A 7-year-old boy with Moebius syndrome and limited ambulation presented for orthopaedic evaluation. He primarily used a stander and occasionally a gait trainer, with no complaints of pain. On examination, he had poor head control but normal muscle tone. Passive joint movements were full in the upper and lower extremities, except for restricted left hip abduction. Radiographs revealed left acetabular dysplasia and bilateral hip subluxation with Reimer’s migration index of 65% on the left and 50% on the right.
Based on these findings, the child underwent left-sided adductor lengthening, bilateral proximal femoral varus derotational osteotomies, and internal fixation with PediLoc Locking Cannulated Infant Blade Plates (90°, 35 mm × 6 mm × 3-hole) along with a left-sided Dega osteotomy. He was immobilised in a Petrie cast postoperatively. At 3 weeks, he developed a minor pressure sore on the left ankle, but was afebrile with pain managed by NSAIDs. Radiographs showed stable hips and intact implants. However, five days later, the child presented with complaints of a loose, slippage-prone cast. Pelvic radiographs showed bilateral failure of the proximal femoral locking plates just distal to the locking screws, along with a loss of reduction at the proximal femoral osteotomy site.