Vol 11 | Issue 2 | May-August 2025 Archives - International Journal of Paediatric Orthopaedics

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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12. Senaran H, Mason D, De Pellegrin M. Cuboid fractures in preschool children. Journal of Pediatric Orthopaedics. 2006 Nov 1;26(6):741-4.

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

1. Kyriakos M., McDonald D. J., & Sundaram M. (2004). Fibrous dysplasia with cartilaginous differentiation (“fibrocartilaginous dysplasia”): a review, with an illustrative case followed for 18 years. Skeletal Radiology, 33(1), 51-62. https://doi.org/10.1007/s00256-003-0718-x
2. Muezzinoglu B., & Oztop F. (2001). Fibrocartilaginous dysplasia: a variant of fibrous dysplasia. The Malaysian Journal of Pathology, 23(1), 35-39.
3. Choi I. H., Kim C. J., Cho T. J., Chung C. Y., Song K. S., Hwang J. K., et al. (2000). Focal fibrocartilaginous dysplasia of long bones: report of eight additional cases and literature review. Journal of Pediatric Orthopedics, 20(4), 421-427.
4. Bian Z., Lyu X., Guo Y., Zhu Z., Feng C., Yang J., et al. (2020). Focal fibrocartilaginous dysplasia of the distal femur. Journal of Pediatric Orthopaedics B, 29(5), 466-471. https://doi.org/10.1097/BPB.0000000000000742
5. Jouve J.-L., Dohin B., & Bollini G. (2007). Focal Fibrocartilaginous Dysplasia (BFibrous Periosteal Inclusion^). J Pediatr Orthop, 27(1).
6. Thabet A. M., Belthur M. V., & Herzenberg J. E. (2010). Spontaneous resolution of angular deformity of the distal femur in focal fibrocartilaginous dysplasia: a case report. Journal of Pediatric Orthopaedics B, 19(2), 161-163. https://doi.org/10.1097/BPB.0b013e3283361b11
7. Johari A., & Anjum R. (2019). Spontaneous resolution of focal fibrocartilaginous dysplasia of femur on long-term follow-up: case report and review of literature. Journal of Pediatric Orthopaedics B, 28(2), 127-131. https://doi.org/10.1097/BPB.0000000000000570
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10. Bell S. N., Campbell P. E., Cole W. G., & Menelaus M. B. (1985). Tibia vara caused by focal fibrocartilaginous dysplasia. Three case reports. The Journal of Bone and Joint Surgery. British Volume, 67(5), 780-784. https://doi.org/10.1302/0301-620X.67B5.4055881
11. Beaty J. H., & Barrett I. R. (1989). Unilateral angular deformity of the distal end of the femur secondary to a focal fibrous tether. A report of four cases. The Journal of Bone and Joint Surgery. American Volume, 71(3), 440-445.
12. Zayer M. (1992). Tibia vara in focal fibrocartilaginous dysplasia. A report of 2 cases. Acta Orthopaedica Scandinavica, 63(3), 353-355. https://doi.org/10.3109/17453679209154802
13. Albiñana J., Cuervo M., Certucha J. A., Gonzalez-Mediero I., & Abril J. C. (1997). Five additional cases of local fibrocartilaginous dysplasia. Journal of Pediatric Orthopedics. Part B, 6(1), 52-55. https://doi.org/10.1097/01202412-199701000-00011
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15. Welborn M. C., & Stevens P. (2017). Correction of Angular Deformities Due to Focal Fibrocartilaginous Dysplasia Using Guided Growth: A Preliminary Report. Journal of Pediatric Orthopaedics, 37(3), e183-e187. https://doi.org/10.1097/BPO.0000000000000785

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.
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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.
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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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Pediatric Anterior Cruciate Ligament Tears: Epidemiology, Evaluation, and Evolving Treatment Strategies

DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.226

Open Access License: CC BY-NC 4.0

Submitted: 01/06/2025; Reviewed: 30/06/2025; Accepted: 06/07/2025; Published: 10/08/2025

Authors: Doria L. Weiss BS [1] , Alexis Carr BS [1], Kevin Berardino MD [1], Kevin Quindlen MD [1], Rachel Talley-Bruns MD [1]

[1] Westchester Medical Center, Department of Orthopaedic Surgery, Valhalla, NY

Address of Correspondence

Dr. Doria L. Weiss,
Westchester Medical Center, Department of Orthopaedic Surgery, Valhalla, NY.
E-mail: dweiss23@student.nymc.edu

Abstract

Introduction: Anterior cruciate ligament (ACL) tears in pediatric patients are increasingly recognized due to rising sports participation and improved imaging. Given the presence of open physes, treatment decisions must balance the need for knee stability with the risk of growth disturbance. This review outlines current approaches to diagnosis, surgical techniques, graft selection, postoperative rehabilitation, and complications in skeletally immature patients.
Methods: This review summarizes recent literature on pediatric ACL injuries, including epidemiology, injury patterns, surgical management strategies, graft options, rehabilitation protocols, and complication rates. Emphasis is placed on the rationale behind technique selection based on skeletal maturity and long-term outcomes.
Results: Surgical reconstruction has become the preferred treatment for most pediatric ACL injuries to prevent secondary damage and restore knee stability. Several physeal-sparing and transphyseal techniques are available, with selection guided by skeletal age and growth remaining. All-epiphyseal and extraphyseal techniques avoid crossing the physis, while transphyseal reconstruction is safe in adolescents nearing skeletal maturity. Hamstring and quadriceps tendon autografts are most commonly used, while bone–patellar tendon–bone grafts and allografts are generally avoided in younger patients. Graft failure and growth disturbance remain key concerns, with retear rates reaching up to 20% and growth abnormalities occurring in 1–5% of cases. Rehabilitation protocols are evolving toward milestone-based progression, with return to sport typically delayed at least 12 months. However, re-injury rates remain high in this population.
Conclusions: ACL injuries in pediatric patients require a nuanced, age-specific approach. Surgical reconstruction using physeal-respecting or transphyseal techniques offers favorable outcomes when matched to skeletal maturity. Careful graft selection, individualized rehabilitation, and delayed return to sport are essential to optimize results and reduce complications. Ongoing research is needed to refine surgical strategies, compare graft types, and establish evidence-based rehabilitation and return-to-sport guidelines.
Keywords: Paediatrics, Anterior Cruciate Ligament Tears, Epidemiology, Evaluation, Evolving Treatment Strategies

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How to Cite this Article: Weiss DL, Carr A, Berardino K, Quindlen K, Bruns RT. Paediatric Anterior Cruciate Ligament Tears: Epidemiology, Evaluation, and Evolving Treatment Strategies. International Journal of Paediatric Orthopaedics . May-August 2025; 11(2): 02-10.

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