Volume 7 | Issue 1 | January-April 2021 | Page: 01 | Jayant  S. Sampat

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

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

Address of Correspondence
Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.

Dear Friends
On behalf of the Editorial Board, I am pleased to present the 1st issue of IJPO for the year 2021. As the world grapples with the pandemic, it has been difficult to find the right frame of mind for research and publication. We would like to record our gratitude to the contributors for the timely completion of the submission and review process.
Dr Maulin Shah has ably curated a symposium on Brachial Plexus Birth Palsy (BPBP) for this issue. The authors include doyens in the field of Brachial Plexus surgery in India. We thank the senior authors for generously sharing their immense experience in managing this difficult problem. The symposium will hopefully act as a practical reference for trainees and practising orthopaedic surgeons alike.
The original articles in this issue deal with familiar problems in Paediatric Orthopaedics namely clubfoot, chronic osteomyelitis and supracondylar fractures of the humerus. The authors describe their experience of managing these problems in a resource-limited setting whilst constantly striving to question current practice and suggest improvements.
We are still a fledgling organisation and need your support to reach greater heights. Please do consider IJPO, the official journal of Paediatric Orthopaedic Society of India when submitting your research work for peer-reviewed publication. The Editorial Board members are making special efforts to improve submitted manuscripts in terms of language and content.
Dr Jayanth S Sampath FRCSEd (Tr & Orth)


How to Cite this Article:  Sampat JS  | Editorial | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 01.

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Volume 6 | Issue 2 | May-August 2020 | Page: 2-3 | Jayant S Sampath

Authors: Jayant S Sampath [1]

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

Address of Correspondence
Dr. Jayanth S Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.

Dear Friends,
This issue comes with the exciting news that Paediatric Orthopaedic Society of India (POSI) has recognised International Journal Of Paediatric Orthopaedics (IJPO) as its official journal.
IJPO was first published in 2015 with the aim of highlighting the treatment of paediatric orthopaedic conditions in the developing world setting. It is well recognised that existing reputable journals tend to focus on the latest technique or device; resources that may not be available to surgeons in emergent nations or affordable by their patients. Through symposia on practical management of supracondylar fractures, clubfoot and radial clubhand; IJPO has made an energetic beginning in tackling this issue. In addition to traditionally written papers, the journal invites authors to submit a summary of their work as a PowerPoint presentation or videos to supplement an article about a new technique.
Over the last 25 years, POSI has emerged as the leading academic body for paediatric orthopaedics in the Asia-Pacific region. Through its commitment to teaching and research, it has forged strong partnerships with sister societies throughout the world. Several ongoing academic collaborations, travelling fellowships, and joint research projects are destined to bear rich fruit in terms of new insights and understanding about the ongoing challenges in our day to day practice.
With the POSI collaboration, IJPO will be the favoured means of disseminating information to the paediatric orthopaedic community at large. Our call for expansion of the Editorial Board met with an enthusiastic response from POSI members. The new board represents a cross-section of members from across the country and different levels of seniority. With this newfound vigour, we endeavour to review your articles and provide a response quickly. Submissions that require further work will be provided mentorship from a senior POSI member. We aim to get you published without any compromise on quality or the peer-review process.
Our readers’ time will be better utilised if the latest trends and developments are summarised in the form of symposia on specific topics and review articles. IJPO will continue to serve this need with high-quality papers from experts in the field. We will also publish practice guidelines which are brought out from time to time by academic societies throughout the world.
IJPO and POSI remain committed to providing surgeons with easy and free access to the journal. Full-text articles will therefore continue to remain accessible through the IJPO and POSI websites. POSI members are provided the additional benefit of publication without any article processing charge.
We invite all POSI members and well-wishers to join us in this effort to create a stronger journal with a bright long-term future. With your help, we can reach our next milestone of achieving indexation in PubMed.
I look forward to receiving your comments and suggestions on

Yours Sincerely,
Dr Jayanth S Sampath

How to Cite this Article: Sampath J | Editorial | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 02-03.

