Vol 12 | Issue 2 | May-August 2026 Archives - International Journal of Paediatric Orthopaedics

Fractured Aneurysmal Bone Cyst in Children – Is Conservative Treatment an Option?

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.268

Open Access License: CC BY-NC 4.0

Submitted: 13/01/2026; Reviewed: 11/02/2026; Accepted: 03/06/2026; Published: 10/08/2026

Authors: Varun Garg [1], Anil Agarwal [2], Sunny Bhalla [2], Md Zafar Iqbal [2]

[1] Department of Orthopedics, All India Institute of Medical Sciences, Guwahati, Assam, India,
[2] Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalya, New Delhi, India.

Address of Correspondence

Dr. Varun Garg,
Department of Orthopedics, All India Institute of Medical Sciences, Assam, Guwahati, India.
E-mail: varungarg9@gmail.com

Abstract

Objective: The objectives are to evaluate the outcomes of conservatively managed pathological fractures through aneurysmal bone cysts (ABCs) in children and to assess the potential for spontaneous cyst healing post-fracture.
Methods: A retrospective review was conducted of hospital records between January 2014 and October 2024. Children aged ≤14 years with fractured long bone ABCs and managed conservatively with at least 6 months of radiographic follow-up were included. Cases treated surgically or with recurrent/previously treated lesions were excluded. Radiographs were reviewed for lesion characteristics, Enneking staging, and radiographic features (loculation, cortical rim, tubulation, and bone scalloping). Outcomes were assessed using fracture union and cyst healing according to Rastogi’s criteria.
Results: Eight patients (6 males, 2 females; mean age 7.3 ± 3.2 years) met the inclusion criteria. The proximal humerus (n = 5) was the most frequently affected site, followed by the proximal femur (n = 2) and distal radius (n = 1). All lesions were metaphyseal and classified as Enneking stage II. At a mean follow-up of 7 ± 1.1 months, all fractures united radiologically. Partial cyst healing occurred in 3 patients (37.5%), while 5 patients (62.5%) showed no significant healing. No deformities or complications were reported.
Conclusion: Conservative management of pathological fractures through ABCs in children achieves fracture union and may induce partial cyst healing. Larger, multi-center studies are required to better define the predictors of healing after a fracture through the cyst.
Keywords: Aneurysmal bone cyst, pathological fracture, benign bone tumor, spontaneous healing, pediatric.

References

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16. Rastogi S, Varshney MK, Trikha V, Khan SA, Choudhury B, Safaya R. Treatment of aneurysmal bone cysts with percutaneous sclerotherapy using polidocanol. A review of 72 cases with long-term follow-up. J Bone Joint Surg Br 2006;88:1212-6.
17. Ahmad S, Alam I, Khan AQ, Abbas MB, Chowdhry M. Polidocanol sclerotherapy for the treatment of aneurysmal bone cyst, with or without pathological fractures: A prospective, comparative study. J Orthop 2023;46:143-9.
18. Karaca MO, Bozkurt OE, Dursun Savran M, Özyıldıran M, Başarır K, Yıldız HY. Aneurysmal bone cysts (ABC): Retrospective analysis of two hundred and fifty eight cases. Int Orthop 2025;49:2207-17.
19. Cha SM, Shin HD, Kim KC, Park JW. Does fracture affect the healing time or frequency of recurrence in a simple bone cyst of the proximal femur? Clin Orthop Relat Res 2014;472:3166-76.
20. Deventer N, Deventer N, Gosheger G, De Vaal M, Budny T, Luebben T, et al. Evaluation of different treatment modalities for fractured and non-fractured simple bone cyst: A single-center review of 68 patients. Medicine (Baltimore) 2021;100:e26703.
21. Biesecker JL, Marcove RC, Huvos AG, Miké V. Aneurysmal bone cysts. A clinicopathologic study of 66 cases. Cancer 1970;26:615-25.

