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Cannulated, locking blade plates for proximal femoral osteotomy in children and adolescents.

Zhou L, Camp M, Gahukamble A, Khot A, Graham HK - J Child Orthop (2015)

Bottom Line: Given that it may be required across a wide range of ages and indications, appropriate instrumentation is necessary to ensure a technically satisfactory result.The principal outcome measures were the radiographic position of the osteotomy at the time of union and surgical adverse events.Further comparative studies will be required to determine whether it offers additional advantages over more traditional systems.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics, The University of Melbourne, Carlton, VIC, 3052, Australia.

ABSTRACT

Background: Proximal femoral osteotomy is the most common major reconstructive surgery in the region of the hip joint in children and adolescents. Given that it may be required across a wide range of ages and indications, appropriate instrumentation is necessary to ensure a technically satisfactory result. Recent developments in fixation include cannulation of the blade plate and locking screw technology.

Methods: We conducted a prospective audit of our first 25 patients who had a unilateral or bilateral proximal femoral osteotomy using a recently available system which combines cannulation and locking plate technology. The principal outcome measures were the radiographic position of the osteotomy at the time of union and surgical adverse events.

Results: Forty-five proximal femoral osteotomies were performed in 25 patients, mean age 8 years (range 3-17 years), for a variety of indications, the most common of which was hip subluxation in children with cerebral palsy. All osteotomies were soundly united by 6 weeks in children and by 3 months in adolescents, in the position achieved intra-operatively. There were no revision procedures and the technical goals of surgery were achieved in all patients. There was one adverse event, a low-grade peri-prosthetic infection, diagnosed at the time of implant removal.

Conclusions: In this prospective audit of our first 25 patients, the new system performed well across a wide range of ages, body weights and surgical indications. Further comparative studies will be required to determine whether it offers additional advantages over more traditional systems.

No MeSH data available.


Related in: MedlinePlus

Cannulated locking blade plate fixation in a sawbone model of VDRO of the proximal femur. Note that the blade plate has been inserted over the guide wire. Two locking towers are in position, in the first screwhole (which is inserted into the proximal metaphysis) and the third screwhole (which is inserted into the diaphysis). The remaining screwholes, the second and fourth, are for non-locking screws and offer the opportunity for compression prior to the insertion of the locking screws
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Fig1: Cannulated locking blade plate fixation in a sawbone model of VDRO of the proximal femur. Note that the blade plate has been inserted over the guide wire. Two locking towers are in position, in the first screwhole (which is inserted into the proximal metaphysis) and the third screwhole (which is inserted into the diaphysis). The remaining screwholes, the second and fourth, are for non-locking screws and offer the opportunity for compression prior to the insertion of the locking screws

Mentions: The proximal femur was exposed subperiosteally with careful retraction of the vastus lateralis to preserve its nerve and blood supply. A suitable entry for the insertion of the guide wire was marked using a combination of analysis of the surgical goals, the likely implant to be used and the patient’s specific anatomy. For the most common procedure (varus derotation osteotomy in CP) the goal was a NSA of 100° and complete containment of the femoral head. The guide wire was inserted into the centre of the femoral neck on both AP and lateral radiographic projections and a 100° plate of the appropriate width and length was selected. Selection of the blade width was aided by passing a seating chisel over the guide wire and, in the flexed-abducted view, checking fluoroscopically that the chisel (and plate) would be able to cross the isthmus of the neck without risk of penetration or fracture. The appropriate seating chisel was used to cut a track for the selected blade plate; the seating chisel and blade plate were matched. Attention was given to cutting the track collinear with the guide wire to avoid inadvertent advancement or removal of the guide wire. The seating chisel was then backed out slightly but left in situ [12]. The appropriate osteotomy was then marked and performed using an oscillating saw with the appropriate spacing device to make sure that the cut was at an appropriate distance from the seating chisel. The first cut was made parallel to the seating chisel. Depending on the correction desired, the second cut was made on the distal fragment to improve the reduction of the osteotomy and coaptation of the fragments [18, 19]. If there was a significant medial offset, then a third cut was made on the lateral surface of the proximal fragment to recess the plate against the femur. This had the added advantages of increasing proximal stability and preventing implant prominence and soft tissue irritation. The osteotomy surfaces were coapted to check for the fit. The seating chisel was removed and the blade plate inserted over the guide wire. A reduction clamp was then used to finalise the position of the implant with respect to both parts of the proximal femur. Preliminary fixation was performed using a non-locking screw to achieve compression at the osteotomy site. Fixation was then completed using the requisite number of locking and non-locking screws (Fig. 1). The position of the implant was recorded in both AP and lateral fluoroscopic projections. The hip was put through a range of motion to ensure that fixation was stable. The fluoroscopic images were also scrutinised to determine whether the goals of surgery had been achieved: e.g., femoral head cover. The stability of fixation was assessed and this determined the need for hip spica casting, restricted weight-bearing or immediate mobilisation (Fig. 2). The guide wire was removed and, following irrigation, the incision was closed in layers. Routine post-operative care was provided with formal imaging of the osteotomy prior to discharge from hospital. Immediate range of motion, physiotherapy and full weight-bearing as tolerated was encouraged in all patients apart from one 3-year-old girl with DDH who had a revision open reduction and capsulorraphy.Fig. 1


Cannulated, locking blade plates for proximal femoral osteotomy in children and adolescents.