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Stop Maligning the Asymptomatic Child’s Flatfoot

Volume 4 | Issue 2 | July-December 2018 | Page: 01-02 | Benjamin Joseph

DOI- 10.13107/ijpo.2018.v04i02.010

Authors: Benjamin Joseph

Aster Medcity, Kochi, Kerala, India

Address of Correspondence
Prof. Benjamin Joseph,
18 H.I.G. Colony, Manipal − 576 104, Karnataka, India

Recently, a lady met me and gave me some very colourful pamphlets about a range of fancy foot wear and shoe inserts for toddlers and young children designed to ’correct’ flatfeet. I asked her why asymptomatic flatfeet need to be treated. I patiently listened to her as she listed several ‘harmful effects of flatfeet’ including a predilection for foot injury, back ache and so on, which, according to her could be avoided by using the shoes and shoe inserts she was promoting. Needless to say, there were no scientific data to support these claims. After she left, I reflected about what the scientific literature had to say about flatfoot and also recollected my personal experience of dealing with flatfeet in young children in my practice.
There has been a long-held notion that flatfeet are bad and that they may interfere with strenuous physical activity. On the basis of this, young men with flatfeet were rejected from recruitment into the armed forces. However, Cowan et al.[1] did a study on army recruits in the USA and could not demonstrate a higher frequency of injuries in those with flatfeet. Esterman and Pilotto[2] did a similar study in Australia and concluded that ’foot shape has little impact on pain, injury and function’. Tudor et al.[3] studied athletic performance in school children with flatfoot and normal arches and documented no difference in performance in 17 different tasks. So it is high time we dispel the erroneous notion that the flatfoot is in some way inferior to feet with a well-formed arch.
Stemming from the belief that flatfoot is undesirable, concerted efforts have been made to ‘treat’ young children with shoe modifications and various types of shoe inserts that elevate the medial longitudinal arch or control the hindfoot valgus. Despite the fact that Wenger et al.,[4] in as early as 1989, demonstrated clearly that shoes and shoe inserts in no way alter the natural history of flatfoot, orthopaedic surgeons continue to prescribe them. This wasteful and meaningless practice needs to stop.
The natural history of asymptomatic flexible flatfoot is that of resolution in the vast majority of children because the arch develops by the age of 6–7 years. This is very evident as at 1 year of age, 95% of children have flatfeet and by the age of 10, the prevalence is as low as 5%. The increase in the tone of muscles that support the arch and spontaneous reduction in joint laxity as the child grows facilitate the arch to develop. Barefoot activity in early childhood also facilitates the arch to develop while shoe-wearing appears to be detrimental to the development of the arch. This was demonstrated in two large cross-sectional surveys, which showed that the prevalence of flatfoot was highest among children who wore closed-toe shoes below the age of 6 years and lowest in the unshod.[5,6] The frequency of flatfoot in children who wore sandals and slippers fell between these two. With this evidence, it seems hardly logical to prescribe shoes for a young child with flatfoot. Instead, we need to spread the message to encourage children to play barefoot outdoors on sand and gravel. We could also encourage school authorities to have sandals rather than shoes as the regulation footwear. These suggestions are perfectly appropriate in the warm climate in India.
In my practice, I have never had parents from the lower socio-economic strata bring a child for the treatment of flatfoot. Every single child brought to me with the complaints of flatfoot has been from an affluent family. Often it has been a paediatrician, or family physician, who referred the child with flatfoot to me. For a long time, I wondered why there was this socio-economic difference in my flatfoot practice. It then dawned on me; the poor child is unshod and in early childhood has played barefoot, and the poor child consequently is unlikely to have flatfoot. Even if the poor child has flatfeet, they cause no pain and the feet function perfectly well. The child’s parents have no access to the internet, so they have never heard anyone maligning their child’s feet. No wonder, I never saw a poor child with flatfoot in my clinic.

