Femoral head reduction osteotomy (FHRO) was described to treat misshapen femoral head that is causing intraarticular hip pain. The published literature showed discrepancies in patient selection, surgical techniques, and decision to perform concurrent acetabular osteotomy. Very few studies used Standardized Outcome Measures (SOMs). This study aims to describe the technique of FHRO and report the results of our series of 22 patients using SOMs and compare them to former peer-reviewed articles. Twenty-two hips in 22 patients with hip pain caused by mishshapen femoral were treated with FHRO with or without triple pelvic osteotomy (TPO). Patients with poor hip range of motion and significant hip joint arthritis were excluded. The mean patient age was 15.8 (range, 9.2–23.9). Clinical results were reported using the HHS. Radiographical results were reported by comparing Lateral Center Edge Angle (LCEA), extrusion index, Tonnis angle, head size percent, sphericity index, and distance from tip of trochanter to center of femoral head. The mean follow-up was 3.2 years. Only 5 patients received TPO. The HHS showed statistical improvement from 62.0 to 81.6 (The median interquartile range 63.5–88.5). Five patients had HHS less than 70 at the latest follow up. All radiographic parameters except the Tonnis angle, showed statistically significant improvement. FHRO with or without pelvic osteotomy is a good salvage procedure for patients presenting with misshapen femoral head with intraarticular hip pain, who still have good preoperative ROM with no signs of hip arthritis. Level of evidence: IV.

Background: Hip arthrography in developmental dysplasia of the hip (DDH) has the advantages of viewing the shape and size of the cartilaginous part of both the femoral head and acetabulum, besides the soft tissue obstacles. The aim of the work was to assess the role of arthrogram in evaluation of closed reduction of developmental dysplasia of the hip. Methods: This prospective study included 30 patients with 36 involved hips who presented with DDH. This study included 7 males (23.3%) and 23 females (76.7%). There were 6 patients with bilateral hip involvement (20.0%) and 24 patients with unilateral involvement (80.0%). In this study we used 3 ml Urografin 76% diluted in 7 ml saline and 3 to 5 ml of diluted Urografin was injected into the hip joint. Results: Out of the 36 hips, closed reduction was successful in 33 hips (91.7%) and failed in 3 (8.3%). After the interpretation of the arthrogram we considered the reduction of 7 (21.2%) reduced hips nonconcentric because of the soft tissue obstacles. In the 7 hips with nonconcentric reduction besides the 3 hips with failed closed reduction, we proceeded to open reduction of the hip through medial approach. At the end of follow up, all hips (100%) showed concentric reduction without re-dislocation in any case. Conclusions: Hip arthrogram is a very reliable method in diagnosing hip concentricity and the presence of soft tissue obstacles in management of DDH by closed reduction. Arthrogram helps the operator to decide open reduction in such cases achieving excellent results in all cases.

<p class="abstract"><strong>Background:</strong> Management of Idiopathic flexible pes planus (IFPP) is debatable. Surgery is rarely indicated for flexible flatfoot. The goal of the surgery should be always to treat symptomatic patients and not to alter the shape of the foot. There are numerous options for surgical treatment in children and adolescents including subtalar arthroereisis or osteotomy with or without soft tissue procedures.</p><p class="abstract"><strong>Methods:</strong> Between June 2013 to December 2017, twenty eight feet in sixteen patients (9 boys, 7 girls) were included in this study. Twelve cases were operated bilaterally, three in the right foot and one in the left side. The mean age of the patients was 8.36±1.704 years (6-12 years). Calcaneal lengthening osteotomy was done with an oscillating saw about 1.5 cm proximal to the calcaneocuboid joint. Usually, 8-10 mm autologous bone graft from iliac crest was sufficient and fixed by K wires. Half of the tibialis posterior tendon after splitting with a periosteal flap from the navicular was then advanced distally until clinical restoration of the medial arch was then performed.<strong></strong></p><p class="abstract"><strong>Results:</strong> Radiographic analysis revealed significant improvements in talo-first metatarsal, calcaneal pitch, talocalcaneal angles in lateral radiographs, and talo-first metatarsal and talonavicular coverage angles in AP radiographs. All patients were evaluated at final follow-up visits. Preoperative mean AOFAS score increased significantly from 64.04±8.867 (range: 50 to75) to 94.11±3.765 (90-100).</p><p class="abstract"><strong>Conclusions:</strong> It is concluded that Evans calcaneal lengthening osteotomy augmented by spilt tibialis posterior tendon advancement is an excellent procedure in the management of IFPP.</p>

No abstract