Complications in orthopedic management of exstrophy

The objective of this study was to examine the complications associated with the orthopedic management of bladder exstrophy. The records of all patients seen for bladder exstrophy repair at the authors' institution between 1988 and 2002 were examined. Orthopedic complications were found to have occurred in 26 of 624 patients, yielding a complication rate of 4%. The observed complications were divided into five categories: bony complications at the osteotomy site, neurologic complications at the osteotomy site, complications of traction, deep infection, and late infections of the plate. Five of the 26 (19.2%) complications were bony and involved nonunion, delayed union, joint pain, or leg length inequality stemming from the osteotomy. Thirteen of the 26 (50%) were neurologic complications. Four of the 26 (15.4%) resulted from traction. All were due to tight dressing around the legs following surgery. Two of the 26 (7.7%) were early deep infection and of the 26 (7.7%) were late infections. This study highlights many of the complications associated with the management of exstrophy and provides suggestions on how to minimize them.