Editorial for WIROC 22 issue

Journal of Clinical Orthopaedics | Vol 7 | Issue 2 |  Jul-Dec 2022 | page: 01 | Dr. Nicholas Antao, Dr. Ashok Shyam

DOI: 10.13107/jcorth.2022.v07i02.501

Author: Dr. Nicholas Antao [1], Dr. Ashok Shyam [2]

[1] Department of Orthopaedics, Hill Way Clinic, Hill N Dale Building, 4th Floor, Hill Road, Bandra West, Mumbai, Maharashtra, India
[2] Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehablitation, Pune, India

Address of Correspondence
Dr. Nicholas Antao
Head of Department of Orthopaedics, Holy Spirit Hospital, Mahakali Road, Andheri (E), Mumbai – 400093, Maharashtra, India.
Email: narantao@gmail.com

Editorial for WIROC 22 Issue

This is our 7th edition with 15 issues inclusive of both online and print form. The journal brings to the reader articles involving regular research, we include review papers, case reports and synopsis/summary of interesting, information of selected topics summary, published in other peer review journals of super speciality. We have also now started special section in superspeciality in the form of symposia focusing always the need of our members. So far we have covered infection, spine and this WIROC issue contains very relevant and important topic “Office paediatric orthopaedic practice” subject of utmost importance to general orthopods for recent information and knowledge to understand the pathology better and manage the treatment better on evidence based outcomes. We are grateful to all the contributing authors and specially in this issue to Dr. Swapnil Kenny and Dr. Atul Bhaskar for being the inspiration and motivation for the authors for sending wisely selecting the topics.

Remember this journal of BOS can bring out issues on regular basis only on the contributions of various authors who can be our members, postgraduates and also established foreign and Indian contributors. Lately we have seen most journals expect quite a high renumeration for processing and publishing the article in their journal. The acts of reviewing editing are satisfactory in many regards that we help to increase the knowledge of our readers, which in turn goes as in good stead for the orthopaedic fraternity who will benefit reading them and putting into practice what’s new and latest in the care of our patients. This is an work ethic and as a physician one is expected to keep oneself abreast of time which in time helps our patients to get the latest service. We at JCORTH appreciate the honorary, voluntary and selfless dedication of our contributors and are very much aware of your altruistic service. Altruism according to Oxford dictionary Altruism is in fact caring about the needs and happiness of others and being selflessly willing to do things which would help others even if it is not going to be of any advantage to the helper. We earnestly urge members and well wishers to strive to send in articles regularly. We understand it involves tremendous effort and sacrifice of your leisure and family time and burning of midnight oil. We must appreciate our members and readers who dedicate voluntarily their leisure time to keep themselves updated and strive to offer their patients, the latest time tested counsel and advice to their patients.

Dr. Nicholas Antao.
Dr. Ashok Shyam.

How to Cite this article: Antao N, Shyam AK. Editorial for WIROC 22 Issue. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):01.

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From the Desk of BOS President & Secretary

Journal of Clinical Orthopaedics | Vol 7 | Issue 2 |  Jul-Dec 2022 | page: 02-03 | Dr. Rajesh Gandhi , Dr. Neeraj Bijlani

DOI: 10.13107/jcorth.2022.v07i02.503

Author: Dr. Rajesh Gandhi [1], Dr. Neeraj Bijlani [1]

[1] Bombay Orthopaedic Society, Mumbai, Maharashtra, India.


Address of Correspondence
Dr. Neeraj Bijlani,
Secretary Bombay Orthopaedic Society, Mumbai, Maharashtra, India.
Email: secretary@bombayorth.com

From the Desk of BOS President & Secretary

We welcome you to the WIROC Max 2022 special issue of the Journal of Clinical Orthopaedics ( The official Journal of BOS As the year 2022 ends, we are delighted to inform all members of BOS that we have successfully completed various events per the calendar of events. We conducted 5 clinical meetings and 4 Master Series so far in the year. The significant change from last year is that we did all
these meetings physically, which provided the much-needed spark among the academics of the Bombay Orthopaedic Society. However, we have also learnt during the pandemic that many BOS members also watch these programs online. For the benefit of our members, we are in the process of uploading selected talks of Master Series on the BOS YouTube channel and OrthoTV.

