
5. Powell RS, Bowe JA. Ipsilateral supracondylar homers fracture and Monteggia lesion: A case report. J Orthop Trauma 2002;16(10):737-740.
6. Rouhani AR, Navali AM, Sadegpoor AR, Soleimanpoor J, Ansari M. Monteggia lesion and ipsilateral humeral supracondylar and distal radial fractures in a young girl. Saudi Med J 2007;28(7):1127-1128.
7. Cobanoglu M, Savk SO, Cullu E, Duygun F. Ipsilateral supracondylar homers fracture and Monteggia lesion with a 5-year follow-up: A rare injury in a young girl. BMJ Case Rep 2015;2015. pii: Bcr2014206313.
8. Peters CL, Scott SM, Stevens PM. Closed reduction and percutaneous pinning of displaced supracondylar homers fractures in children: Description of a new closed reduction technique for fractures with brachialis muscle entrapment. J Orthop Trauma 1995;9(5):430-434.
9. Biyani A, Gupta SP, Sharma JC. Ipsilateral supracondylar fracture of homers and forearm bones in children. Injury 1989;20(4):203-207.
10. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the homers in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg Am 1974;56(2):263-272.
11. Templeton PA, Graham HK. The ‘floating elbow’ in children. Simultaneous supracondylar fractures of the homers and of the forearm in the same upper limb. J Bone Joint Surg Br 1995;77(5):791-796.

How to Cite this Article: Borana C, Jagani N, Shah N, Sharoff L, Mukherjee S. Osteochondroma Arising from the Head of the Fibula: A Rare Cause of Drop Foot in Pediatric Age. International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):6-8.

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Osteochondroma Arising from the Head of the Fibula: A Rare Cause of Drop Foot in Pediatric Age

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 2-5 | Pérez-Ortiz Sergio, Blas-Dobón JA, Peralta-Nieto J, Gómez-Barbero P

Authors : Pérez-Ortiz Sergio [1], Blas-Dobón JA [1], Peralta-Nieto J [1], Gómez-Barbero P [1].

[1] Hospital Universitario Doctor Peset, Valencia, Spain

Address of Correspondence
Dr. Sergio Perez  Ortiz

Hospital Universitario Doctor Peset, Valencia, Spain.



Background: The common peroneal nerve (CPN) or external popliteal nerve is the most frequently involved nerve in entrapment syndromes in the lower extremities. Its proximity to the head of the fibula makes it particularly susceptible to damage by different injury mechanisms. Osteochondromas arising from the proximal fibula are a rare cause of common peroneal nerve injury.
Methods: We report a case of a 13-year-old Caucasian male patient referred to our hospital with drop foot and palpable mass in the head of the right fibula. Physical examination revealed a severe paresis, grade 2 objectified by the scale of the Medical Research Council (MRC) in the extensor hallucislongus, extensor digitorumlongus and tibialis anterior muscles and hypoesthesia in the dorsal surface of foot and portions of the anterior, lower-lateral leg. In magnetic resonance imaging (MRI) a tumor in the head of the fibula compressing the CPN is observed. Electromyographic studies confirmed the presence of severe partial axonotmesis of the right peroneal nerve.
The patient underwent surgery for decompression of the peroneal nerve and resection of the proximal fibula osteocartilaginousexostosis. The histopathological analysis confirmed the diagnosis of osteochondroma.
Results: At the 12-month postoperative follow-up the patient recovered sensitivity and presented, according to the MRC scale, muscle strength of 4 out of 5 in thepreviouslynamed muscles, being able to walk without orthotic devices. In the electromyography, subacuteaxonotmesis with important signs of active reinnervation observed
Conclusions : Osteochondroma in the head of the fibula is a rare cause of CPN injury, that can go easily unnoticed and has to be considered in the differential diagnosis of the drop foot in pediatric ages. Diagnosis and treatment should not be delayed to get a good neurological recovery because, otherwise, it could be irreversible.
Keywords: Drop foot, peroneal palsy, osteochondroma, tumor, nerve injury, surgery, nerve decompression, tumor of the fibula, pediatrics.


