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Purpose: Evaluate a modification of the original modified Dunn technique, for unstable slipped capital femoral epiphysis (SCFE), where the proximal femoral epiphysis is not dislocated from the acetabulum., Methods: We compared two cohorts of patients with unstable SCFE: one operated with dislocation of the femoral epiphysis (DG) and the other without (NDG). Groups were compared demographically and radiographically. Femoral head bleeding was determined after reduction of the slip. Operative time, development of AVN and other complications were registered. The influence of surgical technique and covariates on the slip correction was modeled by a generalized linear mixed model. The risk of necrosis was modeled by logistic regression., Results: The groups (20 patients each) were similar regarding age (p = 0.8), time until operation (p = 0.8), gender (p = 1), laterality (p = 1) and race (p = 0.45). Operative time was longer in DG (p = 0.07). Not dislocating the head reduced Southwick angle correction by 3.74 degrees (p = 0.04). Femoral head bleeding was associated with an 85.14% reduction in AVN odds (p = 0.04). Shorter operative time (< 200 min) decreased AVN rate by 44% (p = 0.37). Both surgical techniques had similar complication rates, including 20% AVN (p > 0.05)., Conclusion: Not dislocating the femoral head in the modified Dunn technique presents similar AVN rates when compared to the original operation, shortens the operative time but provides a lower degree of Southwick angle correction. Femoral head bleeding following slip reduction is a good prognostic indicator for AVN occurrence., Level of Evidence: Level III-Retrospective comparative study., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: The experiments included in this work are in compliance with Brazilian current ethical standards and legislations., (© 2025. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Patellofemoral instability (PFI) is a multifactorial condition typically observed following initial traumatic patellar dislocation. PFI depends on various factors such as limb alignment, bony structure, and the integrity of static and dynamic stabilizers. Patients with below-knee amputation have a higher risk of experiencing PFI. This report describes a successful case involving a patient with patellofemoral instability and a transtibial amputation. The patient was effectively treated with distal realignment and patellar stabilization achieved by reconstructing the medial patellofemoral complex (MPFC).

Introduction: Legg-Calvé-Perthes disease (LCPD) is the idiopathic osteonecrosis of the capital femoral epiphysis in children. It is a self-healing condition, and the morphology of the hip may vary according to the severity of the disease, among several other factors. The treatment focuses on attempts to prevent femoral head collapse, obtain functional hip motion recovery, and reduce pain. Osteochondritis Dissecans (OCD) of the femoral head has been reported in 2% to 7% of patients diagnosed with healed LCPD. Although OCD may remain asymptomatic, the osteochondral fragment has the potential to become unstable, evolving into symptoms of pain, locking, catching, and snapping., Case Report: We present a case report of a ten-year-old boy with an OCD lesion following LCPD who underwent effective osteochondral fixation through the surgical hip dislocation approach. The patient evolved to excellent functional recovery at 1 year post-operatively., Discussion: The surgical hip dislocation approach allows anatomical fixation of the OCD fragment, as well as improvement of hip biomechanics, decreasing pain, improving range of motion and joint congruency, and preserving the native articular cartilage. It also gives the surgeon the opportunity to assess hip stability, femoroacetabular impingement and labral tears, allowing a wide variety of options for the treatment of the healed LCPD. Level of Evidence IV; Type of study Case Report. , Competing Interests: All authors declare no potential conflict of interest related to this article.

Background: The etiology of Legg-Calvé-Perthes disease (LCPD) remains unknown; however, interruption of medial circumflex femoral artery (MCFA) supply to the femoral head is the key pathogenic factor. The main purpose of this study is to determine the feasibility of using magnetic resonance angiography (MRA) to evaluate the course of the MCFA in the normal and affected hips of patients with unilateral LCPD., Methods: We analyzed 24 patients with unilateral LCPD using a time-resolved imaging of contrast kinetics magnetic resonance angiography (TRICKS-MRA). The course of the MCFA was divided into 4 segments in the coronal plane and in 3 segments in the axial plane, based on its location with respect to the femoral neck. The visibility of each segment was studied in the normal and affected sides. The segments were defined as not visible when no contrast was seen within the vessel lumen or visible when the lumen was partially or completely visualized with contrast. The statistical analysis was done using the χ2 test., Results: TRICKS-MRA provided well-defined images of the first 2 segments of the MCFA on both the normal and affected sides of patients with LCPD (P=1). In half of the patients, the third segment was also visible using TRICKS-MRA on both sides (P=1). The fourth segment of the MCFA, which was the ascending lateral epiphyseal segment, was not visible on either side (P=0.49). No significant difference was found between the normal and affected hips in terms of visibility of the 4 segments of the MCFA using TRICKS-MRA. Anastomosis of the MCFA with the inferior gluteal artery was found in 3 hips (2 hips with LCPD and 1 normal hip)., Conclusions: TRICKS-MRA provides well-defined images of the arterial supply to the proximal femoral epiphysis in children with LCPD, presenting a noninvasive and radiation-free alternative to conventional angiography. However, the TRICKS-MRA method used did not allow visualization of the ascending lateral epiphyseal segment of MCFA in the affected and the contralateral normal side. We believe that further advancement of this noninvasive imaging technique may open new opportunities for research aimed at evaluating the vascular supply of the femoral head in children., Level of Evidence: Level IV-case-control study., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: In myelomeningocele, several classifications have been used. The present manuscript proposes a new functional classification to better assess the prognosis and management of these patients., Methods: The manual muscle test is what defines the actual group in which the patient should be included. Furthermore, this new classification brings information about the bracing and external supports recommended to each functional level. We also recommend that the patient's Functional Mobility Scale should always be mentioned together with their functional level., Results: The four levels in this classification are MMFC1, MMFC2, MMFC3 and MMFC4. The MMFC1 group includes patients with significant muscle weakness. They need to use high braces crossing the hip joint with a walker to achieve some ambulation. The MMFC2 group includes patients who have functional hip flexors, knee extensors and knee flexors. However, the hip abductors are quite weak. These patients usually need to use a walker - or crutches - and Ankle-Foot Orthosis (AFOs). The MMFC3 group includes patients with functional hip flexors, knee extensors, knee flexors and hip abductors. However, the ankle plantar flexion function is absent. Most of them are able to walk independently, only using AFOs without any external support. The MMFC4 group includes patients who have preserved function in the entire lower limb musculature. These patients don't need any assistive devices to achieve an adequate ambulation pattern., Conclusions: We hope that this new classification is a system that is simple to understand, serves as a gait prognosis guide and facilitates communication among healthcare professionals., Level of Evidence: V., (Copyright © 2021, The author(s).)