Benjamin Joseph
Aster Medcity, Kochi, Kerala, India


1. Cowan DN, Jones BH, Robinson JR. Foot morphologic characteristics and risk of exercise-related injury. Arch Fam Med 1993;2: 773-7.
2. Esterman A, Pilotto L. Foot shape and its effect on functioning in Royal Australian Air Force recruits. Part 1: Prospective cohort study. Mil Med 2005;170:623-8.
3. Tudor A, Ruzic L, Sestan B, Sirola L, Prpic T. Flat-footedness is not a disadvantage for athletic performance in children aged 11 to 15 years. Pediatrics 2009;123:e386-92.
4. Wenger DR, Mauldin D, Speck G, Morgan D, Lieber RL. Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. J Bone Joint Surg Am 1989;71:800-10.
5. Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br 1992;74:525-7.
6. Sachithanandam V, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 1846 skeletally mature persons. J Bone Joint Surg Br 1995;77:254-7.

How to Cite this Article:  Joseph B Stop Maligning the | Asymptomatic Child’s Flatfoot | July- December 2018; 4(2): 01-02.


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Paediatric Orthopaedics and Global Initiative for Children’s Surgery

Volume 4 | Issue 1 | January-June 2018 | Page: 01-02 | Vrisha Madhuri

DOI- 10.13107/ijpo.2018.v04i01.001

Authors: Vrisha Madhuri

Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India

Address of Correspondence
Dr. Vrisha Madhuri,
Professor and Head, Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India

Global burden of surgical disease and attendant morbidity and mortality has received much attention in the recent past from the World Health Organization and the Lancet Commission on Global Surgery.[1],[2],[3] This has led to several initiatives in the last 2 years by the global surgical community to address the relevant issues. Among them is a coalition of children’s surgery organizations, led by American Paediatric Surgery Association and British Association of Paediatric Surgeons, who are working to bring together the providers and the implementers of surgical services for children in low- and medium-income countries. The coalition consists of health, advocacy and policy experts from the western world. Two meetings of this Global Initiative for Children’s Surgery (GICS) have taken place with the aim of analysing the current state of the surgical care; develop priorities to improve its delivery and identify and bring together needed resources.[4] The dream of GICS is that every child in the world with a surgical need will have access to the resources necessary to optimise his or her individual care.[4]
India has the largest child population in the world. Similar to other developing countries, we have a very wide range of causes including acute, chronic and neglected problems, with many of them being amenable to surgical treatment. The few centres providing high-quality specialised paediatric surgical care are concentrated in the metropolises, and inadequately trained non-paediatric specialists are available to address these problems in the community. Despite the success of a few focussed programs, such as ‘Smile Train’ for cleft lip and palate and the collaborative program between CURE International, India and several state governments for clubfoot conservative treatment and bracing, much of the surgical needs of the children in the community remain unaddressed because of the lack of adequate infrastructure to support children’s surgery, service delivery systems and trained manpower. The supporting services such as paediatric anaesthesia, intensive care, nursing and orthotics also lack infrastructure and trained personnel. Adequate planning at national and regional levels requires paediatric-specific determination of burden of illnesses in different areas such as congenital, neuromuscular disorders, trauma and oncology.
Rashtriya Bal Swasthya Karyakram, a new initiative by the Government of India, envisages the screening of all children and adolescents for key medical and surgical conditions and their referral and treatment by the existing healthcare providers in public and private sectors. However, in the existing system, the lack of paediatric surgical specialists forms a crisis, wherein identified children are unable to access or obtain quality care, and those suffering from complex conditions do not receive comprehensive care. The lack of a triaging system burdens the tertiary care referral centres with routine surgical conditions, which are best handled at secondary levels, causing overcrowding.
The paediatric orthopaedic community is a major stakeholder in the development of surgical services in the country. Our help, along with other paediatric surgical specialists, is required in needs assessment in the area of infrastructure, service delivery and manpower. A specialist organization such as paediatric orthopaedic society can do these in addition to setting up appropriate standards of care for different conditions, triaging systems by level of hospital, standardizing training programs and identifying areas of research. They can also be great advocates for children’s surgery and attract funding and resources. The baseline demographic studies can be used to determine optimal resources such as the number of children’s hospitals required for the population served. The other important areas are the standardization of equipment to be made available for children’s need and integration of infrastructure needs into national children’s surgical plan. They can also promote preventive strategies such as improved prenatal diagnosis and health promotion and rehabilitation.
While GICS is setting up the needs assessment and standards for infrastructure, healthcare delivery and processes and personnel at all levels of care, we can join hands with them and other paediatric surgical colleagues to provide the appropriate inputs and help build up systems and best practices to provide safe affordable surgical care for children.


1. Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet 2015;386:569-624.
2. Available from: [Last accessed on 2017 Jan 23].
3. Available from: [Last accessed on 2017 Jan 23].
4. Global Initiative for Children’s Surgery (GICS) Organizing Committee, GICS I Summary. Available from: June 2016. [Last accessed on 2017 Jan 31].

How to Cite this Article: Madhuri V | Paediatric orthopaedics and global initiative for children’s surger y| International Journal of Paediatric Orthopaedics | January-June 2018; 4(1): 01-02.

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Vol 1 | Issue 1 | July – Sep 2015 | page: 1 | Sandeep Patwardhan, Taral  Nagda.

Authors: Dr. Sandeep Patwardhan[1], Dr.Taral  Nagda[2].

Dr. Sandeep Patwardhan: Paediatric Orthopaedic Surgeon, Sancheti Institute for Orthopaedics and Rehabilitation. Pune, India: Email:
Dr. Taral Nagda: Paediatric Orthoapedic Surgeon, Institute for Paediatric Orthopaedic Disorders, Mumbai and Jupiter Hospital, Thane, India.


Paediatric orthopaedics is evolving by leaps and bounds on a day to day basis as we have more insights in to biology and access to improved imaging and technology for management. With the changing demographics of the world, India is poised on the crossroads where we have a healthy mix of educated urban literate population who demands the best management at par with the western world. At the same time we have a large volume of children who are subjected to gross neglect due to inability to access healthcare or poor understanding & quality of training in the country with respect to paediatric orthopaedics. There are only about 50- 60 paediatric orthopaedic surgeons for a population of 450 million children. As we march towards improving paediatric orthopaedic services through improved training acquired through western world, we realised the shortcomings of this training with respect to differential needs of our native populations. No amount of literature or fellowship training in the west can prepare us for management of neglected and complicated paediatric orthopaedic conditions. We realised that we will have to evolve our own strategies and share the knowledge through publications for effective management of our children. We found the existing journals restrictive and difficult to access with respect to their norms of publications. Hence the International Journal of Paediatric Orthopaedics (IJPO) which is an attempt to allow easy open access online sharing of knowledge with emphasis to the eastern world and the different requirements of our populations. I am sure that contributions to this journal will foster a better understanding as well as interactions between the western and eastern worlds. We believe we have a spectrum of disease which is unseen and under-reported in current literature but which is still quite relevant to two thirds of the world. IJPO will aim to provide a platform where global interactions are possible and views and opinions can be shared easily. New formats of articles will be encouraged and in the first issue we have an article written in dialectic format and another in case based format along with the usual review formats. We would welcome articles from all over the world and we hope to be able to make it a patient driven Journal along with being evidence based.
We would like to thank the Orthopaedic Research Group and ResearchOne® Publishers in helping us through the process. We would thank our affiliate body ‘International Fractures in Children Symposium’ (I-FICS) for their unconditional support an allowing the launch of the Journal in their annual meeting. We would like to thank every author who has contributed to the first issue and special thanks to all the editorial board members who have shown faith in us and have joined us in an effort to create a world class journal

Sandeep Patwardhan & Taral Nagda

How to Cite this Article: Patwardhan S, Nagda T. Editorial. International Journal of Paediatric Orthopaedics July-Sep 2015;1(1):1.          


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