1. Çinar A, Yumrukçal F, Salduz A, Dirik Y, Eralp L. A rare cause of ‘drop foot’ in the pediatric age group: Proximal fibular osteochondroma a report of 5 cases. Int J Surg Case Rep 2014;5(12):1068-1071.
2. Dowson D. Entrapment Neuropathies. 2nd ed. Boston: Boston 7 Little, Brown and Company; 1990.
3. Flores LP, Koerbel A, Tatagiba M. Personal nerve compression resulting from fibular head osteophyte-like lesions. SurgNeurol 2005;64(3):249-252.
4. Mumenthaler M, Schliack H. Peripheral Nerves Lesions – Diagnosis and Therapy. New York: Stuttgart 7 Thieme Medical; 1991.
5. Abdel MP, Papagelopoulos PJ, Morrey ME, Wenger DE, Rose PS, Sim FH. Surgical management of 121 benign proximal fibula tumors. ClinOrthopRelat Res 2010;468(11):3056-3062.
6. Unni K. Dahlin’s Bone Tumors: General Aspects and Data on 11,087 Cases. Philadelphia, PA: Lippincot – Raven Publishers; 1996.
7. Kumar M, Malgonde M, Jain P. Osteochondroma arising from the proximal fibula: A rare presentation. J ClinDiagn Res 2014;8(4):LD01-LD03.
8. Flanigan RM, DiGiovanni BF. Peripheral nerve entrapments of the lower leg, ankle, and foot. Foot Ankle Clin 2011;16(2):255-274.
9. Paternostro-Sluga T, Grim-Stieger M, Posch M, Schuhfried O, Vacariu G, Mittermaier C, et al. Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med 2008;40(8):665-671.
10. Yildiz C, Erler K, Atesalp AS, Basbozkurt M. Benign bone tumors in children. CurrOpinPediatr 2003;15(1):58-67.
11. Springfield DS, Gebhardt MC. Bone and soft tissue tumors. In: Morrissy RT, Weisnstein SL, editors. Lowell and Winter’s Pediatric Orthopedics. Philadelphia, PA: Lippincott Williams and Wilkins; 2001. p. 507-561.
12. Saglik Y, Altay M, Unal VS, Basarir K, Yildiz Y. Manifestations and management of osteochondromas: A retrospective analysis of 382 patients. ActaOrthopBelg 2006;72(6):748-755.
13. Bovée JV. Multiple osteochondromas. Orphanet J Rare Dis 2008;3(1):1-7.
14. Biermann JS. Common benign lesions of bone in children and adolescents. J PediatrOrthop 2002;22(2):268-273.
15. Kushner BH, Roberts SS, Friedman DN, Kuk D, Ostrovnaya I, Modak S, et al.Osteochondroma in long-term survivors of high-risk neuroblastoma. Cancer 2015;121(12):2090-2096.
16. Marcovici PA, Berdon WE, Liebling MS. Osteochondromas and growth retardation secondary to externally or internally administered radiation in childhood. PediatrRadiol 2007;37(3):301-304.
17. Unger EC, Gilula LA, Kyriakos M. Case report 430: Ischemic necrosis of osteochondroma of tibia. Skeletal Radiol 1987;16(5):416-421.
18. Khosla A, Parry RL. Costalosteochondroma causing pneumothorax in an adolescent: A case report and review of the literature. J PediatrSurg 2010;45(11):2250-2253.
19. Ferriter P, Hirschy J, Kesseler H, Scott WN. Popliteal pseudo aneurysm. A case report. J Bone Joint Surg Am 1983;65(5):695-697.
20. Van den Bergh FR, Vanhoenacker FM, De Smet E, Huysse W, Verstraete KL. Peroneal nerve: Normal anatomy and pathologic findings on routine MRI of the knee. Insights Imaging 2013;4(3):287-299.
21. Paprottka FJ, Machens HG, Lohmeyer JA. Partially irreversible paresis of the deep personal nerve caused by osteocartilaginous exocytosis of the fibula without affecting the tibia is anterior muscle. J PlastReconstrAesthetSurg 2012;65(8):e223-e225.
22. Bunch K, Hope E. An uncommon case of bilateral personal nerve palsy following delivery: A case report and review of the literature. Case Rep ObstetGynecol2014;2014:746480.
23. Mnif H, Koubaa M, Zrig M, Zammel N, Abid A. Personal nerve palsy resulting from fibular head osteochondroma. Orthopedics 2009;32(7):528.
24. Baima J, Krivickas L. Evaluation and treatment of personal neuropathy. Curr Rev Musculoskelet Med 2008;1(2):147-153.
25. Sunderland S, Bradley KC. The cross-sectional area of peripheral nerve trunks devoted to nerve fibers. Brain 1949;72(3):428-449.
26. Cardelia JM, Dormans JP, Drummond DS, Davidson RS, Duhaime C, Sutton L. Proximal fibular osteochondroma with associated personal nerve palsy: A review of six cases. J PediatrOrthop 1995;15(5):574-577.
27. Paik NJ, Han TR, Lim SJ. Multiple peripheral nerve compressions related to malignantly transform hereditary multiple exocytosis. Muscle Nerve 2000;23(8):1290-1294.
28. Bernard SA, Murphey MD, Flemming DJ, Kransdorf MJ. Improved differentiation of benign osteochondromas from secondary chondrosarcomas with standardized measurement of cartilage cap at CT and MR imaging. Radiology 2010;255(3):857-865.
29. Ozden R, Uruc V, Kalaci A, Dogramaci Y. Compression of common personal nerve caused by an extra neural ganglion cyst mimicking intermittent claudication. J Brachial PlexPeripher Nerve Inj 2013;8(1):5.
30. Pedrini E, Jennes I, Tremosini M, Milanesi A, Mordenti M, Parra A, et al. Genotype-phenotype correlation study in 529 patients with multiple hereditary exocytosis: Identification of “protective” and “risk” factors. J Bone Joint Surg Am 2011;93(24):2294-2302.
31. Chin KR, Kharrazi FD, Miller BS, Mankin HJ, Gebhardt MC. Osteochondromas of the distal aspect of the tibia or fibula. Natural history and treatment. J Bone Joint Surg Am 2000;82(9):1269-1278.
32. Pigott TJ, Jefferson D. Idiopathic common personal nerve palsy – A review of thirteen cases. Br J Neurosurg 1991;5(1):7-11.