There are 13 Instructional courses planned this year out of which we successfully completed 9 courses and others will be completed between January to March 2023, and more will continue into the coming year. These are flagship courses of BOS, and we saw a tremendous response to the same, with delegates coming from all corners of the country. We also had DR. J. C. Taraporvala P. G. Teaching course held at the SION Hospital auditorium, which was very well received by enthusiastic young residents and trainees.

The Year 2022 is a historic year for the Bombay Orthopaedic Society. For the first time in the history of BOS, two flagship events, WIROC GLOBAL and WIROC MAX, were held in the same calendar year. The pandemic and the schedule of IOACON delayed WIROC GLOBAL, which was held in March, and WIROC MAX in December at the expected dates of WIROC. Also, the trend of having a tagline for WIROCs, which started with WIROC UNLOCKED, has continued with WIROC GLOBAL and WIROC MAX. I think these taglines have helped define and project the scope & personalities of WIROCs. WIROC Global was a truly global phenomenon with the participation of 87 global and national orthopaedic societies giving BOS the maximum international exposure. It was a mix of physical and virtual
content that gave the delegates a live surgery platter, a global virtual hall and four days of academic extravaganza. WIROC MAX, as the name suggests, has maximised everything about WIROC. The venue is the main highlight, with maximum space and facilities. The program looks so fantastic, with more than 100 hours of academic deliberations. Both WIROCs have received tremendous participation in the form of delegate registrations and faculty enrolment. Again, to maximise the outreach and to add to the academic commitment of BOS, we will be premiering select content from both WIROCs on online portals.

We will have reports of both WIROCs and all the activities of BOS at the GBM. The GBM of BOS will be held on 26th February 2023, and we invite all the members of BOS to please attend the GBM and participate in the growth of the society.

The entire world has gone through a difficult time in the last two years. I thank all BOS members for their support and faith in BOS as the premier academic body in the country and now across the globe. I also thank all members of the BOS Executive council for working tirelessly to uplift the BOS Banner. Lastly, we would like to extend our best wishes to the two WIROC secretaries of WIROC MAX, Dr Ashish Phadnis and Dr Abhijit Kale. The journal will be released during WIROC MAX, and we hope you enjoy the academic extravaganza while reading this editorial.

Wishing all of you a very Happy New year.


Dr. Rajesh Gandhi,

Dr. Neeraj Bijlani.

How to Cite this article: Gandhi R, Bijlani N. From the Desk of BOS President & Secretary. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):02-03.

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WIROC Max 2022

Journal of Clinical Orthopaedics | Vol 7 | Issue 2 |  Jul-Dec 2022 | page: 04-05 | Dr. Ashish Phadnis, Dr. Abhijit Kale

DOI: 10.13107/jcorth.2022.v07i02.505

Author: Dr. Ashish Phadnis [1], Dr. Abhijit Kale [2]

[1] Head of Orthopaedic Department, Jupiter Hospital, Thane, Maharashtra, India.

[2] Spine Surgeon (Ortho), Ortho Surgeon and Joint Replacement, Sion Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Ashish Phadni,
Head of Orthopaedic Department, Jupiter Hospital, Thane, Maharashtra, India.
Email: aapjadnis@gmail.com

WIROC Max 2022 

Greetings to one and all.

WIROC is back … and how. The the spirit of Mumbai, the drive for betterment, the zest for life, the resilience in the face of challenges, with a spring in our step and wearing our hearts on our sleeves, has shaped our thought and actions in dishing out an academic programme for our 57th Annual Conference this year.

