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Bilateral transverse iliac osteotomy in the correction of neonatal bladder extrophies
1Department of Paediatric Surgery, Faculty of Medicine, Ankara University Hospital, Turkey.
Insights
This study explored treating bladder exstrophy (BX) and congenital hip dislocation (CHD) in neonates using bilateral transverse iliac osteotomy. The combined approach showed promising results with a low failure rate, simplifying pelvic reconstruction.
Area of Science:
- Pediatric Surgery
- Orthopedic Surgery
- Neonatal Care
Background:
- Bladder exstrophy (BX) often involves pelvic skeletal abnormalities, including pubic bone separation and acetabular rotation.
- These abnormalities predispose neonates to bilateral congenital hip dislocation (CHD).
- Current treatments for BX and associated CHD can be complex, often requiring staged procedures.
Purpose of the Study:
- To evaluate the efficacy of a combined bilateral innominate osteotomy and bladder reconstruction in neonates with bladder exstrophy (BX).
- To assess the incidence of failure due to congenital hip dislocation (CHD) and BX following this combined surgical approach.
- To determine the feasibility of using bilateral transverse iliac osteotomy in the neonatal period for pelvic reconstruction.
Main Methods:
- A clinical and radiological study involving seven neonates with bladder exstrophy (BX).
- Treatment included a combined bilateral innominate osteotomy and reconstruction of the urinary bladder.
- Bilateral transverse iliac osteotomy was utilized, chosen over conventional two-stage posterior iliac vertical osteotomies for its simplicity and supine patient positioning.
Main Results:
- The combined surgical approach demonstrated a low failure rate: two failures due to congenital hip dislocation (CHD) and three due to bladder exstrophy (BX).
- Failures were successfully managed in later sessions.
- Bilateral transverse iliac osteotomy proved to be an easily performed procedure in the neonatal period when combined with pelvic reconstructive surgery.
Conclusions:
- Combined bilateral innominate osteotomy and bladder reconstruction is a viable treatment for neonates with bladder exstrophy (BX) and associated hip abnormalities.
- Bilateral transverse iliac osteotomy offers a simpler and more accessible alternative for pelvic reconstruction in neonates compared to traditional methods.
- This approach effectively addresses the early predisposition to bilateral congenital hip dislocation (CHD) in neonates with BX.
Abstract:
In a clinical and radiological study of seven neonates with bladder extrophy (BX), separation of pubic bones from the midline, lateral and caudal tilting of the iliac alae and external rotation of the acetabula, with consequent early predisposition to bilateral congenital hip dislocation (CHD), who were treated by a combined bilateral innominate osteotomy and reconstruction of the urinary bladder, there were only two failures due to CHD and three due to BX, which were dealt with at a later session. Although the bilateral transverse iliac osteotomy procedure is very rarely, if ever, employed in the neonatal period, it may well be combined with the reconstructive surgical procedures that involve pelvic skeletal structures while dealing with soft tissue procedures. Bilateral transverse iliac osteotomy was preferred to the conventional two-stage posterior iliac vertical osteotomies because of its easiness and the simple approach provided by the supine positioning of the patient.