How to Cite this Article: Sergio PO, Blas-Dobón JA, Peralta-Nieto J, Gómez-Barbero POsteochondroma Arising from the Head of the Fibula: A Rare Cause of Drop Foot in Pediatric Age. International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):20-23.

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Correlation of Pirani Score and Ultrasound in Assessing the Severity of Clubfoot in Neonates Treated by Ponseti Method

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 16-19 | Vineet Bajaj, Rahul Anshuman, Nikhil Verma, Mahipal Singh, Anupama Tandon, Neerav Anand Singh

Authors : Vineet Bajaj [1], Rahul Anshuman [1], Nikhil Verma [1], Mahipal Singh [1], Anupama Tandon [1], Neerav Anand Singh [1].

[1] Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi-110095, India.

Address of Correspondence
Dr Rahul Anshuman
Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi-110095, India.


Aim: The aim of this study is to correlate Pirani score and ultrasound in assessing the severity of clubfoot in neonates treated by Ponseti method.
Materials and Methods: A total of 32 ft with idiopathic congenital talipes equinovarus deformity in neonates were prospectively treated by Ponseti method. Pirani score and ultrasound parameters were measured 3 times, i.e., at the time of initial presentation, at 4 weeks of treatment, and at completion of treatment. Feet were divided according to Pirani score in groups: One (0–2.0), two (2.5–4), and three (4.5–6). Correlation between ultrasound parameters and Pirani score was evaluated using one-way ANOVA and Tukey test.
Results: Correlation between Pirani score and ultrasound parameters was statistically significant (p<0.05).
Conclusion: Ultrasound has the potential to accurately depict the pathoanatomy in clubfoot. Ultrasound is objective method to assess the severity of clubfoot. Pirani score and ultrasound correlated in severity of deformity and correction achieved along the course of treatment.
Keywords: Idiopathic congenital talipes equinovarus, Pirani score, Ponseti method, ultrasound.


1. Brewster MB, Gupta M, Pattison GT, Dunn-van der Ploeg ID. Ponseti casting: A new soft option. J Bone Joint Surg Br 2008;90:1512-5.
2. Matuszewski L, Gil L, Karski J. Early results of treatment for congenital clubfoot using the Ponseti method. Eur J Orthop Surg Traumatol 2012;22:403-6.
3. Porecha MM, Parmar DS, Chavda HR. Mid-term results of Ponseti method for the treatment of congenital idiopathic clubfoot–(a study of 67 clubfeet with mean five year follow-up). J Orthop Surg Res 2011;6:3.
4. Ponseti IV, Smoley EN. Congenital club foot: The results of treatment. J Bone Joint Surg Am 1963;45:2261-75.
5. Ponseti IV. Clubfoot management. J Pediatr Orthop 2000;20:699-700.
6. Bhargava SK, Tandon A, Prakash M, Arora SS, Bhatt S, Bhargava S. Radiography and sonography of clubfoot: A comparative study. Indian J Orthop 2012;46:229-35.
7. Wainwright AM, Auld T, Benson MK, Theologis TN. The classification of congenital talipes equinovarus. J Bone Joint Surg Br 2002;84:1020-4.
8. Shaheen S, Jaibala H, Pirani S. Intraobserver reliability in Pirani clubfoot severity scoring between a paediatric orthopedic surgeon and a physiotherapy assistant. J Pediatr Orthop B 2012;21:366-8.
9. Desai S, Aroojis A, Mehta R. Ultrasound evaluation of clubfoot correction during Ponseti treatment: A preliminary report. J Pediatr Orthop 2008;28:53-9.
10. El-Adwar KL, Taha Kotb H. The role of ultrasound in clubfoot treatment: Correlation with the Pirani score and assessment of the Ponseti method. Clin Orthop Relat Res 2010;468:2495-506.
11. Shiels WE 2nd, Coley BD, Kean J, Adler BH. Focused dynamic sonographic examination of the congenital clubfoot. Pediatr Radiol 2007;37:1118-24.
12. Gigante C, Talenti E, Turra S. Sonographic assessment of clubfoot. J Clin Ultrasound 2004;32:235-42.
13. Aurell Y, Johansson A, Hansson G, Wallander H, Jonsson K. Ultrasound anatomy in the normal neonatal and infant foot: An anatomic introduction to ultrasound assessment of foot deformities. Eur Radiol 2002;12:2306-12.

How to Cite this Article: Bajaj V, Anshuman R, Verma N, Singh M, Tandon A, Singh A.  Correlation of Pirani Score and Ultrasound in Assessing the Severity of Clubfoot in Neonates Treated by Ponseti Method. International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):16-19.

(Abstract)      (Full Text HTML)      (Download PDF)