How to Cite this Article: Garg V, Agarwal A, Bhalla S, Iqbal MZ | Fractured Aneurysmal Bone Cyst in Children – Is Conservative Treatment an Option? | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 03-07.

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The Correlation between Vitamin D Deficiency and Orthopedic Manifestations in Children during the COVID-19 Pandemic

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.276

Open Access License: CC BY-NC 4.0

Submitted: 19/01/2026; Reviewed: 14/02/2026; Accepted: 21/06/2026; Published: 10/08/2026

Authors: Premal Naik [1], Mugdha M Mehta [2]

[1] Rainbow Superspeciality Hospital & Children’s Orthopaedic Centre, Ahmedabad, Gujarat, India.
[2] Department of Neurology, UTMB, Galveston, Texas

Address of Correspondence

Dr. Premal Naik,
Director, Rainbow Superspeciality Hospital & Children’s Orthopaedic Centre, Ahmedabad, Gujarat, India
E-mail: premalnaik@gmail.com

Abstract

Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, Vitamin D (Vit-D) deficiency in children was reported from many parts of the world, but no such study exists for Indian children. Vit-D deficiency leading to orthopedic manifestations during the COVID-19 pandemic has not been reported to date. We studied the correlation between Vit-D deficiency and orthopedic manifestations during the COVID-19 pandemic in otherwise healthy children.

Materials and Methods: The study group included children aged 5–18 years who had prolonged home confinement during the COVID-19 pandemic and exhibited signs of Vit-D deficiency, such as proximal myopathy, deformity, and pathological fractures. The study group was compared to a similar group from the preceding 2 years (control group).

Results: Thirty-six children (9 pre-adolescents and 27 adolescents) were enrolled in the study group. Twenty-five children presented with genu varum or valgum, six had insufficiency fractures of the femoral neck, and five had proximal myopathy. After medical treatment, 21 children with deformities were either treated or advised growth modulation or osteotomy, and fractures were stabilized. All children with myopathy recovered with medical treatment, and all fractures united without complications.

Conclusion: There was a sudden increase in the incidence of children with Vitamin-D deficiency due to prolonged home confinement during the COVID-19 pandemic. We could not find any correlation between Vit-D levels, the amount of delay, and the mode of presentation. Many children presented late with orthopedic problems requiring surgical interventions, which could have been prevented with timely diagnosis.

Keywords: Vitamin D deficiency, COVID-19 pandemic, orthopedic manifestation of Vitamin D deficiency, children, case series.

