Posterior Hip Subluxation in

Bladder Exstrophy

Dr. Anwar
Dr. M Asif Peracha
• 7 years old female patient, known case of Congenital Bladder
Exstrophy (CBE).

• Presented to us with complaints of left lower limb deformity

and difficulty in walking for last 10 months.
 Birth History

• According to the child's mother, the child was born full term
with exstrophy of the bladder and ambiguous genitalia.
 Past Surgical History

• Bladder augmentation + bladder neck reconstruction +

B/L pubic osteotomies – 2015 (No record is available)

• Cystoscopy + Genitoplasty + oct 2021

• According to the parents, they noticed that child had left lower
limb deformity and difficulty in walking after the cystoscopy
procedure.

• No specific treatment was done during the past 10 months.

• Orthopaedic opinion was sought as referral when she was

admitted for some urological procedure.
 Examination

• Unable to walk.

• There was previous scar marks in pubic region.

• Left lower was short, internally rotated and adducted.

• No peripheral neurovascular deficit

• Shortening; ?
Age: 7 years
• Diagnosis: Posterior Subluxation of Hip Joint

• We planned for open or closed reduction of hip

 Examination Under Anaesthesia

• Hip easily reduced

• Stable in external rotation but it dislocated in internal rotation

• :
 Planning
• For this posterior instability, we planned pelvic osteotomy to
achieve internal rotation of acetabulum.
• Approach: ?
• adductor tenotomy ?
• Osteotomy type ?
Post op Xrays
Current xrays
Clinical video
Thank you