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Varus Derotation Osteotomy of the Proximal Femur in Neuromuscular Children Using a Locking Plate-Surgical Technique and Initial Results

Case Series | Volume 11 | Issue 2 | May-August 2025 | Page: 16-20 | Njalalle Baraza, Mordicai Ating’a DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.232 Open Access License: CC BY-NC 4.0 Copyright Statement: Copyright © 2025; The Author(s). 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 & […]

“Rachitomalacia” – Radiological Findings of a “New” Intermediate Entity in Adolescents

Original Article | Volume 11 | Issue 2 | May-August 2025 | Page: 11-15 | Anil Agarwal, Sitanshu Barik, Eknoor Kaur DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.230 Open Access License: CC BY-NC 4.0 Copyright Statement: Copyright © 2025; The Author(s). 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], […]

Varus Derotation Osteotomy of the Proximal Femur in Neuromuscular Children Using a Locking Plate-Surgical Technique and Initial Results

“Rachitomalacia” – Radiological Findings of a “New” Intermediate Entity in Adolescents

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Varus Derotation Osteotomy of the Proximal Femur in Neuromuscular Children Using a Locking Plate-Surgical Technique and Initial Results

DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.232

Open Access License: CC BY-NC 4.0

Submitted: 21/06/2024; Reviewed: 18/07/2024; Accepted: 27/05/2025; Published: 10/08/2025

Authors: Njalalle Baraza FRCS (Tr & Orth) [1], Mordicai Ating’a FRCS (Tr & Orth) [1]
[1] Department of Trauma and Orthopaedics, Aga Khan University, 3rd Parklands Avenue, P.O. Box 30270, GPO 00100, Nairobi, Kenya

Address of Correspondence
Dr. Njalalle Baraza,
Department of Trauma and Orthopaedics, Aga Khan University, 3rd Parklands Avenue, P.O. Box 30270, GPO 00100, Nairobi, Kenya
E-mail: njaleb@doctors.org.uk

Abstract

Introduction: Hip dysplasia affects up to 33% of children with neuromuscular disease. The main objective of treatment is improvement of femoral head coverage. Depending on the severity of dysplasia, treatment required may range from casting in abduction to salvage procedures including excision arthroplasty. The most commonly employed surgical procedure is a varus derotation osteotomy (VDRO) which is usually undertaken using a fixed angle blade plate, with or without a pelvic osteotomy. Unfortunately these implants are not always available. We therefore developed a novel technique using a locally available locking reconstruction plate to perform VDRO surgery, and present our initial results following the use of this technique.
Methods: Six hip in four patients of GMFCS IV or V suffering from hip dysplasia were included in the study. Pre and postoperative Reimers migration percentage (MP) was measured. In the three hips that underwent pelvic (Dega) osteotomy, the acetabular index (AI) was also measured. A paired t-test for non-parametric data was used to determine statistical significance.
Results: At an average of 8 months follow up, the pre-op MP had reduced from 64% to 23.3% (p=0.026). In the hips who had Dega osteotomy, the AI went down from 33.3 degrees to 23.3 degrees (p=0.013) at an average of 5 months follow up.
Conclusion: In the absence of a blade plate, the novel technique described is an effective alternative in performing VDRO surgery.
Keywords: Varus derotation osteotomy, VDRO, Neuromuscular hip, Hip dysplasia, Cerebral palsy, Hip surgery

References

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

How to Cite this Article: Baraza N, Ating’a M. Varus Derotation Osteotomy of the Proximal Femur in Neuromuscular Children Using a Locking Plate-Surgical Technique and Initial Results. International Journal of Paediatric Orthopaedics . May-August 2025; 11(2):16-20.

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“Rachitomalacia” – Radiological Findings of a “New” Intermediate Entity in Adolescents

DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.230

Open Access License: CC BY-NC 4.0

Submitted: 21/06/2025; Reviewed: 02/07/2025; Accepted: 23/07/2025; Published: 10/08/2025

Authors: Anil Agarwal MS Ortho [1], Sitanshu Barik MS Ortho [2], Eknoor Kaur MS Ortho [3]

[1] Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
[2] Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, India.
[3] Department of Hand Surgery, Christian Medical College, Vellore, Tamil Nadu, India.

Address of Correspondence

Dr. Anil Agarwal,
Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Delhi, India
E-mail: anilrachna@gmail.com

Abstract

Background: This study proposes an intermediate radiological entity in adolescents with calcium/vitamin D deficiency, exhibiting features of both rickets and osteomalacia but lacking classical signs of either. We have used the term “Rachitomalacia” to describe this unique radiographic presentation. The report describes the atypical radiological findings of rachitomalacia in adolescents and highlights its distinction from classical rickets and osteomalacia. The study will aid in the early diagnosis and appropriate management of this previously unrecognized clinical and radiographic entity.
Material and Methods: A retrospective analysis of 10 adolescents (8 females, 2 males; mean age 11.1±0.6 years) presenting to a tertiary pediatric hospital (2020–2021) with knee deformities or pain. Inclusion criteria: (1) radiographs showing metaphyseal lucency with vertical striations or widened physis without cupping/splaying; (2) biochemical evidence of vitamin D deficiency (25(OH)D <20 ng/mL) and/or elevated alkaline phosphatase; (3) exclusion of non-nutritional metabolic disorders (e.g., hypophosphatemic rickets). Biochemical and radiographic assessments were performed, followed by calcium/vitamin D therapy.
Results: All patients demonstrated hypovitaminosis D (18.9±4.8 ng/mL) and elevated alkaline phosphatase (1196.7±689.9 IU/L), with normal serum calcium/phosphorus. Radiographs revealed: (1) loss of metaphyseal architecture with vertical striations, (2) widened physis with osteopenia, and (3) incomplete metaphyseal fractures. Treatment normalized biochemical/radiological parameters.
Conclusion: Rachitomalacia presents with subtle, atypical radiographic features in adolescents, distinct from classical rickets or osteomalacia. Recognizing these signs—particularly metaphyseal striations and physeal widening—is critical to prompt diagnosis and treatment, preventing deformities during rapid pubertal growth. Clinicians should consider rachitomalacia in adolescents with nonspecific musculoskeletal complaints and suboptimal vitamin D levels.
Keywords: Rickets, Osteomalacia, Adolescent, Radiograph

References

[1] Moncrieff MW, Lunt HR, Arthur LJ. Nutritional rickets at puberty. Arch Dis Child 1973;48:221–4. https://doi.org/10.1136/adc.48.3.221.
[2] Teitelbaum SL. Pathological manifestations of osteomalacia and rickets. Clin Endocrinol Metab 1980;9:43–62. https://doi.org/10.1016/s0300-595x(80)80020-x.
[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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