Pelvis & HipBilateral horizontal salter osteotomies with anterior symphyseal closure using a nylon tape in the treatment of exstrophy of the bladderAly, Ahmad S. Author Information Department of Orthopedic Surgery, Ain Shams University, Cairo, Egypt Correspondence to Ahmad S. Aly, MD, Department of Orthopedic Surgery, Ain Shams University, 102 Marghany Street, Heliopolis, Cairo 11311, Egypt Tel: + 20 100 122 8514; fax: + 20 24 039 036; e-mails: [email protected], [email protected] Journal of Pediatric Orthopaedics B 29(3):p 209-213, May 2020. | DOI: 10.1097/BPB.0000000000000631 Buy Metrics Abstract The aim of this case series study is to describe the orthopedic management of bladder exstrophy and to report on the intermediate-term outcomes following bilateral horizontal Salter osteotomies with anterior symphyseal closure using a nylon tape. This retrospective study included seven patients (five boys and two girls) who underwent bilateral horizontal osteotomies after reconstruction of the urogenital deformity using the Cantwell–Ransley technique and symphyseal closure by nylon tape number 2–5. the age range was between 7 months and 8 years (median age = 17 months). Three patients had recurrent bladder exstrophy after they underwent “ramotomy” early in their life, whereas four were operated primarily. All patients were followed up over 2 years, with a mean follow-up duration of 3.27 years (2–5 years). Petrie cast was applied, with both legs abducted and internally rotated till bony union had been achieved. This allowed free handling of the wounds and catheters. Removal of k-wires was performed in an outpatient clinic after the complete union of bony osteotomies had been achieved (6–8 weeks). Satisfactory bladder closure was achieved in all patients. None of the patients had a bone infection or nonunion at the osteotomy sites. No postoperative wound dehiscence has occurred for up to 5 years. The foot progression angle improved from 37°–70° (median = 45°) preoperatively to 0°–15° (median = 5°) postoperatively. Symphyseal diastasis was closed well in all of our patients in postoperative plain radiography compared with 5.8–11 cm (median = 8.2 cm) diastasis preoperatively. One patient had a superficial wound infection. Another patient had a sutured bladder neck by a nylon tape during the symphyseal closure. Bilateral horizontal Salter osteotomies with anterior symphyseal closure using nylon tape are safe and effective in the management of bladder exstrophy, especially in older children and in extreme diastasis (> 6 cm); with improvement in the gait as it corrects the acetabular external rotation. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.