Case 1: Clubfoot in a Newborn — The Ponseti Method
A 5-day-old boy was brought with bilateral clubfoot (congenital talipes equinovarus). Treatment began that week with the Ponseti method: gentle weekly manipulation and long-leg casting. After five casts the feet were corrected except for equinus, addressed with a 5-minute percutaneous Achilles tenotomy, followed by boots-and-bar bracing to prevent relapse.
Management
Weekly Ponseti casting ×5, percutaneous tenotomy, foot-abduction brace (23 hrs/day for 3 months, then nights until age 4).
Outcome
Plantigrade, flexible, pain-free feet; walking on time at 14 months.
Case 2: Developmental Dysplasia of the Hip — Caught at 3 Months
A 3-month-old girl (breech delivery, positive family history — both major risk factors) had limited hip abduction on routine check. Ultrasound confirmed a dislocated left hip (Graf IV). She was treated in a Pavlik harness, which holds the hips flexed and abducted so the femoral head remodels the socket while the child kicks freely.
Management
Pavlik harness full-time 10 weeks with ultrasound monitoring, then weaning.
Outcome
Concentric, stable hip; normal X-ray at 1 year; walking normally.
Case 3: Limping 6-Year-Old — Perthes Disease and the Art of Containment
A 6-year-old boy limped painlessly for a month with occasional knee ache — a reminder that children's hip disease often presents as knee pain. X-rays showed Perthes disease (avascular necrosis of the growing femoral head). At his age with less than half the head involved, treatment was containment by non-operative means: activity restriction and physiotherapy to keep the hip mobile while the head revascularises over 2–3 years.
Management
Activity modification, abduction stretches, swimming, serial X-rays every 4 months.
Outcome
Healed spherical head at age 9; full sport allowed.
Case 4: Slipped Capital Femoral Epiphysis in an Overweight 13-Year-Old
A 13-year-old overweight boy had three weeks of thigh pain and an out-turned foot; X-rays (frog-lateral view — the key image) showed a stable slipped capital femoral epiphysis. The femoral head was fixed where it lay with a single percutaneous screw the next morning — SCFE is fixed urgently to prevent further slip and the dreaded avascular necrosis.
Management
In-situ single cannulated screw fixation; protected weight-bearing 6 weeks. Endocrine screen normal.
Outcome
Pain-free with full activity at 3 months; contralateral hip monitored.
Case 5: Greenstick Forearm Fracture — Bones That Bend
A 7-year-old fell off her bicycle; X-rays showed greenstick fractures of the radius and ulna with 20° angulation — the bone bent and cracked on one side only, as young bone does. Under sedation, the fracture was gently corrected and an above-elbow cast applied. Children's bones remodel: alignment need not be perfect, only acceptable for age.
Management
Closed reduction under sedation, moulded above-elbow cast 5 weeks with weekly X-rays for 2 weeks.
Outcome
United and remodelling well; full function at 8 weeks.
Case 6: Pulled Elbow — The 30-Second Cure
A 2-year-old girl suddenly stopped using her arm after her mother pulled her up by the wrist. She held the arm slightly flexed and would not supinate — a classic pulled elbow (radial head subluxation). With the annular ligament reduced by a quick supination-flexion manoeuvre, she was using the arm to reach for a toy within minutes. No X-ray, no cast.
Management
Supination-flexion reduction manoeuvre in the clinic.
Outcome
Immediate full use of the arm; parents taught to avoid lifting by the wrists.
Case 7: Acute Haematogenous Osteomyelitis — 48 Hours That Saved a Tibia
A 9-year-old boy had two days of fever and refusal to walk, with exquisite tenderness over the upper tibia. Blood markers were high; MRI confirmed early osteomyelitis without abscess. IV antibiotics begun within hours (after blood cultures) aborted the infection — the window before pus forms is short, and he had arrived inside it.
Management
IV cloxacillin + ceftriaxone 5 days → oral 4 weeks, guided by cultures (MSSA) and CRP.
Outcome
Walking pain-free at 2 weeks; normal X-rays and markers at 3 months.
Case 8: Septic Arthritis of the Hip in an Infant — A Same-Day Operation
An 11-month-old girl had fever, an immobile left leg held flexed and abducted, and scream-on-movement of the hip. Ultrasound showed a joint effusion; aspiration returned frank pus. The hip was opened and washed out within hours — in septic arthritis, articular cartilage is being digested by the hour, and the infant hip additionally risks head necrosis from pressure.
Management
Emergency arthrotomy, lavage, IV antibiotics 2 weeks → oral 4 weeks.
Outcome
Normal hip motion at 6 months; X-ray surveillance until age 5 planned.
Case 9: Bowlegs at 2 Years — Physiological or Blount Disease?
Anxious parents brought a 2-year-old with bowlegs. Symmetric bowing, normal height, and no lateral thrust on walking suggested physiological genu varum, which peaks around age 2 and self-corrects. X-rays confirmed no beaking of the medial tibial epiphysis (which would indicate Blount disease). Reassurance and a review at age 3 were the entire treatment.
Management
Clinical + radiographic assessment, reassurance, review at 12 months.
Outcome
Legs straightened spontaneously by age 3½.
Case 10: Pathological Fracture Through a Bone Cyst — Let It Heal, Then Treat
A 10-year-old boy fractured his upper humerus with a trivial throw; X-rays revealed the fracture ran through a simple (unicameral) bone cyst — a benign fluid-filled cavity. The fracture was treated in a sling and, interestingly, the fracture itself sometimes heals the cyst. When the cyst persisted after union, it was treated with percutaneous injection rather than open surgery.
Management
Sling 4 weeks for the fracture; persistent cyst treated with aspiration + injection at 4 months.
Outcome
Cyst consolidated over a year; full sport allowed.
Explore More Cases
This series is part of the OrthoChronicles Surgical Case Library — 50 real-world cases across trauma, joint replacement, spine, paediatric and sports orthopaedics.