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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

Windswept hips in a 7-year-old boy with a neuromuscular disease. A left hip abduction contracture and right hip adduction contracture were released and combined with bilateral VDROs using 40 mm, 90° child plates. Both hips are contained and the pelvis has been levelled. This is the simplest type of osteotomy because the guide wire, chisel and blade plate are placed centrally in the proximal metaphysis
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Fig4: Windswept hips in a 7-year-old boy with a neuromuscular disease. A left hip abduction contracture and right hip adduction contracture were released and combined with bilateral VDROs using 40 mm, 90° child plates. Both hips are contained and the pelvis has been levelled. This is the simplest type of osteotomy because the guide wire, chisel and blade plate are placed centrally in the proximal metaphysis

Mentions: Seventeen children had cerebral palsy, two had other neuromuscular diseases, two had DDH, two had metabolic disease and two had Perthes’ disease. Five ambulant children with CP had bilateral external rotation PFOs to improve gait, 15 children with CP/other neuromuscular and metabolic disorders had bilateral varus derotation osteotomies (VDROs) for hip subluxation, two girls with DDH had unilateral VDROs, one boy with Perthes’ disease had unilateral VDRO for containment and another boy with Perthes’ disease had valgus osteotomy for coxa vara. One child with a metabolic disorder had fixation of an insufficiency fracture. In the CP/neuromuscular group who had bilateral VDROs for hip subluxation (Fig. 3), the mean MP pre-operatively was 48 % (SD 24 %) and post-operatively was 11 % (SD 13 %) The mean NSA was 155° (SD 9.6°) and the mean post-operative NSA was 112° (SD 9°). These changes were significant at P < 0.001. The ambulant CP group had satisfactory correction of internal rotation gait clinically, which was confirmed on gait analysis in the first two patients who have had follow-up gait analysis (Figs. 4, 5).Fig. 3


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)

Windswept hips in a 7-year-old boy with a neuromuscular disease. A left hip abduction contracture and right hip adduction contracture were released and combined with bilateral VDROs using 40 mm, 90° child plates. Both hips are contained and the pelvis has been levelled. This is the simplest type of osteotomy because the guide wire, chisel and blade plate are placed centrally in the proximal metaphysis
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Windswept hips in a 7-year-old boy with a neuromuscular disease. A left hip abduction contracture and right hip adduction contracture were released and combined with bilateral VDROs using 40 mm, 90° child plates. Both hips are contained and the pelvis has been levelled. This is the simplest type of osteotomy because the guide wire, chisel and blade plate are placed centrally in the proximal metaphysis
Mentions: Seventeen children had cerebral palsy, two had other neuromuscular diseases, two had DDH, two had metabolic disease and two had Perthes’ disease. Five ambulant children with CP had bilateral external rotation PFOs to improve gait, 15 children with CP/other neuromuscular and metabolic disorders had bilateral varus derotation osteotomies (VDROs) for hip subluxation, two girls with DDH had unilateral VDROs, one boy with Perthes’ disease had unilateral VDRO for containment and another boy with Perthes’ disease had valgus osteotomy for coxa vara. One child with a metabolic disorder had fixation of an insufficiency fracture. In the CP/neuromuscular group who had bilateral VDROs for hip subluxation (Fig. 3), the mean MP pre-operatively was 48 % (SD 24 %) and post-operatively was 11 % (SD 13 %) The mean NSA was 155° (SD 9.6°) and the mean post-operative NSA was 112° (SD 9°). These changes were significant at P < 0.001. The ambulant CP group had satisfactory correction of internal rotation gait clinically, which was confirmed on gait analysis in the first two patients who have had follow-up gait analysis (Figs. 4, 5).Fig. 3

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