WIROC will be held from the 29th to the 31st of December at the Jio World convention Centre at the Bandra Kurla Complex. Ample space, Comfort ease of access and spaced out sessions is what one can expect in this convention centre. We move slightly away from the conventional didactic talks by having almost all the convenors carving an interactive discussion in the sessions, use of app based audience interaction will be the norm. Motivate, Innovate, Integrate-Redefining Orthopaedics is the central theme of the conference. One thing a delegate won’t lack here is motivation to go beyond, motivation to get going and motivation to lead a life not only a career. Kaleidoscope – highlights for the first time an exhibition of paintings and photographs of orthopaedic artists, hobbies of orthopods that shape the individual adds facets to their beaming personas, watch it all, interact with them and reflect. More than 100 exhibits will be displayed along with a play list of orthopaedic surgeon’s music cafe. Sessions on Innovation for the Orthopaedic Surgeon, to give a shape to his ideas, the place to look for resources, the people to turn to for answers, the industry that matters and the attorney that patents hear it all from the people who have been there done that.

We promise to make this a more immersive and an engaging conversation. Problem based solutions, adoption of new techniques and technology, cutting edge tech for all will be the central theme of the robotic and modern technology sessions.

About 90 academic sessions covering orthopaedic subspecialties will be the highlight.

The plenary sessions have been the Jewel In the Crown of WIROC. This time too we will be having our country ‘s illustrious Jewels from Mumba i addressing us at the Presidential Guest Lecture.
Mr Viren Rasquinha – Olympian and Director of the Olympic Gold Quest will take us through “The Journey to build India’s Olympic champions.” Mr Yadvendra Jhala the Dean of the forest School at Dehradun, the man behind getting the Cheetah s to India , will be talking to us about the “Role of Science in wildlife conservation in India”.

Our Dr R J Katrak Orator Dr Sanjay Agarwala will be speaking to us on “Inspiration and Perspiration a winning combination.” The Dr K S Masalawala paper award presenters were selected from a pool of more than 350 abstracts that were reviewed by 5 blinded reviewers in a huge and an exhaustive exercise in record time. The A K Talwalkar Symposium features Paediatric Supracondylar fractures for the first time. The robotic zone and a VR zone will add another dimension along with daily 3D printing hands on workshops for the delegates.

Learning above earning – talks about cases that we learn more from than all the accolades and remunerations that one may expect . What I did and What I wish I knew then is a window to a by gone era and how the expanding and evolving knowledge has shaped practises that we reflect on the Past practises with amusement and thought.

Career planning for the next generation orthopod features very high on our list and hence an entire half day is dedicated to subspecialty training, fellowship training, and hearing both sides of the story the mentor and mentee where they also thrash out the challenges in the ever increasing digital noise. Financial planning and social well being are a regular feature however fitness is another dimension that has been added to the mental well being of the delegates. Listen to the fitness fanatics take you on a myth busting and an inspiring journey to get fit, stay fitter longer.

All in all this WIROC Max plans to deliver education with Motivation, Inspiration for Innovation, and Integration of everything we need to be a better surgeon and a better individual.


Dr. Ashish Phadnis,

Dr. Abhijit Kale.

How to Cite this article: Phadnis A, Kale A. Wiroc Max 2022. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):04-05.


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Journal of Clinical Orthopaedics | Vol 7 | Issue 2 |  Jul-Dec 2022 | page: 06-07 | Dr. Sangeet Gawhale, Dr. Vishal Kundnani, Dr. Ashok Shyam

DOI: 10.13107/jcorth.2022.v07i02.507

Author: Dr. Sangeet Gawhale [1], Vishal Kundnani [2], Ashok Shyam [3]

[1] Department of Orthopaedic, JJ Hospital, Mumbai, Maharashtra, India,
[2] MS Ortho, Consultant Spine Surgeon at Lilavati Hospital and Research Centre, Mumbai, India,
[3] Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehablitation, Pune, India.

