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Proximal femoral osteotomy in children with cerebral palsy: the perspective of the trainee

View Article: PubMed Central - PubMed

ABSTRACT

Background: There are a range of implants for fixation of proximal femoral osteotomies (PFOs) in children. We investigated the training experiences and preferences of orthopaedic residents and fellows who were learning PFO, using a fixed angled blade plate (ABP) or a locking, cannulated blade plate (LCBP). We also studied short-term technical and radiographic outcomes.

Methods: This was a prospective, parallel-group, cohort study of 90 consecutive children and adolescents with cerebral palsy who underwent bilateral PFOs with ABP or LCBP. Surgical trainees completed a questionnaire to document the ease or difficulty of each operative step.

Results: There were 48 boys and 42 girls, with a mean age of eight years and a mean follow-up of 25 months. Trainees preferred the LCBP system for: insertion of the guidewire, the seating chisel and the blade plate, as well as overall technical ease of use (p < 0.001). Radiographic outcomes were similar with no between-group differences for migration percentage (p = 0.996) or neck shaft angle (p = 0.849), but there was a higher prevalence of technical errors in the ABP group.

Conclusions: Trainee surgeons expressed a preference for LCBPs when learning PFO in children with cerebral palsy. Radiographic outcomes were similar in both groups, with close attending surgeon supervision.

No MeSH data available.


Related in: MedlinePlus

At 18 months after bilateral varus derotation osteotomies (VDROs) with angled blade plate (ABP) fixation, the hips are well contained; some remodelling of both the femoral head and the acetabulae has occurred, and the lateral acetabular epiphysis has appeared on both sides. However, there was penetration of the calcar in the left hip with type 3 avascular necrosis (AVN) changes in the femoral head, the significance of which will not be apparent until long-term follow-up. Penetration of the calcar may be a risk factor for AVN.
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Figure 6: At 18 months after bilateral varus derotation osteotomies (VDROs) with angled blade plate (ABP) fixation, the hips are well contained; some remodelling of both the femoral head and the acetabulae has occurred, and the lateral acetabular epiphysis has appeared on both sides. However, there was penetration of the calcar in the left hip with type 3 avascular necrosis (AVN) changes in the femoral head, the significance of which will not be apparent until long-term follow-up. Penetration of the calcar may be a risk factor for AVN.

Mentions: Femoral derotation osteotomies (FDOs) for gait correction surgery were performed to correct internal hip rotation and intoed gait (Figs 2 to 4). The aim was to correct excessive femoral neck anteversion, by a single oblique osteotomy in the intertrochanteric region, to between 5° and 10°. Varus derotation osteotomies (VDROs) for hip displacement surgery were undertaken to correct excessive valgus and anteversion in the proximal femur, hip subluxation and to prevent dislocation (Figs 5 and 6). In some children, it was necessary to correct intoed gait and hip displacement simultaneously (Figs 3 and 4). The indications and techniques for both types of osteotomy have been previously described.18,19 The range of hip abduction was assessed before PFO and adductor lengthening was performed, following published protocols.12,18 Osteotomies were performed in children at GMFCS IV and V, in a supine position.18 Ambulant children had a full biomechanical assessment, including three-dimensional gait analysis and axial imaging prior to surgery, and underwent gait correction surgery in a prone position.18,19 The indication and techniques for the SEMLS procedures have been previously published.13,18 Intra-operative fluoroscopy was used in both groups and selected images were saved in PACS for subsequent analysis.Fig. 3


Proximal femoral osteotomy in children with cerebral palsy: the perspective of the trainee
At 18 months after bilateral varus derotation osteotomies (VDROs) with angled blade plate (ABP) fixation, the hips are well contained; some remodelling of both the femoral head and the acetabulae has occurred, and the lateral acetabular epiphysis has appeared on both sides. However, there was penetration of the calcar in the left hip with type 3 avascular necrosis (AVN) changes in the femoral head, the significance of which will not be apparent until long-term follow-up. Penetration of the calcar may be a risk factor for AVN.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5382338&req=5

Figure 6: At 18 months after bilateral varus derotation osteotomies (VDROs) with angled blade plate (ABP) fixation, the hips are well contained; some remodelling of both the femoral head and the acetabulae has occurred, and the lateral acetabular epiphysis has appeared on both sides. However, there was penetration of the calcar in the left hip with type 3 avascular necrosis (AVN) changes in the femoral head, the significance of which will not be apparent until long-term follow-up. Penetration of the calcar may be a risk factor for AVN.
Mentions: Femoral derotation osteotomies (FDOs) for gait correction surgery were performed to correct internal hip rotation and intoed gait (Figs 2 to 4). The aim was to correct excessive femoral neck anteversion, by a single oblique osteotomy in the intertrochanteric region, to between 5° and 10°. Varus derotation osteotomies (VDROs) for hip displacement surgery were undertaken to correct excessive valgus and anteversion in the proximal femur, hip subluxation and to prevent dislocation (Figs 5 and 6). In some children, it was necessary to correct intoed gait and hip displacement simultaneously (Figs 3 and 4). The indications and techniques for both types of osteotomy have been previously described.18,19 The range of hip abduction was assessed before PFO and adductor lengthening was performed, following published protocols.12,18 Osteotomies were performed in children at GMFCS IV and V, in a supine position.18 Ambulant children had a full biomechanical assessment, including three-dimensional gait analysis and axial imaging prior to surgery, and underwent gait correction surgery in a prone position.18,19 The indication and techniques for the SEMLS procedures have been previously published.13,18 Intra-operative fluoroscopy was used in both groups and selected images were saved in PACS for subsequent analysis.Fig. 3

View Article: PubMed Central - PubMed

ABSTRACT

Background: There are a range of implants for fixation of proximal femoral osteotomies (PFOs) in children. We investigated the training experiences and preferences of orthopaedic residents and fellows who were learning PFO, using a fixed angled blade plate (ABP) or a locking, cannulated blade plate (LCBP). We also studied short-term technical and radiographic outcomes.

Methods: This was a prospective, parallel-group, cohort study of 90 consecutive children and adolescents with cerebral palsy who underwent bilateral PFOs with ABP or LCBP. Surgical trainees completed a questionnaire to document the ease or difficulty of each operative step.

Results: There were 48 boys and 42 girls, with a mean age of eight years and a mean follow-up of 25 months. Trainees preferred the LCBP system for: insertion of the guidewire, the seating chisel and the blade plate, as well as overall technical ease of use (p < 0.001). Radiographic outcomes were similar with no between-group differences for migration percentage (p = 0.996) or neck shaft angle (p = 0.849), but there was a higher prevalence of technical errors in the ABP group.

Conclusions: Trainee surgeons expressed a preference for LCBPs when learning PFO in children with cerebral palsy. Radiographic outcomes were similar in both groups, with close attending surgeon supervision.

No MeSH data available.


Related in: MedlinePlus