We describe a little-known variety of hip dysplasia, termed 'acetabular retroversion', in which the alignment of the mouth of the acetabulum does not face the normal anterolateral direction, but inclines more posterolaterally. The condition may be part of a complex dysplasia or a single entity. Other than its retroversion, the acetabulum is sited normally on the side wall of the pelvis, and its articular surface is of normal extent and configuration. The retroverted orientation may give rise to problems of impingement between the femoral neck and anterior acetabular edge. We define the clinical and radiological parameters and discuss pathological changes which may occur in the untreated condition. A technique of management is proposed.

W e describe a little-known variety of hip dysplasia, termed 'acetabular retroversion', in which the alignment of the mouth of the acetabulum does not face the normal anterolateral direction, but inclines more posterolaterally.The condition may be part of a complex dysplasia or a single entity. Other than its retroversion, the acetabulum is sited normally on the side wall of the pelvis, and its articular surface is of normal extent and configuration. The retroverted orientation may give rise to problems of impingement between the femoral neck and anterior acetabular edge.We define the clinical and radiological parameters and discuss pathological changes which may occur in the untreated condition. A technique of management is proposed.

OBJECTIVE.Jumper's knee, or chronic patellar tendinitis, can be a source of considerable pain in athletes.

Study Design: Single-center prospective cohort. Objectives: To evaluate a multidisciplinary led, structured protocol for reducing surgical site infections (SSIs) in pediatric scoliosis surgery. Methods: Following a spike to 8.6% in local annual infection rate, a multidisciplinary team was convened to identify interventions. The team consisted of spinal surgeons, infectious diseases consultants, physiotherapists, specialist nurses, and theatre managers. A protocol was initiated, including preoperative skin decontamination; standardized operative site prepreparation; betadine-soaked swabs sutured to wound edges; blood loss minimization; 3 L0.9% saline pulsed-lavage; defined protocol of glove changes; antibiotic regime of preoperative gentamicin, intraoperative subfascial vancomycin powder, 48-hour cefuroxime; and intraoperative normothermia. A 4-year audit was initiated of all patients aged ≤18 years undergoing corrective spinal deformity surgery. Institutional board review was not required. Results: Between January 1, 2014 and January 1, 2018, 414 operations were performed on 355 patients: male:female = 1:2.2, mean age 13.7 years (range 2.5-17.9), 233 idiopathic (mean operated vertebral levels 12), 122 neuromuscular (mean operated vertebral levels 14), 66 growing rod procedures, 41 multistage procedures. The mean number of operated vertebral levels both overall and in infected cases was 13 (range 2-17). Nine SSIs occurred in 8 patients at 3 months (4 neuromuscular), resulting in an overall SSI per operation of 2.2%. Conclusion: A multidisciplinary approach with standardized measures significantly reduced SSIs in the unit’s pediatric scoliosis surgery.

Morphea is an inflammatory disorder that produces sclerosis of the skin and subcutaneous tissues. Disease activity (inflammation) is difficult to determine when pathology extends into the subcutaneous fat. Because deep lesions produce the most devastating permanent sequelae including limb length discrepancy and joint contracture, the lack of measures to discern activity presents a substantial challenge to care of patients with deep morphea. The purpose of the present pilot study is to compare clinical assessment of deeper morphea lesions to magnetic resonance imaging (MRI). Participants were recruited from the Morphea in Adults and Children Cohort at UT Southwestern Medical Center in Dallas, TX. Imaging using MRI with a dedicated musculoskeletal protocol was performed on 19 participants with lesions suspicious for deep morphea. The extent of lesions was marked based on clinical examination to determine whether pathology extended beyond the clinical border of the lesion. The majority were Caucasian (68%), female, (74%), and had linear morphea (68%). Seventeen had imaging of an extremity, while two had maxillofacial imaging. Twelve had clinically apparent active disease and seven had no evidence of active disease on clinical examination. On imaging, 90% of participants had evidence of active disease as indicated by subcutaneous edema and fat stranding. All had involvement of the superficial fascia, six had involvement of deep fascia, and two had muscle involvement. On imaging, the lesions on the extremities extended beyond clinical margin by an average of 6.3 cm, highlighting that deep morphea lesions can have very subtle clinical extension. Results of this pilot study examining MRI findings in morphea reveal that lesions clinically suspicious for subcutaneous involvement frequently extend beyond clinical margins in breadth and depth. In addition, MRI demonstrated occult activity in clinically quiescent lesions. This underscores the need for further study to define indications for MRI in morphea and optimize imaging protocols. 629Registered clinical trials in epidermolysis bullosa: An update H Rishel Rishel Pediatric Dermatology, San Francisco, California, United States ClinicalTrials.gov is a resource which can provide insight in to Epidermolysis bullosa (EB) bench-to-bedside advancements. Measurements of quantity, study status, study type (interventional vs observational), study phase, child enrollment, enrollment category and funding type were acquired and analyzed on September 2017 and again on December 2018. In 2017, sixty-one clinical trials were registered with regards to EB, of which 59 focused on genetic EB and 4 studies reported being withdrawn. Of those 55 studies, eleven were observational and 44 were labeled as interventional / clinical trials. Newly registered trials represent 29% of those listed in 2017, as 16 of 55 studies were registered in 2016-17, and with seven of these new 16 trials in the drug repurposing & novel treatments category. Of note, 49 of 55 studies included enrollment of children (b...