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Stabilizing a Femur Osteotomy with a Plate Fixation in Ambystoma mexicanum
Published on: April 12, 2024
Proximal femoral osteotomy in neurologic pediatric hips using the locking compression plate
Nejib Khouri1, Rami Khalife, Eric Desailly
1Department of Pediatric Orthopaedic Surgery, Armand Trousseau Hospital, Paris, France. nejib.khouri@trs.aphp.fr
Insights
The proximal femoral locking compression plate (LCP) system effectively treats pediatric hip instability in patients with neurologic abnormalities, improving hip alignment and reducing subluxation. This study shows promising results for the LCP in proximal femoral osteotomy (PFO) procedures.
Area of Science:
- Pediatric Orthopedics
- Surgical Innovation
- Biomechanical Engineering
Background:
- Proximal femoral osteotomy (PFO) is a common surgery for pediatric neurologic abnormalities.
- Traditional fixation devices have limitations in osteoporotic bone and stability.
- The proximal femoral locking compression plate (LCP) system offers a novel solution with a low profile and locking screws for enhanced fixation.
Purpose of the Study:
- To report the surgical technique and outcomes of PFO using the LCP system in children with neurologic diagnoses.
- To evaluate the effectiveness of the LCP system in improving hip stability and alignment.
- To assess complications and functional outcomes associated with LCP fixation in pediatric PFO.
Main Methods:
- A retrospective study of 52 children (70 hips) undergoing PFO with the LCP device.
- Analysis of clinical records and radiographs, including neck-shaft angle (NSA), acetabular slope, and Reimer migration percentage.
- Inclusion of 59 hips with over 1 year of follow-up.
Main Results:
- Significant improvement in NSA and Reimer migration percentage in hips with subluxation and dislocation.
- Stable fixation maintained, with full range of motion preserved.
- Successful treatment of various deformities including hip dysplasia, windswept deformities, and pseudarthrosis without angular loosening.
Conclusions:
- The LCP system is a versatile fixation option for PFO in pediatric patients with neurologic conditions, provided precise preoperative planning.
- Rigid primary fixation with the LCP enables early mobilization and weight-bearing in ambulatory patients.
- The LCP system demonstrates a low complication rate and effective management of hip instability in this cohort.
Background:
Proximal femoral osteotomy (PFO) is a widely performed reconstructive surgery in pediatric patients with diagnosis of neurologic abnormalities. Many implants have been used for the fixation of these osteotomies. These devices have been evolved to provide stable fixation. A novel fixation system, the proximal femoral locking compression plate (LCP), which has a low lateral profile system, has been developed to address the problem of loosening in the osteoporotic bone, and to reach a more precise angular reduction and fixation stability through the use of locking screws. In this study, we report the surgical technique and results of PFO in children with a neurologic diagnosis.
Methods:
Fifty-two children with a primary neurologic diagnosis had a femoral osteotomy with the LCP device. Clinical records and radiographs, neck-shaft angle (NSA), acetabular slope, the Reimer migration percentage, and healing of the osteotomy site were studied. Among the 70 operated hips, 59 operated hips had a follow-up superior to 1 year and were included in this study.
Results:
Among the 59 operated hips, 25 operated hips presented with subluxations. NSA improved from 145 degrees (130 degrees to 165 degrees) to 120 degrees (110 degrees to 125 degrees) and to 125 degrees (115 degrees to 130 degrees) on last follow-up. The Reimer migration percentage improved from 60% (35% to 90%) to 25% (15% to 35%). Ten operated hips presented with dislocations. Their NSA improved from 150 degrees (145 degrees to 170 degrees) to 122 degrees (115 degrees to 125 degrees) and to 125 degrees (118 degrees to 130 degrees) at last follow-up. The stability of the operative reduction was maintained and full range of motion was preserved. Five operated hips presented with dysplastic hips with NSA>130 degrees without associated subluxation, 6 operated hips presented with windswept deformities, 10 operated hips presented with excessive femoral anteversion, and 3 operated hips presented with pseudarthrosis after earlier PFO were also treated and neither presented angular loosening at last follow-up. No major complications were observed.
Conclusions:
The LCP system may be used for a wide range of indications if precise preoperative planning was achieved. Rigid primary fixation allows early mobilization and weight bearing in ambulant patient. LEVEL OF EVIDENCE LEVEL IV: Therapeutic study investigating the results of a treatment studying a case series.