Address of Correspondence
Dr. Sangeet Gawhale,
Department of Orthopaedic, JJ Hospital, Mumbai, Maharashtra, India.
E-mail: sangeetgawhale@hotmail.com


WIROC GLOBAL was a fantastic experience for all three of us, and we hope it was for all the delegates and faculties. It represented a change and a transition from the virtual world into a physical conference. It had the best of both worlds included in one which did full justice to the presidential theme of Dr Sangeet Gawhale; ‘Adapt & Evolve.’

The entire event was planned in 3 months! Yes, just three months is what was needed to plan and execute a conference of such a massive scale. And we thank the entire team with us that has helped us realise this dream.
The first proof of concept was the balance of Virtua l and Physical components and the involvement of National and International Societies on One Single Platform. The concept and term ‘WIROC Global’ was suggested by Ashok Shyam and was readily accepted by the other pillars of WIROC and thus began a journey of partnership, friendship, and comradeship among all of us three. The first step was creating a Team for WIROC GLOBAL. We received full support from the entire academic fraternity of the Bombay Orthopaedic Society. The scientific program planning started in January 2022 and was completed by mid of February under the guidance of Dr. Sangeet Gawhale, Dr. Vikas Agashe and Dr. Anil Karkhanis. All the convenors did a fabulous job of bringing together a fantastic program.

The virtual part of WIROC Global was planned to include a 36 hours program which will be 12 hours running after the physical conference. We had scheduled 2 hours slots with societies and started approaching them. To our amazement, most of the organisations were delighted to participate. This was a unique concept to them. The most remarkable part was that we off e red members of all participating societies Free Access to the Virtual Platform and content of all other organisations. We also asked the societies to add a small introduction to their societies so that members of other societies visiting the platform can know more about their activities. This was to be given by the presidents of the societies, and we are delighted to have the presidents of prestigious organisations like the British Orthopaedic Association, Canadian Orthopaedic Association, AO North America, SLARD, SICOT, SPOT, and many more personally participate and spoke about their associations. It was such a delight to see the inclination to share and collaborate among the entire orthopaedic community from across the world. We have a total of 87 societies participating, with more than 258 speakers from more than 104 countries. That shows the spirit of companionship that the orthopaedic community enjoys. Massive technology infrastructure was required to record, process, and schedule the entire Global part of WIROC Global. The team of Ashok Shyam and Neeraj Bijlani executed this. This was a massive task of organising recordings with each society and coordinating with a vast list of faculty. A lot of faculty send pre-recorded videos which were to be stitched together to make a comprehensive program. The shape of the program looked terrific and diverse. Speakers and viewpoints from Africa, the middle east, Europe, Asia, North America, Canada, Latin America, and Australia presented various views on seemingly similar topics. This was another revelation of how differently we deal with our problems depending on the resources and infrastructure.

One of the essential highlights of WIROC GLOBAL is the Live Surgery Platter which was entirely Dr. Vishal Kundnani’s brainchild. Again it required tremendous technology support, and the audiovisual expertise of Mr Anand Peter came into play in the area. Five centres of ex cellence offered their help in conducting the Live Surgeries and stirred the entire nation’s excitement. Meet the master program was conceptualised to present the best surgeons with the best surgical techniques. More than 60 surgeons responded to our call, glad to share and demonstrate their expertise. The physical days of WIROC GLOBAL are start studded with Plenary sessions, Orations, CME, and fantastic research presentations. All these fulfilled the traditional WIROC Element, which is graded as one of the highest levels of academics in the country. The hospitality of VAMA Events with Mr Vikram Patwardhan’s team and designing of the Event structure by Mr Rajesh Menon adds immensely to the delegate’s experience and the meeting’s success.

We had some fantastic facades at the venue, with a Walk of Fame including all past president secretaries and EC of BOS. The façade included the participating societies too, and highlights of WIROC Global. One of the unique features of the WIROC Global program was the inclusion of free research papers in the scientific sessions. Rather than cornered into empty halls, the young researchers could present their papers to a panel of experts in related fields.

