Bladder exstrophy is a severe congenital anomaly involving failed midline fusion of the infraumbilical abdominal wall. Which associated musculoskeletal deformity is universally present and requires orthopaedic correction at the time of bladder closure?

• A Hip dislocation requiring open reduction
• B Bilateral talipes equinovarus
• C Congenital kyphoscoliosis
• D Diastasis pubis with external rotation of the iliac wings, corrected by pelvic osteotomy ✓

Explanation

Bladder exstrophy invariably includes diastasis (separation) of the pubic symphysis with external rotation of the innominate bones, resulting in a wide-based waddling gait and anteriorly rotated acetabuli. Bilateral iliac osteotomies (posterior and sometimes anterior) are performed concurrently with bladder closure to allow the pubic bones to be approximated in the midline, which facilitates tension-free abdominal wall closure and improves long-term continence outcomes. Hip dislocation and talipes are not characteristic of exstrophy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.