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

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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.


When using the angled blade plate (ABP) system, the guidewire and blade may not be parallel in the frontal plane. The seating chisel and the implant are inserted distal to the guidewire, in the femoral neck. The space available between the trochanteric apophysis and the calcar is limited.
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Figure 7: When using the angled blade plate (ABP) system, the guidewire and blade may not be parallel in the frontal plane. The seating chisel and the implant are inserted distal to the guidewire, in the femoral neck. The space available between the trochanteric apophysis and the calcar is limited.

Mentions: Technical outcomes included the position of the implant in the proximal femur and stability of fixation. The angulation between the guidewire and blade plate was measured in hips where the ABP was used, in anteroposterior (AP) and lateral projections, from saved fluoroscopic images in PACS (Figs 7 and 8). Operating time was measured as the time required for bilateral PFOs. Anaesthetic time, surgical time for concomitant procedures and time required for cast application in the SEMLS group were excluded.


Proximal femoral osteotomy in children with cerebral palsy: the perspective of the trainee
When using the angled blade plate (ABP) system, the guidewire and blade may not be parallel in the frontal plane. The seating chisel and the implant are inserted distal to the guidewire, in the femoral neck. The space available between the trochanteric apophysis and the calcar is limited.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: When using the angled blade plate (ABP) system, the guidewire and blade may not be parallel in the frontal plane. The seating chisel and the implant are inserted distal to the guidewire, in the femoral neck. The space available between the trochanteric apophysis and the calcar is limited.
Mentions: Technical outcomes included the position of the implant in the proximal femur and stability of fixation. The angulation between the guidewire and blade plate was measured in hips where the ABP was used, in anteroposterior (AP) and lateral projections, from saved fluoroscopic images in PACS (Figs 7 and 8). Operating time was measured as the time required for bilateral PFOs. Anaesthetic time, surgical time for concomitant procedures and time required for cast application in the SEMLS group were excluded.

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.