WIROC Global has extended its invitation to all academic bodies worldwide and provided free access to the global program for all its members. More than 70,000 surgeons visited the platform in the next three months and took advantage of the academic deliberation. With this huge responsibility, the WIROC GLOBAL Virtual platform was made to be one of the best in the world with every conceivable feature on it. It is made to specification from the WIROC Tech team and aims to make it user-friendly and to take such massive traffic.

We also have the feature of ‘WIROC-on-Demand’ where visitors can view the WIROC Physical event, Live Surgery platter, and Meet the Master Session on payment. This was helpful for anyone wishing to attend WIROC but could not participate and for members of other societies who want to see the entire conference virtually.

WIROC FOREVER is the Last stage of WIROC Global which is envisioned to give back to the orthopaedic community in a huge way. We are still working out the details, but WIROC FOREVER will be initiated in the first month of 2023, and we plan to open the entire WIROC Content for everyone to watch and enrich themselves.

In short, WIROC GLOBAL has been a global phenomenon with huge academic repercussions. We learned that there is a great sense of partnership and wish to collabor ate among orthopaedic surgeons, societies, and the entire community. And also, as we saw the diverse application of principles, we realised that there is a huge need to learn from each other. WIROC GLOBAL is the beginning of a more collaborative Future, and we hope and wish we can organise more such events in the future too.

We received a tremendous response from the industry that helped and supported us in manifesting this Mega Event. On WIROC Global’s behalf, we made certificates and handed them over to every stall during WIROC. This marked our deep gratitude and appreciation for each and every participating industry Lastly, we would like to thank the entire BOS Executive Council for helping immensely in every aspect of this GLOBAL meeting. We want to thank all the scientific and organising committee members for supporting us and creating this resource for the orthopaedic community. Ultimately, we would like to thank our 1100 delegates and more than 300 faculty whoparticipated wholeheartedly in making WIROC GLOBAL a tremendous success.


Dr. Sangeet Gawhale
Organising Chairman WIROC GLOBAL

Dr. Vishal Kundnani
Organising Secretary WIROC GLOBAL

Dr. Ashok Shyam
Organising Secretary WIROC GLOBAL.

How to Cite this article: Gawhale S, Kundnani V, Shyam A. WIROC GLOBAL: A Mega-Event. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):06-07.


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Children are not young adults

Journal of Clinical Orthopaedics | Vol 7 | Issue 2 |  Jul-Dec 2022 | page: 08 | Dr. Swapnil M Keny

DOI: 10.13107/jcorth.2022.v07i02.509

Author: Dr. Swapnil M Keny [1]

[1] MS, FCPS, D’Ortho, Sir H. N. Reliance Hospital, Mumbai, India.

Address of Correspondence
Dr. Swapnil M Keny,
MS, FCPS, D’Ortho, Sir H. N. Reliance Hospital, Mumbai, India.
E-mail: peadortho@gmail.com

“Children are not young adults”

The growing skeleton and the manifestations of its anomalies , poses peculiar sets of challenges for health workers treating children with orthopaedic disorders. This is especially true when such children and adolescents are seen and treated in the office of orthopaedic surgeons.

In India and across the subcontinent, certain taboos, customs and tradition are further hinderances for providing appropriate and timely treatment in children.

Children and their parents are extremely apprehensive when they visit the clinics of physicians. The first job of a physician then is to put the child and parents at ease. The Clinic decor, the demeanour of the medical and nursing staff and a friendly environment puts the child at ease and helps perform a thorough examination or procedures if need be.

It is preferable that the child be lured with a some form of a distraction like music, toys or even child friendly edibles so that a thorough clinical examination may be performed or a out patient procedure can be done.