References

1. Ellison DL, Moran HR. Vitamin D: Vitamin or hormone? Nurs Clin North Am 2021;56:47-57.
2. Rustecka A, Maret J, Drab A, Leszczyńska M, Tomaszewska A, Lipińska-Opałka A, et al. The impact of COVID-19 pandemic during 2020-2021 on the vitamin d serum levels in the paediatric population in Warsaw, Poland. Nutrients 2021;13:1990.
3. Greenbaum LA. Vitamin D deficiency (rickets) and excess. In: Kliegman RM, St. Geme J, editor. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2019. p. 198-205.
4. Cashman KD. Vitamin D in childhood and adolescence. Postgrad Med J 2007;83:230-5.
5. Naik A, Naik H, Naik P, Vora K. Clinical profile and outcome of pediatric covid-19 during second wave in Gujarat, India; a cross-sectional study. Glob J Res Anal 2022;???:28-31.
6. Yu L, Ke HJ, Che D, Luo SL, Guo Y, Wu JL. Effect of pandemic-related confinement on vitamin D status among children aged 0–6 years in Guangzhou, China: A cross-sectional study. Risk Manag Healthc Policy 2020;13:2669-75.
7. Beyazgül G, Bağ Ö, Yurtseven İ, Coşkunol F, Başer S, Çiçek D, et al. How vitamin D Levels of children changed during COVID-19 pandemic: A comparison of pre-pandemic and pandemic periods. J Clin Res Pediatr Endocrinol 2022;14:188-95.
8. Sodri NI, Mohamed-Yassin MS, Nor NS, Ismail IA. Rickets due to severe vitamin d and calcium deficiency during the COVID-19 pandemic in Malaysia. Am J Case Rep 2021;22:e934216.
9. Olotu E, Olapido G. Intermalleolar distance in normal adults and adults with genu valgum. Glob J Pure Appl Sci 2007;12:???.
10. Ganavi R. Bow legs and knock knees: Is it physiological or pathological? Int J Contemp Pediatr 2016;3:687-91.
11. Sacks D. Age limits and adolescents. Paediatr Child Health 2003;8:577.
12. Wagner CL, Greer FR. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008;122:1142-52.
13. Holick MF. Vitamin D: A d-lightful solution for health. J Investig Med 2011;59:872-80.
14. Chabra T, Tahbildar P, Sharma A, Boruah S, Mahajan R, Raje A. Prevalence of skeletal deformity due to nutritional rickets in children between 1 and 18 years in tea garden community. J Clin Orthop Trauma 2016;7:86-9.
15. Shore RM, Chesney RW. Rickets: Part I. Pediatr Radiol 2013;43:140-51.
16. Soliman A, De Sanctis V, Elalaily R, Bedair S, Kassem I. Vitamin D deficiency in adolescents. Indian J Endocrinol Metab 2014;18:S9-16.
17. Sahni S, Kakkar S, Kumar R, Goraya J. Osteomalacic myopathy in children and adolescents with vitamin-D deficiency. Neurol India 2021;69:1650-4.
18. Hazzazi M, Alzeer I, Tamimi W, Al Atawi M, Al Alwan I. Clinical presentation and etiology of osteomalacia/rickets in adolescents. Saudi J Kidney Dis Transplant 2013;24:938.
19. Cabarrus MC, Ambekar A, Lu Y, Link TM. MRI and CT of insufficiency fractures of the pelvis and the proximal femur. Am J Roentgenol 2008;191:995-1001.
20. Stevens PM. Guided growth for angular correction: A preliminary series using a tension band plate. J Pediatr Orthop 2007;27:253-9.
21. Naik P, Ganjwala D, Bhatt C, Vora KS. Usefulness of the sauvegrain method of bone age assessment in Indian children. Indian J Orthop 2021;55:116-24.
22. Worldometer. COVID Live – Coronavirus Statistics – Worldometer. Available from: https://www.worldometers.info/coronavirus [Last accessed on 2023 Jan 05].

How to Cite this Article: Naik P, Mehta MM | The correlation between Vitamin D deficiency and orthopaedic manifestations in children during the COVID-19 pandemic | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 26-35.

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Adapting Joshi External Stabilization System for Congenital Talipes Equinovarus Correction: A Practical Solution for Unavailable Distractor Sizes

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.282

Open Access License: CC BY-NC 4.0

Submitted: 17/01/2026; Reviewed: 10/02/2026; Accepted: 25/05/2026; Published: 10/08/2026

Authors: Md Zafar Iqbal [1], Anil Agarwal [1], Shivank Khurana [1]

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

Address of Correspondence

Md Zafar Iqbal,
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi – 110031, India.
E-mail: docmdzafariqbal@gmail.com

Abstract

Congenital talipes equinovarus is a complex foot deformity that is principally corrected by gradual manipulation. The Joshi external stabilization system (JESS) fixator uses this principle of gradual correction by ligamentotaxis. The principal component of the JESS system is the distractor applied at multiple planes to achieve soft-tissue stretching, enabling gradual correction of the deformity. As recommended, the size of the JESS should be at least 2/3rd of the limb to get maximum outcome. However, situations may arise where the exact size of the distractor is unavailable, posing a challenge to achieving optimal correction. This article describes a practical solution involving the use of an additional Z-rod or L-rod, allowing the application of a smaller size distractor. This adaptation ensures continued correction of the deformity, ultimately benefiting patients with optimal outcomes.
Keywords: Clubfoot, Joshi external stabilization system fixator, distractor, adaptation, surgical tip, children.

