Limits...
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.


With the locking cannulated blade plate (LCBP) system, both the seating chisel and the implant are inserted over the guidewire. There can be no angulation between the seating chisel, or the LCBP, and the guidewire.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5382338&req=5

Figure 11: With the locking cannulated blade plate (LCBP) system, both the seating chisel and the implant are inserted over the guidewire. There can be no angulation between the seating chisel, or the LCBP, and the guidewire.

Mentions: In this study, trainees reported that the cannulated system was easier to use in four of six domains.1,9 Guidewire placement with the LCBP system is the most important step in PFO. The seating chisel and implant are passed directly over the wire (Figs 11 and 12), which thereby dictates the final blade plate position. This contrasts with the ABP system in which guidewire placement serves only as a reference plane for the insertion of the seating chisel and implant (Figs 7 and 8).6,7 Deviation of the blade plate angle from the direction of the guidewire with the ABP introduces an uncontrolled variable, which has not been previously reported. Experienced surgeons are usually able to manage this angulation. After several guidewire placements, some surgeons may choose to accept a position which is less than perfect and to make a correction by altering the angle of the seating chisel to the guidewire (Figs 7 and 8). Trainees dislike this variability because it is unpredictable and makes it difficult to ensure that the pre-operative plan is correctly executed. These problems were not encountered with the cannulated system.Fig. 11


Proximal femoral osteotomy in children with cerebral palsy: the perspective of the trainee
With the locking cannulated blade plate (LCBP) system, both the seating chisel and the implant are inserted over the guidewire. There can be no angulation between the seating chisel, or the LCBP, and the guidewire.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 11: With the locking cannulated blade plate (LCBP) system, both the seating chisel and the implant are inserted over the guidewire. There can be no angulation between the seating chisel, or the LCBP, and the guidewire.
Mentions: In this study, trainees reported that the cannulated system was easier to use in four of six domains.1,9 Guidewire placement with the LCBP system is the most important step in PFO. The seating chisel and implant are passed directly over the wire (Figs 11 and 12), which thereby dictates the final blade plate position. This contrasts with the ABP system in which guidewire placement serves only as a reference plane for the insertion of the seating chisel and implant (Figs 7 and 8).6,7 Deviation of the blade plate angle from the direction of the guidewire with the ABP introduces an uncontrolled variable, which has not been previously reported. Experienced surgeons are usually able to manage this angulation. After several guidewire placements, some surgeons may choose to accept a position which is less than perfect and to make a correction by altering the angle of the seating chisel to the guidewire (Figs 7 and 8). Trainees dislike this variability because it is unpredictable and makes it difficult to ensure that the pre-operative plan is correctly executed. These problems were not encountered with the cannulated system.Fig. 11

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.