The radiographs of children may appear different from that of adults. One needs to aware of the ossification process during the attainment of skeletal maturity so that a physiological change is not interpreted as pathology and vice versa.

Applying a cast in a child can turn our to be a Herculean task at times. It is extremely important that every member of the clinic team performs their jobs optimally, whether it be restraining, distracting the child or helping the physician with the procedure.

Certain disorders and deformities are peculiar to children. Diagnosing these deformities with a relevant investigation, keeping a diligent follow up and managing them timely are key determinants to successful treatment.

Children come in all shapes and sizes. Also no two children of the same age are alike. One needs to modulate the methods of examination and treatment so that a tailored regime for a specific child may be designed.

Finally, children with neurological, neuromuscular and muscular disorders have their own sets of challenges. Managing them on out patient basis needs patience and perseverance which can only come with experience.

To summarise, children are not young adults. The peculiarities of disorders in the immature skeleton need to be understood, diagnosed, treated and rehabilitated optimally.

Dr. Swapnil M Keny.

How to Cite this article: Keny S. “Children are not young adults”. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):08.


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Toe Walking in Children

Journal of Clinical Orthopaedics | Vol 7 | Issue 2 |  Jul-Dec 2022 | page: 09-11 | Atul Bhaskar

DOI: 10.13107/jcorth.2022.v07i02.511

Author: Dr. Atul Bhaskar [1]

[1] Paediatric Orthopaedic Surgeon, Holy Spirit Hospital, Dr RN Cooper Hospital & HBT Medical College, Mumbai,

Address of Correspondence
Dr. Atul Bhaskar,
Paediatric Orthopaedic Surgeon, Holy Spirit Hospital, Dr RN Cooper Hospital & HBT Medical College, Mumbai,
E-mail: arb_25@yahoo.com


Toe walking pattern of gait is often seen in toddlers and can persist into early childhood. A detailed assessment is warranted in children that presents after 5 years of age with persistent TW. Treatment varies from simple reassurance and physiotherapy to orthotics, casting and sometimes surgery. Prognosis of surgery is good in select cases.

Keywords: Toe Walking, Idiopathic, Neurology, Treatment


  1. Sala DA, Shulman LH, Kennedy RF, Grant AD, Chu M. Idiopathic toe-walking: Areview. Dev Med Child Neurol
  2. van Kuijk AA, Kosters R, Vugts M, Geurts AC. Treatment for idiopathic toe walking: A systematic. review of the literature. J Rehabil Med 2014;46:945-57.
  3. Engström P, Tedroff K. The prevalence and course of idiopathic toe-walking in 5-year-old children. Pediatrics 2012;130:279-84.


How to Cite this article: Bhaskar A. Toe Walking in Children. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):09-11.

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Managing a Pulled Elbow in the Clinic

Journal of Clinical Orthopaedics | Vol 7 | Issue 2 |  Jul-Dec 2022 | page: 12-14 | Shalin Shah, Mandar Agashe

DOI: 10.13107/jcorth.2022.v07i02.513

Author: Shalin Shah [1], Mandar Agashe [2]

[1] Department of Paediatric Orthopaedics, BJ Wadia Hospital, Mumbai, Maharashtra, India,
[2] Consultant Paediatric Orthopaedic Surgeon, Agashe Hospital, BJ Wadia Hospital and SRCC Children’s Hospital,
Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Raja Ganesh Rayudu,
Dr. D. Y. Patil University-School of Medicine, Navi Mumbai, Maharashtra, India.
E-mail: rajaganesh70@gmail.com


Pulled elbow is one of the commonest clinical conditions encountered by the Paediatric orthopaedic surgeon. It is primarily due to axial force applied to a semi-prone forearm which leads to proximal radio-ulnar joint dislocation. Diagnosis is usually clinical and radiographs are rarely needed. Reduction maneuvers include the Traction-supination and traction-hyperpronation method and almost always cause immediate pain relief and return to function.

