ANTERIOR INNOMINATE OSTEOTOMY FOR CLOSURE OF NEGLECTED BLADDER EXSTROPHY: A REPORT OF TWO CASES AND A BRIEF REVIEW OF THE LITERATURE

Congenital malformations in bladder and cloacal exstrophy involve the genitourinary tract, musculoskeletal tissue, and occasionally the gastrointestinal tract. Pediatric orthopedists and urological surgeons need to have substantial knowledge in order to properly manage such cases. The foremost goal of orthopedic reconstruction is to reduce pelvic diastasis, which enables closure of the bladder and abdominal wall, while reducing tension. Here, we report two cases of a seven-year-old boy and a 12-year old boy who were referred to our pediatric surgery service with the diagnosis of bladder exstrophy. Preoperatively, the pubic diastasis of the two patients was 6 and 9 cm, respectively. Bilateral anterior innominate osteotomy with external fixator placement was executed by the pediatric urological surgical team following bladder closure. Both patients remained hospitalized for two weeks on bed rest. Skin traction was not applied. External fixators were applied for eight weeks. Immediately after surgery, the diastases were reduced to 4 cm in the 7-year-old patient and 6 cm in the 12-year-old patient. No postoperative complications occurred in either patient and both were able to walk with normal gaits. Slight external leg rotation was noted. Urological abnormalities were improved. Despite the technique, it is difficult to achieve perfect closure of the pelvic diastasis in this age group. Pelvic osteotomy remains the most beneficial intervention for corrective exstrophy closure. The bilateral anterior technique is recommended for this procedure and is applicable in neglected cases. Further follow-up is needed to evaluate the effectiveness of this technique.