Congenital pseudarthrosis of the clavicle (CPC) is a rare disorder diagnosed at birth or early childhood presenting with a painless, non-tender mass on the clavicle. Its etiology is unknown, caused by failure of fusion of the medial and lateral ossification centers of the clavicle. Left-sided CPC is rare and linked to other pathological abnormalities. Bilateral involvement is extremely rare and it is seen in association with other congenital malformations. A full-term newborn baby girl was examined after a complicated emergency cesarean section delivery. Upon initial pediatric examination, there was suspicion of bilateral clavicle fracture with no limitation of movement and equal moro reflex bilateral. Plain radiographs of the clavicle revealed a suspected bilateral fracture of the clavicle. At the two-month follow-up, X-rays were taken to assess the clavicle fractures showing persistent bilateral clavicle deformities and there was no interval callus formation which confirmed the diagnosis of bilateral CPC and excluded the presence of the fracture. Bilateral pseudarthrosis of the clavicle is a rare entity, and surgical correction is not required unless the patient develops symptoms of limitations of movement or for aesthetic causes.

BACKGROUND: Congenital knee dislocation (CKD) is a rare condition, which accounts for 1% of congenital hip dislocations. It can present as an isolated condition or coexist with other genetic disorders. Treatment options include serial casting, percutaneous quadriceps recession, and V-Y quadricepsplasty (VYQ). The pathogenesis and hereditary patterns of CKD are not fully understood, with most cases being familial. CKD is usually managed immediately after birth. However, in this report, the patient was neglected for 2 years.
METHODS: A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting; the patient had seizures and limited access to healthcare because of her family\'s low socioeconomic status. Her birth was noted for a breech presentation accompanied by oligohydramnios. The delivery took a long time, requiring immediate medical interventions. As an infant, she had chronic diseases, including a small patent ductus arteriole, multicystic dysplastic kidney disease, and epilepsy. She was found to have a bilateral knee dislocation of approximately -90° on hyperextension. A multidisciplinary team was involved, and medical care was optimized. She underwent VYQ plus semitendinosus and sartorius transfer. After four postoperative follow-ups, her knees were regaining mobility, and she could walk for 2-3 steps without assistance.
CONCLUSIONS: This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.

A 12-year-old male came to our Emergency Department with chief complaints of pain and inability to move the right shoulder for one day following a fall while playing. The range of motion of the right shoulder was restricted and painful in all directions. Initial radiographs revealed a transverse, displaced proximal humerus fracture at the head-shaft junction. The patient was managed by closed reduction internal fixation with percutaneous K-wiring (Kirschner wires). The K-wires were removed after four weeks, and the shoulder was mobilized. The patient had a near-normal and pain-free range of motion at three months of follow-up. Percutaneous K-wiring remains a viable option for the treatment of paediatric proximal humerus fractures, and good post-operative rehabilitation can help restore near-normal function, as demonstrated in this report.

Fibrous dysplasia (FD) is a rare benign skeletal disorder that replaces normal bone with fibrous tissue and immature woven bone. We present a case of a 13-year-old girl with right-sided facial swelling and craniofacial deformity since birth, accompanied by nasal obstruction and difficulty in breathing and swallowing. Computed tomography (CT) imaging revealed an expansile bony lesion with a ground-glass matrix involving multiple craniofacial bones. Histopathological examination confirmed the diagnosis of FD. Management involved regular monitoring and conservative measures, with surgical intervention reserved for symptomatic progression or cosmetic concerns. This case underscores the importance of considering FD in the differential diagnosis of craniofacial asymmetry and highlights the collaborative approach to patient care. Further research is needed to optimize management strategies and outcomes for pediatric patients with FD.

Osteogenesis imperfecta (OI) is a rare skeletal disorder that increases a patient\'s susceptibility to bone fracture. One complication commonly associated with fractures in this population is the occurrence of non-union leading to pseudoarthrosis. In this case series, three cases of non-union of the distal humerus leading to pseudoarthrosis in the pediatric OI population are presented. One case presents a successful attempt at treatment, one case presents a failed attempt at treatment, and the third case presents a patient\'s refusal to get treated. Furthermore, a literature review highlighting other institutions\' attempts, successes, and failures at treating this clinical entity is presented. Combining the data retrieved from our institution and others, this review demonstrates that there is currently no standard for treating these patients. Additionally, based on the small case series and literature review presented in this article, definitive guidelines for the treatment of pseudoarthrosis of the distal humerus in pediatric OI patients cannot be outlined. However, our findings suggest that both non-surgical and surgical treatments could be viable options for patients with asymptomatic pseudoarthrosis of the distal humerus.

Dietrich\'s disease, also known as Mauclaire\'s disease, is a rare condition characterized by avascular necrosis of the metacarpal heads, predominantly affecting adolescents. This case report aims to elucidate the diagnostic process and management of Dietrich\'s disease in adolescents. A 15-year-old male adolescent presented with left ring finger metacarpophalangeal joint pain and restricted range of motion following a remote history of sports-related trauma. Clinical examination revealed tenderness and limited flexion at the affected joint. Radiographic evaluation demonstrated characteristic features of Dietrich\'s disease, including lucency and loss of height in the fourth metacarpal head and volar subluxation of the ring finger. Computed tomography and magnetic resonance imaging (MRI) confirmed the diagnosis, revealing flattening of the metacarpal head, subchondral marrow edema, and joint effusion consistent with avascular necrosis. The pathogenesis of Dietrich\'s disease remains incompletely understood, likely involving acquired deficits in arteriolar blood supply. Radiographic and MRI findings aid in diagnosis, distinguishing it from other conditions such as chondroblastoma and osteomyelitis. Treatment options range from conservative management to surgical interventions, depending on the severity of symptoms. Dietrich\'s disease, though rare, should be considered in adolescents presenting with metacarpal pain and predisposing factors such as trauma or steroid use. Recognition of characteristic imaging features is essential for accurate diagnosis and appropriate management in adolescent populations. This case highlights the importance of early detection and multidisciplinary management in adolescents with Dietrich\'s disease to optimize outcomes and preserve hand function.

