Purpose Congenital dislocation of the knee (CDK) is a relatively rare condition. It may occur as an isolated deformity, it may be associated with musculoskeletal anomalies such as developmental dysplasia of the hip and clubfoot, or it may occur as part of a syndrome such as arthrogryposis multiplex congenita or Larsen syndrome, or it may occur in paralytic conditions such as meningomyelocele. Treatment options include serial casting, percutaneous quadriceps recession (PQR) and V-Y quadricepsplasty (VYQ). The aim of this study is to evaluate the medium-term results of PQR and VYQ, and to set a protocol of management for CDK based on a modified grading system. Methods Eleven infants with 21 CDK were treated at our unit. Five knees were treated with serial casting, 12 knees with PQR and four knees with VYQ. Follow up averaged 41 months. Results Twelve knees achieved excellent results, seven knees achieved good results and two knees achieved fair results. Conclusion A modified grading system for CDK is introduced. Based on this, we recommend the following. Serial casting is performed in patients with GI CDK. In GII CDK in neonates (babies up to the age of 1 month) serial casting is started. A maximum of four weekly manipulations and castings are attempted. If a range of flexion [90°i s achieved, serial casting is continued; if range of flexion remains \90°it is necessary to proceed to PQR. In babies older than 1 month when first seen; PQR is performed from the start. VYQ is indicated in patients with GIII CDK or in recurrent cases.

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Congenital vertical talus is a rare and complex foot anomaly. Serial casting with or without minimally invasive surgery is a universal management strategy especially for children in the first year of life. Nevertheless, extensive surgical treatment of late-presenting, neglected and multiple operated children with congenital vertical talus may be required with guarded results. The results of naviculectomy as a more conservative intervention and directed exclusively at ambulatory children with intractable congenital vertical talus have not been reported. We present the radioclinical outcomes of two ambulatory children with intractable congenital vertical talus treated by naviculectomy/midtarsal resection and limited soft tissue release. One child had an isolated congenital vertical talus whereas the other had a nonisolated etiology. Generally, naviculectomy/midtarsal resection revealed a positive benefit-risk profile in children with intractably severe congenital vertical talus on the short-term. We reported favorable results in terms of foot appearance, function and radiology. We believe that a less invasive procedure like naviculectomy/midtarsal resection is an encouraging technique to investigate in children with intractable congenital vertical talus.

Introduction: This systematic review aims to answer three research questions concerning the management of hereditary multiple osteochondromas of forearm in children: What is the best available evidence for the currently employed surgical procedures? What patient characteristics are associated with better prognosis? What disease characteristics are associated with better prognosis?Methods: We searched the literature using three major databases with no publication date restrictions. To enhance search sensitivity and maintain precision we used keywords/subject terms correlating with patient population, problem and interventions. We used strict inclusion/exclusion criteria to improve validity evidence.Results: The search process yielded 34 eligible studies with a total of 282 patients (315 forearms). We comprehensively analysed study and patient demographics and interventions and outcomes. Eleven studies (32%) had a long-term follow-up and 31 studies (91%) were retrospective. Of the total number of forearms, ulnar lengthening +/− associated procedures was used in 210 forearms (66.7%), isolated osteochondroma excision in 65 forearms (20.6%) and isolated distal radius hemiepiphysiodesis in 15 forearms (4.7%) among others.Discussion: Ulnar lengthening can restore radiologic anatomy, improve appearance and to a lesser extent objective clinical parameters like joint range of motion on the short/intermediate term. Isolated osteochondroma excision can relief pain and satisfy cosmetic concerns occasionally. There is poor evidence to suggest that surgery improves quality of life or function. Predictors of surgical success in regard to patient and disease characteristics remain elusive. Natural history and prospective randomized control studies where the control group receives no treatment should be rethought. They have the potential for bias control and identification of the ideal surgical candidate. The complex interplay between the confounding variables has undermined the capability of most studies to provide well-grounded evidence to support and generalize their conclusions. Valid quality of life scales should supplement objective outcome measures.