References

1. Ponseti IV, Smoley EN. The classic: Congenital club foot: The results of treatment. Clin Orthop Relat Res 2009;467:1133-45.
2. Joshi BB, Prabhoo R, Kanaji BG, Kaushik. Management of Clubfoot by Joshi’s External Stabilization System (JESS). Uttar Pradesh: Jaypee; 2010.
3. Singh A. Evaluation of neglected idiopathic ctev managed by ligamentotaxis using jess: A long-term followup. Adv Orthop 2011;2011:218489.
4. Altaf KA, Shah SB, Ahmad S, Mumtaz U, Mantoo SA. Results of JESS (Joshi’s external stabilizing system) in relapsed, neglected and neurogenic clubfoot in an age group of 2-10 years. Ortop Traumatol Rehabil 2020;22:121-9.
5. Suresh S, Ahmed A, Sharma VK. Role of Joshi’s External Stabilisation System Fixator in the Management of Idiopathic Clubfoot. J Orthop Surg 2003;11:194-201.

How to Cite this Article: Iqbal MZ, Agarwal A, Khurana S | Adapting Joshi External Stabilization System for Congenital Talipes Equinovarus Correction: A Practical Solution for Unavailable Distractor Sizes | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 44-46.

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Age Pattern and Bone Predilection in Pediatric Septic Arthritis and Osteomyelitis: A Retrospective Analysis at a Tertiary Care Center

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.272

Open Access License: CC BY-NC 4.0

Submitted: 03/05/2026; Reviewed: 22/05/2026; Accepted: 16/06/2026; Published: 10/08/2026

Authors: Rupika T [1]

[1] Department of Paediatrics, Apollo Hospitals Chennai, Tamil Nadu, India.

Address of Correspondence

Dr. Rupika T
Department of Paediatrics, Apollo Hospitals Chennai, Tamil Nadu, India.
E-mail: rupithiru@gmail.com

Abstract

Background: Pediatric musculoskeletal infections, specifically septic arthritis (SA) and osteomyelitis (OM), are significant causes of morbidity. Understanding local epidemiological trends is vital for early diagnosis and empirical management.
Objectives: To analyze age-specific patterns and the anatomical predilection of bones and joints affected by SA and OM in a tertiary hospital setting.
Methods: This retrospective study reviewed pediatric patients (0–18 years) diagnosed with SA or OM over 8 years. Data on age, gender, infection site, and microbiology were analyzed.
Results: A retrospective analysis of 210 pediatric cases revealed a male preponderance (58%). The mean age was 10.8 years. The tibia (21%) and femur (20%) were the most common bones involved in OM. A significant portion of the cohort (29%) presented with SA, with the hip (18%) and knee (14%) being the most frequently affected joints. Chronic presentations and post-infectious sequelae, such as joint dislocations and pathological fractures, were prevalent, particularly in cases involving the proximal femur and hip joint.
Conclusion: Long bones of the lower limb and the major weight-bearing joints (hip and knee) are the primary sites of pediatric musculoskeletal infections at our center. The significant incidence of joint-related sequelae highlights the critical importance of early surgical debridement and long-term follow-up in managing these infections to preserve joint function and limb alignment.
Keywords: Pediatric orthopedics, septic arthritis, osteomyelitis, bone predilection, epidemiology.