Keywords: Pulled elbow, Proximal radioulnar joint dislocation, Supination maneuver, Hyper-pronation maneuver.


  1. Hanes L, McLaughlin R, Ornstein AE. Suspected radial head subluxation in infants: The Need for radiologic evaluation. Pediatr Emerg Care 2021;37:e58-9.
  2. Krul M, van der Wouden JC, Kruithof EJ, van Suijlekom-Smit LW, Koes BW. Manipulative interventions for reducing pulled elbow in young children. Cochrane Database SystRev 2017;7:CD007759.
  3. Guzel M, Salt O, Demir MT, Akdemir HU, Durukan P, Yalcin A. Comparison of hyperpronation and supination-flexion techniques in children presented to emergency department with painful pronation. Niger J Clin Pract 2014;17:201-4.
  4. Schunk JF. Radial head subluxation: Epidemiology and treatment of 87 episodes. Ann Emerg Med 1990;19:1019-23.
  5. Teach SJ, Schutzman SA. Prospective study of recurrent radial head subluxation. Arch Pediatr Adolesc Med 1996;150:164-6.
  6. Quan L, Marcuse EK. The epidemiology and treatment of radial head subluxation. Am J Dis Child 1985;139:1194-7.
  7. Kosuwon WE, Mahaisavariya BA, Saengnipanthkul SU, Laupattarakasem WI, Jirawipoolwon PO. Ultrasonography of pulled elbow. J Bone Joint Surg 1993;75:421-2.
  8. Pring M, Wenger D, Rang M. Elbow-proximal radius and ulna. In: Rang M, Wenger DR, Pring ME, editors. Rang’s Children’s Fractures. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. p. 119.


How to Cite this article: Shah S, Agashe M. Managing a Pulled Elbow in the Clinic. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):12-14.

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The magic of moulding – Applying upper limb cast in a child

Journal of Clinical Orthopaedics | Vol 7 | Issue 2 |  Jul-Dec 2022 | page: 15-17 | Chintan Doshi

DOI: 10.13107/jcorth.2022.v07i02.515

Author: Chintan Doshi [1]

[1] Consultant Orthopedic Surgeon, Department of Orthopedics, Seth V.C. Gandhi & M. A Vora Municipal General
Rajawadi Hospital, Mumbai, India.

Address of Correspondence
Dr. Chintan Doshi,

1304, Building No 92, B wing, Road No 13, Tilaknagar, Chembur West, Mumbai 400089, India.
E-mail: drchintandoshi@gmail.com


Upper limb fractures are common in pediatric population. Most of these injuries need application of cast as a routine procedure. The purpose of this review is to discuss the art of applying a well moulded upper limb cast in children in order to get excellent outcome. Material to be selected for cast application depends on the fracture configuration, requirement for moulding, and other physical properties of the cast required for particular patient. A well –moulded cast should be applied in order to prevent further fracture displacement. It is important to understand and maintain certain radiographic indices in order to ensure a good outcome from casting technique. Preventing cast related complications like wet cast, skin complication, compartment syndrome, thermal injuries, and cast syndrome are important consideration when taking care of the cast. Patient education is one of the most important factor in ensuring proper cast maintenance.

Keywords: Pediatric fractures, Upperlimb cast, Casting, Cast technique, Cast complication


