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

Abstract

BackgroundProximal 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.MethodsWe 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.ResultsForty-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.ConclusionsIn 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.

The use of pediatric locked plates in the paralytic hip: preliminary results of 61 cases

“…The consolidation time was comparable to that described in the literature, as well as the preoperative CDA and RMI measurements and their postoperative improvement, 15 , 16 , 17 even with the use of several implants (locking blade plate or non-locking blade plate in these studies). The rate of complications in the literature after reconstructive surgeries of the paralytic hip was in the range of 26%, vs. 29.5% in the present sample.…”

“… 13 , 14 These surgeries are classically made with the use of angled plates; however, aiming to improve bone fixation under osteopenia conditions, modern implants with locking screws technology have been developed. 15 , 16 , 17 …”

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

“…16,17 Time to union was assessed and defined as the presence of bridging callus across more than 75% of the width of the bone at the level of the osteotomy surface, as well as external, medial bridging callus. 1 …”

“…1 There are many indications, the most common of which are to provide hip containment or correct internal hip rotation gait in children with cerebral palsy. 2–5 In our tertiary level paediatric teaching hospital, approximately 150 PFOs are performed each year.…”

“…This may result in more precise technique with greater intra-operative control and decreased margin for error. 1,8 In addition, most trainees in orthopaedic surgery are familiar with referencing internal fixation over a guidewire and with the use of locking screws. Alternative systems, which involve multiple points of fixation in the proximal femur with locking screws, include the paediatric locking compression plate (LCP).…”