References

1. Trueta J. The three-dimensional vascularity of the metaphysis. J Bone Joint Surg Br 1959;41-B:392-400.
2. Peltola H, Pääkkönen M. Acute osteomyelitis in children. N Engl J Med 2014;370:352-60.
3. Gafur OA, Copley LA, Hollmig ST, Browne RH, Thornton LA, Crawford SE. The impact of the current epidemiology of pediatric musculoskeletal infection on evaluation and treatment guidelines. J Pediatr Orthop 2008;28:777-85.
4. Dartnell J, Ramachandran M, Katchburian L. Haematogenous acute and subacute paediatric osteomyelitis: A systematic review of the literature. J Bone Joint Surg Br 2012;94:584-95.
5. Ilharreborde B. Sequelae of pediatric osteoarticular infection. Orthop Traumatol Surg Res 2015;101 Suppl 1:S129-37.
6. Dodwell ER. Osteomyelitis and septic arthritis in children: Current concepts. Curr Opin Pediatr 2013;25:58-63.
7. Montgomery CO, Siegel E, Blasier RD, Suva LJ. Concurrent septic arthritis and osteomyelitis in children. J Pediatr Orthop 2013;33:464-7.
8. Safdieh G, Silberman J, Nguyen J, Doyle SM, Blanco JS, Scher DM, et al. Pediatric septic arthritis and osteomyelitis in the USA: A national KID database analysis. HSS J 2019;15:159-66.

How to Cite this Article: Rupika T | Age Pattern and Bone Predilection in Paediatric Septic Arthritis and Osteomyelitis: A Retrospective Analysis at a Tertiary Care Center | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 15-18.

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Removal of Broken Retrograde Rush Rod from Tibia: A Technical Tip

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.284

Open Access License: CC BY-NC 4.0

Submitted: 14/04/2026; Reviewed: 07/05/2026; Accepted: 11/06/2026; Published: 10/08/2026

Authors: Tariq Mir [1], Anoop Mavila [1]

[1] Department of Paediatric Orthopaedics Unit, Paras Health, Durganag, Dalgate, Srinagar, Jammu and Kashmir, India.

Address of Correspondence

Dr. Tariq Altaf Mir,
Department of Paediatric Orthopaedics Unit, Paras Health, Durganag, Dalgate, Srinagar, Jammu and Kashmir, India.
E-mail: mirtariqaltaf@gmail.com

Abstract

Broken rush rods within the tibia present a challenging scenario for orthopedic surgeons, particularly when the retrograde inserted nails break at the ankle or distal tibial level, and the distal fragment remains embedded with the tibial canal. This technical tip outlines a practical and reproducible method for the removal of a broken rush rod using minimally invasive principles and avoiding iatrogenic complications.

Keywords: Broken rush rod, tibia.

References

1. Joseph B, Mathew G. Management of congenital pseudarthrosis of the tibia by excision of the pseudarthrosis, onlay grafting, and intramedullary nailing. J Pediatr Orthop 2000;9:16-23.
2. Joseph B, Rebello G, Kant BC. The choice of intramedullary devices for the femur and the tibia in osteogenesis imperfecta. J Pediatr Orthop B 2005;14:311-9.
3. Shah H, Rousset M, Canavese F. Congenital pseudarthrosis of the tibia: Management and complications. Indian J Orthop 2012;46:616-26.
4. Hak DJ, McElvany M. Removal of broken hardware. J Am Acad Orthop Surg 2008;16:113-20.

How to Cite this Article: Mir T, Mavila A | Removal of Broken Retrograde Rush Rod from Tibia: A Technical Tip | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 47-49.

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A Rare but Preventable Injury: Surgical Management of Traumatic Achilles Tendon Tear Caused by Glass-coated Kite String (Chinese Manja) in a Child – A Case Report

DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.280

Open Access License: CC BY-NC 4.0

Submitted: 27/03/2026; Reviewed: 21/04/2026; Accepted: 09/06/2026; Published: 10/08/2026

Authors: Amandeep [1], Umesh Meena [1], Varun Goyal [1], Ranadeep Ghosh [1]

[1] Department of Orthopaedics, Government Medical College, RK Puram, Kota, Rajasthan, India.