Zhou L, Camp M, Gahukamble A, Khot A, Graham HK - J Child Orthop (2015)

Cannulated locking blade plate fixation in a sawbone model of VDRO of the proximal femur. Note that the blade plate has been inserted over the guide wire. Two locking towers are in position, in the first screwhole (which is inserted into the proximal metaphysis) and the third screwhole (which is inserted into the diaphysis). The remaining screwholes, the second and fourth, are for non-locking screws and offer the opportunity for compression prior to the insertion of the locking screws
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4417733&req=5

Fig1: Cannulated locking blade plate fixation in a sawbone model of VDRO of the proximal femur. Note that the blade plate has been inserted over the guide wire. Two locking towers are in position, in the first screwhole (which is inserted into the proximal metaphysis) and the third screwhole (which is inserted into the diaphysis). The remaining screwholes, the second and fourth, are for non-locking screws and offer the opportunity for compression prior to the insertion of the locking screws
Mentions: The proximal femur was exposed subperiosteally with careful retraction of the vastus lateralis to preserve its nerve and blood supply. A suitable entry for the insertion of the guide wire was marked using a combination of analysis of the surgical goals, the likely implant to be used and the patient’s specific anatomy. For the most common procedure (varus derotation osteotomy in CP) the goal was a NSA of 100° and complete containment of the femoral head. The guide wire was inserted into the centre of the femoral neck on both AP and lateral radiographic projections and a 100° plate of the appropriate width and length was selected. Selection of the blade width was aided by passing a seating chisel over the guide wire and, in the flexed-abducted view, checking fluoroscopically that the chisel (and plate) would be able to cross the isthmus of the neck without risk of penetration or fracture. The appropriate seating chisel was used to cut a track for the selected blade plate; the seating chisel and blade plate were matched. Attention was given to cutting the track collinear with the guide wire to avoid inadvertent advancement or removal of the guide wire. The seating chisel was then backed out slightly but left in situ [12]. The appropriate osteotomy was then marked and performed using an oscillating saw with the appropriate spacing device to make sure that the cut was at an appropriate distance from the seating chisel. The first cut was made parallel to the seating chisel. Depending on the correction desired, the second cut was made on the distal fragment to improve the reduction of the osteotomy and coaptation of the fragments [18, 19]. If there was a significant medial offset, then a third cut was made on the lateral surface of the proximal fragment to recess the plate against the femur. This had the added advantages of increasing proximal stability and preventing implant prominence and soft tissue irritation. The osteotomy surfaces were coapted to check for the fit. The seating chisel was removed and the blade plate inserted over the guide wire. A reduction clamp was then used to finalise the position of the implant with respect to both parts of the proximal femur. Preliminary fixation was performed using a non-locking screw to achieve compression at the osteotomy site. Fixation was then completed using the requisite number of locking and non-locking screws (Fig. 1). The position of the implant was recorded in both AP and lateral fluoroscopic projections. The hip was put through a range of motion to ensure that fixation was stable. The fluoroscopic images were also scrutinised to determine whether the goals of surgery had been achieved: e.g., femoral head cover. The stability of fixation was assessed and this determined the need for hip spica casting, restricted weight-bearing or immediate mobilisation (Fig. 2). The guide wire was removed and, following irrigation, the incision was closed in layers. Routine post-operative care was provided with formal imaging of the osteotomy prior to discharge from hospital. Immediate range of motion, physiotherapy and full weight-bearing as tolerated was encouraged in all patients apart from one 3-year-old girl with DDH who had a revision open reduction and capsulorraphy.Fig. 1

Bottom Line: Given that it may be required across a wide range of ages and indications, appropriate instrumentation is necessary to ensure a technically satisfactory result.The principal outcome measures were the radiographic position of the osteotomy at the time of union and surgical adverse events.Further comparative studies will be required to determine whether it offers additional advantages over more traditional systems.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics, The University of Melbourne, Carlton, VIC, 3052, Australia.

ABSTRACT

Background: Proximal femoral osteotomy is the most common major reconstructive surgery in the region of the hip joint in children and adolescents. Given that it may be required across a wide range of ages and indications, appropriate instrumentation is necessary to ensure a technically satisfactory result. Recent developments in fixation include cannulation of the blade plate and locking screw technology.

Methods: We conducted a prospective audit of our first 25 patients who had a unilateral or bilateral proximal femoral osteotomy using a recently available system which combines cannulation and locking plate technology. The principal outcome measures were the radiographic position of the osteotomy at the time of union and surgical adverse events.

Results: Forty-five proximal femoral osteotomies were performed in 25 patients, mean age 8 years (range 3-17 years), for a variety of indications, the most common of which was hip subluxation in children with cerebral palsy. All osteotomies were soundly united by 6 weeks in children and by 3 months in adolescents, in the position achieved intra-operatively. There were no revision procedures and the technical goals of surgery were achieved in all patients. There was one adverse event, a low-grade peri-prosthetic infection, diagnosed at the time of implant removal.

Conclusions: In this prospective audit of our first 25 patients, the new system performed well across a wide range of ages, body weights and surgical indications. Further comparative studies will be required to determine whether it offers additional advantages over more traditional systems.

No MeSH data available.


Related in: MedlinePlus