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This letter responds to a previous letter discussing the surgical outcomes of developmental dysplasia of the hip (DDH) at a specific institution. The authors clarify that pre-operative traction has been used at their institution for several decades and remains a current practice. They explain that the pelvic procedure has evolved over time, leading to improved outcomes. The authors conclude that pre-operative traction is safe and effective based on their findings. [Extracted from the article]

Purpose This prospective study was undertaken to describe patterns of fragmentation of the femoral epiphysis following a proximal femoral varus osteotomy (PFVO) done during stage I of LCPD and to assess the disease duration and outcome in each pattern. Methods A total of 25 children treated by a PFVO in stage I of LCPD were followed until healing. The MRI Perfusion Index, radiographic changes in the femoral epiphysis, disease duration and the Sphericity Deviation Score (SDS) at healing were documented. The reproducibility of classification of the pattern of fragmentation, estimation of disease duration and SDS were assessed. The duration of the disease and SDS in the patterns of fragmentation were compared. Results Four patterns of fragmentation were noted, namely, typical fragmentation, bypassing fragmentation, abortive fragmentation and atypical fragmentation with horizontal fissuring. The reproducibility of classifying the pattern of fragmentation was moderate (Kappa: 0.48) while the reproducibility of other continuous variables was excellent. The Perfusion Index was less than 50% in every affected hip. The duration of the disease and SDS were lowest in children in whom the stage of fragmentation was bypassed but these differences were not statistically significant. Conclusion Following a proximal femoral osteotomy during stage I of LCPD the fragmentation stage may be bypassed partially or completely and the chances of a good outcome appear to be very good if fragmentation is bypassed. [ABSTRACT FROM AUTHOR]

We report the unique case of a 14-year-old male with axillary artery pseudo-aneurysm associated with brachial plexus compression after a simple shoulder dislocation. Following shoulder reduction under anaesthetic, the child was discharged on chemical deep vein thrombosis (DVT) prophylaxis. However, progressive shoulder swelling and upper limb neurological symptoms developed. A multi-disciplinary approach was taken to diagnose and treat this complication. After stopping the anti-coagulants, a combination of endovascular stent-graft and open surgical decompression of the brachial plexus was employed. Paediatric guidelines on DVT prophylaxis are scarce but DVT has never been reported in children following upper limb trauma. [ABSTRACT FROM AUTHOR]

Metaphyseal corner fractures (MCFs) in infants are strongly associated with inflicted injuries. These fractures occur due to shearing forces and involve the chondro-osseous junction in skeletally immature bones. We present the unique case of a MCF of the distal femur caused in utero by external cephalic version (ECV). The illustration of this case links the mechanism to the injury. It is critical for this mechanism to be understood to prevent an erroneous diagnosis of child abuse. [ABSTRACT FROM AUTHOR]