Address of Correspondence

Dr. Ranadeep Ghosh,
Department of Orthopaedics, Government Medical College, RK Puram, Kota Rajasthan, India.
E-mail: ranadeepghosh9@gmail.com

Abstract

Introduction: Acute traumatic Achilles tendon tear is very uncommon in the pediatric population. This injury is particularly important in the current era due to the increasing and widespread use of glass-coated kite strings (manja). The Achilles tendon lies superficially with minimal soft-tissue protection, making it particularly vulnerable to sharp kite string injuries. This case highlights the rarity of this injury pattern, an emerging and preventable cause of trauma in developing countries, and its effective surgical management.
Case Report: We report the case of a 12-year-old male who sustained a traumatic distal Achilles tendon laceration near its insertion after a glass-coated kite string became entangled around his ankle while running. This resulted in a deep wound over the Achilles tendon with complete transection. The patient was successfully treated with primary tendon repair using non-absorbable sutures with the Krackow technique following thorough wound irrigation and debridement.
Conclusion: Traumatic Achilles tendon laceration caused by kite string injury is a rare but preventable serious condition. Early recognition and timely surgical intervention are crucial. Primary repair using non-absorbable sutures with the Krackow technique provides strong tendon approximation, promotes early healing, and effectively restores tendon continuity when combined with meticulous wound irrigation and debridement.
Keywords: Traumatic tendoachilles, paediatrics.

References

1. Ashebo LB, Stevens AC, MacAlpine EM, Wittstein JR, Bradley KE, Lawrence JT. Achilles tendon injuries in the pediatric population. J Pediatr Orthop 2023;43:e513-8.
2. Singh D, Aryala S. Kite string injury: An unusual cause of extensive ankle trauma with vascular injury. Indian J Vasc Endovasc Surg 2022;9:319-21.
3. Singh RK, Kumar V, Mishra B, Halagiri SM, Singh A. Kite string (manja) injury: Rare presentations of common entity leading to disability. Acta Sci Surg Res 2022;1:10-2.
4. Bansal A, Goyal S, Kumar A. Kite string (manjha) injuries in children: An ongoing and preventable public health problem. Injury 2022;53:3550-6.
5. Sharma R, Sodhi KS, Khandelwal N. Pattern and severity of kite string injuries during festive seasons: A recent trauma center experience. Indian J Pediatr 2023;90:356-61.
6. Patel NM, Ganley TJ. Evaluation and management of acute Achilles tendon injuries in children and adolescents. J Pediatr Orthop 2022;42:e820-6.
7. Verma A, Singh V, Gupta P. Kite string injuries as a preventable cause of pediatric trauma: Need for stricter regulation and awareness. J Fam Med Prim Care 2024;13:890-5.

How to Cite this Article: Amandeep, Meena U, Goyal V, Ghosh R | A Rare but Preventable Injury: Surgical Management of Traumatic Achilles Tendon Tear Caused by Glass-coated Kite String (Chinese Manja) in a Child – A Case Report | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 40-43.

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

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

Open Access License: CC BY-NC 4.0

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

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

[1] Department of Paediatric Orthopaedics Unit, Paras Health, Durganag, Dalgate, Srinagar, Jammu and Kashmir, India.

Address of Correspondence

Dr. Tariq Altaf Mir,
Department of Paediatric Orthopaedics Unit, Paras Health, Durganag, Dalgate, Srinagar, Jammu and Kashmir, India.
E-mail: mirtariqaltaf@gmail.com

Abstract

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

References

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

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

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

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

Open Access License: CC BY-NC 4.0

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

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

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

Address of Correspondence

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

Abstract

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

References

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

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

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

Open Access License: CC BY-NC 4.0

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

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

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

Address of Correspondence

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

Abstract

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

References

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

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

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

Open Access License: CC BY-NC 4.0

Authors: Mandar Agashe [1]

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

Address of Correspondence

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

Editorial

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

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

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