BACKGROUND: Adolescent spinal injuries such as flexion-distraction injuries with posterior ligament complex (PLC) stripping require specialized management because of the unique interplay between injury mechanics and spinal growth. This case report sheds light on these rare occurrences and their management.
METHODS: An 11-year-old boy sustained spinal flexion-distraction injuries resulting in posterior ligament complex stripping following a passenger traffic accident. He underwent a meticulously planned surgical intervention involving urgent posterior fusion with pedicle screw fixation at the L1-2-3 levels and allograft bone grafting. This approach was chosen considering the unique challenges posed by his adolescent spinal anatomy and the nature of his injuries. Postoperative management included using thoracolumbar-sacral orthosis (TLSO), facilitating early ambulation and recovery.
CONCLUSIONS: The rarity of PLC stripping in adolescents underscores the importance of case studies for guiding care. This instance validates the surgical approach and highlights the importance of postoperative management with TLSO for early mobility and prevention of growth-related deformities. This case emphasizes the need for vigilant surgical and postoperative strategies in adolescent spinal injury management.
CONCLUSIONS: An early surgical approach complemented by strategic postoperative management, including the use of TLSO for early mobilization, is vital for the treatment of adolescent spinal injuries. Effective recovery and careful consideration of spinal growth are essential during treatment. Documenting such cases contributes to the body of knowledge necessary to enhance the care strategies for patients with similar injuries.

Osteogenesis Imperfecta (OI) is a rare hereditary disorder that leads to fragile bone mineralization and is most often due to a genetic defect in type I collagen, the primary collagen subtype that comprises bone. Patients with OI suffer from a significant burden of fractures and bony deformities. It has been recognized in countries throughout the world and has a variable age and severity of presentation depending on the subtype of OI. Recognition of this disorder requires a high index of suspicion on the part of the clinician, as it can easily be mistaken for non-accidental trauma in children. The current approach to care for patients with this disorder comprises surgical care with intramedullary rod fixation, cyclic bisphosphonate therapy, and rehabilitation to maximize the patient\'s quality of life and function. This case report demonstrates the importance of considering OI in the differential diagnosis of a child presenting with recurrent fractures so that appropriate testing and treatment interventions can be implemented. The case presented here is that of a male patient with osteogenesis imperfecta who suffered from recurrent long bone fractures, including his femurs bilaterally. His index fracture occurred after a visit to the pediatric ER for an unrelated issue, where his mother claimed that the boy demonstrated pain in his affected leg shortly after the visit. There was a delay in his diagnosis, and the patient suffered multiple fractures before undergoing the insertion of Fassier-Duval rods bilaterally into his femurs to prevent further injury.

UNASSIGNED: Deep vein thrombosis (DVTs) in children is rare, normally linked to pathologies such as major traumatic injury, thrombophilia, and malignancy. Osteonecrosis is still poorly understood. There is growing support to include hypercoagulable states as a predisposing factor, however, no definitive correlation has been found. At present, there are no conclusive literature on the links between osteonecrosis and DVT.
UNASSIGNED: This report describes an unusual and rare case of osteonecrosis and idiopathic DVT in an 11-year-old girl who initially presented with a sprained left ankle. On follow-up, pain was persistent and subsequent radiological investigations revealed extensive DVT, and magnetic resonance imaging scan revealed osteonecrosis of the distal left tibia. Initial blood tests were normal, however with follow-up with hematology, a diagnosis of antithrombin deficiency was made, with the treatment of lifelong anticoagulation. Our patient had continued orthopedic input for clinical and radiographic surveillance to monitor leg length discrepancy.
UNASSIGNED: This case highlights the need to engage in close follow-up and the cautionary care required when young children present with non-resolving severe pain, to consider osteonecrosis and DVT. Our case also highlights the need for further research into the relationship between minor injuries and DVTs and osteonecrosis in children, and the potential synergistic relationship between DVTs and osteonecrosis.

Hypophosphatasia (HPP) is a rare genetic condition that can manifest from the prenatal period to adulthood. Clinical presentation is characterized by six major forms. HPP can be complex and debilitating. A two-year-old male with a past medical history of HPP presented to our emergency room with a non-displaced supracondylar fracture after minor trauma. Non-accidental trauma was considered in addition to inadequate medical control of his HPP. He was referred to our multidisciplinary clinic and asfotase alfa was increased to an appropriate dose. A multidisciplinary approach is the standard of care for the management of children with HPP, allowing for routine evaluation by tertiary specialists. This includes medication dosing surveillance with serum studies and imaging. Enzyme replacement therapy, appropriately dosed by considering weight and laboratory values, may reduce orthopedic complications. A multidisciplinary team\'s surveillance of patients with HPP ensures proper medication management, decreases the likelihood of bony injury and encourages continued patient follow-up.