1. Halanski M, Noonan KJ. Cast and splint immobilization: complications. J Am Acad Orthop Surg. 2008;16:30–40.
2. Iltar S, Alemdaroğlu KB, Say F, Aydoğan NH. The value of the three-point index in predicting redisplacement of diaphyseal fractures of the forearm in children. Bone Joint J. 2013;95-B:563–567. .
3. Wolff CR, James P. The prevention of skin excoriation under children’s hip spica casts using the goretex pantaloon. J Pediatr Orthop. 1995;15:386–388.
4. Webb GR, Galpin RD, Armstrong DG. Comparison of short and long arm plaster casts for displaced fractures in the distal third of the forearm in children. J Bone Joint Surg Am. 2006;88:9–17.
5. Chess DG, Hyndman JC, Leahey JL, Brown DC, Sinclair AM. Short arm plaster cast for distal pediatric forearm fractures. J Pediatr Orthop. 1994;14:211–213.
6. Bhatia M, Housden PH. Redisplacement of paediatric forearm fractures: Role of plaster moulding and padding. Injury. 2006 Mar 1;37(3):259-68.
7. Malviya A, Tsintzas D, Mahawar K, Bache CE, Glithero PR. Gap index: a good predictor of failure of plaster cast in distal third radius fractures. Journal of Pediatric Orthopaedics B. 2007 Jan 1;16(1):48-52.
8. Edmonds EW, Capelo RM, Stearns P, Bastrom TP, Wallace CD, Newton PO. Predicting initial treatment failure of
fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal-radius angle. J Child Orthop. 2009;3:375–381.


How to Cite this article: Doshi C. The magic of moulding – Applying upper limb cast in a child. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):15-17.

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“Severs Disease” – Manifestations and Management

Journal of Clinical Orthopaedics | Vol 7 | Issue 2 |  Jul-Dec 2022 | page: 18-21 | Khyati Gupta [1], Avi Shah [2]

DOI: 10.13107/jcorth.2022.v07i02.517

Author: Khyati Gupta [1], Avi Shah [2]

[1] Fellow in Paediatric Orthopaedics, NH SRCC Children’s Hospital, Mumbai, Maharashtra, India.
[2] Consultant Paediatric Orthopaedics, NH SRCC Children’s Hospital, Mumbai, Maharashtra, India..

Address of Correspondence
Dr. Avi Shah,
Consultant Paediatric Orthopaedics, NH SRCC Children’s Hospital, Mumbai, Maharashtra, India.
E-mail: dravi.paedortho@gmail


Calcaneal apophysitis (Sever’s Disease) is a common cause of heel pain in growing children. It’s true incidence and etiology in unknown but, recent evidence supports overuse injury as an underlying etiology. It can present as either unilateral or bilateral heel pain in active growing children or adolescents who had a history of new-onset sports activity. Diagnosis mainly relies on a thorough clinical examination with a positive squeeze test being confirmatory. Radiologic imaging may be unnecessary but can help rule out or avoid missing other problematic conditions. Treatment options are mainly conservative and include rest, medications, therapy, or orthosis. Educating parents and coaches is pivotal for the prevention of these self-limiting conditions in young athletes. Evidence suggests a return to sports in most in a few weeks to months after appropriate care.

Keywords: Sever disease, heel pain, calcaneal apophysitis, overuse injury


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How to Cite this article: Gupta K, Shah A. “Severs Disease” – Manifestations and Management. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):18-21.

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In Toeing and Out Toeing in Children

Journal of Clinical Orthopaedics | Vol 7 | Issue 2 |  Jul-Dec 2022 | page: 22-26 | Prajakta Bhide [1], Sandeep V Vaidya [1,2]

DOI: 10.13107/jcorth.2022.v07i02.519

Author: Prajakta Bhide [1], Sandeep V Vaidya [1,2]

[1] Department of Orthopaedics, Pinnacle Orthocentre Hospital, Thane, Maharashtra, India,
[2] Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Sandeep V Vaidya,
Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
E-mail: drsvvaidya@gmail.com


Intoed and out-toed gait in children can occur due to foot deformities or torsional alignment of the femur and/or tibia. In most cases, these deformities are physiological and resolve with age. Physical examination consists of assessment of rotational profile of the lower limb which includes foot progression angle, torsional alignment of the femur and tibia, and foot shape. Few cases may be due to underlying pathological conditions which need to be identified and treated.

Keywords: in-toeing, out- toeing, torsional profile


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How to Cite this article: Bhide P, Vaidya SV. In Toeing and Out Toeing in Children. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):22-26.

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