My Experience in Paediatric Orthopaedics at Sanchetti Institute For Orthopaedics and Rehabilitation

My Experience in Paediatric
Orthopaedics at Sanchetti
Institute for Orthopaedics
and Rehabilitation
Case No. 1
• Management of unicameral cystic lesion of
long bone with Intramedullary elastic nail.
• It is a good option for in terms of function&
osseus consolidation
Some hypothesis regarding the
pathogenesis of unicameral bone cyst
1. Entrapment of the synovial tissue into

medullary cavity
2. Localised failure of ossification
3. Venous blocked leads to retrograde arteriolar
obstruction
• Common sites
Proximal humerus & femur
• Surgical options include
1. Curettage and bone grafting
2. Intralesional steroid injection
• Recurrance rate
40% but IM nailing has less recurrence rate with
advantage of early mobilization and rapid cure
Case No. 2
• Hemiepiphysodesis for management of genu
varus or valgus deformity with plate and screw
• The eightplate or guided growth plate is an
unique figure 8 shaped device that gently
guides growth & allows safe and gradual
correction of limb alignment,
• Indication
– Knock knee, bowed legs, deformities of ankle
• Application – 18 months to 14 years
• Benefits to the surgeon
– Simple andmimimal invasive technique
– Learning curve 1-2 cases
– Benefits for the patients
• Outpatient procedure
• No surgical risk
• Procedure is not so painful
• Immediate mobilization
• Flexible implant will tether (not compress) physis allowing
more rapid correction
Case No. 4
• Stimulan to fill the osseus deffect
What is stimulan
• It contains synthetic implant grade calcium
sulphate dihydrate powder and mixing
solution in a premeasured quantities and
when mixed together they formed paste and
placed into the mould to form beads.
• The biodegradable radiopaque beads are
resolved in approximately 30 to 60 day and
the gap is subsequently healed by new bone
formation
• Indication
– To fill a bone void or defect created by
• Surgery
• A cyst
• A tumor
• Osteomyelitis
• Traumatic injury
Contraindication
severe vascular or neurologicaldisease
Uncontrolled DM
Severe degenerative bone disese
Pregnancy
Uncooperative patient who can not follow the post operative instruction
Hypercalcemia
Renal compromised patient
Case No. 5
• Management of Congenital pseudoarthrosis of
tibia (CPT) with telescopic nail
• Congenital pseudoarthrosis of tibia is a rare
condition and is a great challenge for the
orthopaedics surgeon to achive union after
surgical excision of the pseudoarthrosis site.
• Multiple methods have been described like
– IM nail
– External fixators ( eg. Ilizarov)
– Fassier duval rod ( telescopic nail)
• The rate of union with FD rod is realatively good
than other options
• Surgical techniques
• Approach – Anteromedial (Patellar tendon retracted
laterally and the extra articular surface of tibial platue
is exposed )
• Small diameter K- wire is inserted
• Reaming done with special reamers
• Osteotomy done
• Male rod is inserted and centered in the middle of the
epiphysis
• Next the female componenet is placed over
the female component and screwed in the
proximal tibia
Case No. 5
• Management of DDH with VDO with
acetabuloplasty (Pembarton procedure)
• The diagnosis of DDH is confirmed by infant –
Ortolani’s test, Barlows test, USG and
Vonrosen’s line (with the abducted by 45
degree)
• Childhood and adolescence – wadling gait,
increased lumber lordosis, shortening and
asymmetrical gluteal and thigh fold, positive
telescopic and trendelenberg test , positive
galeazzi sign and positve radiology
Case No. 6
• Management of paediatric fracture shaft of
femur with TENS(EISN).
Options for the management of paediatric
fracture shaft of femur
A. Conservative (Prolonged Immobilization)
B. Operative
1. Plate Osteosynthesis-
i) Large exposure
ii) Relatively longer duration of operation
iii) Risk of delayed union
iv) Infection
v) Large dissection for removal
2. External fixation
i. Provide good stability & early mobilization
ii. Associated with risk of pin tract infection & takes
longer time for wait bearing
3. K wire Fixation
Stability and fracture angulation correction is not
satisfactory
4. For skeletally mature patient (11 – 16 yrs)
Interlocking IM nail can be an option avoiding
piriformis fossa.
5. TENS
Advantage over other surgical modalities because
i. It is simple load sharing
ii. internal splint that does not violet open physis
allows early mobilization and maintain alignment
iii. Micromotion promots external bridging callus
formation
iv. Periosteum is not disturbed and no disturbance of
frature haematoma
v. Less chance of infection
• Nail diameter isthmus in AP view x 0.4
• Entry port – 2.5 to 3 cm proximal to physeal plate,
• Medial nail will go to the neck
• Lateral nail will go to the trochanter
• When to give weight bearing? - 2 to 3 weeks after
operation
• Complicatiion- Skin and subcutaneous tissue irritation
around the knee,Mismatched diametre of the nail not a
good option for obese children , overgrowth of the femur,
about 0.6 cm incase of fracture midshaft of the femur,
• When to remove? – depends upon age of the pt & degree
of consolidation
• Nail diameter isthmus in AP view x 0.4
• Entry port – 2.5 to 3 cm proximal to physeal
plate,
• Medial nail will go to the neck
• Lateral nail will go to the trochanter
• Complicatiion-
– Skin and subcutaneous tissue irritation around the
knee,
– Mismatched diametre of the nail not a good
option for obese children ,
– overgrowth of the femur, about 0.6 cm incase of
fracture midshaft of the femur,
• When to give weight bearing? - 2 to 3 weeks
after operation
• - 2 to 3 weeks after operation
Case No. 7
• Management of CP patient with crouch gait
• Patient present with following deformities
– Flexion adduction deformities of the hip
– Flexion deformities of the knee
– Equinus deformity of the ankle
All these deformities are dynamic.
Patient treated with adductor tenotomy ,medial
hamstring release, Fractional lengthening of the
tendoachilis with supratrochanteric extension
osteotomy of the femur with inj. Botox in calf
muscle
• Mechanism of action of Inj.Botox
– It acts by binding presynaptic cholenergic nerve terminal
and decrease the release of acetylcholine and thus causing
a neuromuscular blocking effect.
– Dose – 2to 3 unit /kg of body wt.
– Complication
• Neck weakness
• Dysphagia
• Local pain at injection site
• Lethargy
• Dry mouth
• Dizziness
• dysphonia
Case No. 8
• Management of supracondylar # by closed
reduction and percutaneous pinning from
lateral side with one assistant

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My Experience in Paediatric

1. Entrapment of the synovial tissue into

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