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Updated: May 15, 2026
Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy
Published on: February 17, 2023
Proximal femoral osteotomies in children
D Louahem M'sabah1, C Assi, J Cottalorda
1Service de chirurgie orthopédique pédiatrique, CHU Lapeyronie, 371 avenue du Doyen-Gaston-Giraud, Montpellier cedex 5, France. d-louahemm_sabah@chu-montpellier.fr
Insights
Proximal femoral osteotomies (PFO) in children correct hip anatomy to prevent long-term degeneration. Advances in surgical techniques and implants like LCP plates improve stability and precision for better hip joint outcomes.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Hip biomechanics
Background:
- Proximal femoral osteotomies (PFO) are crucial for hip joint preservation in children.
- Neurological hip subluxations/dislocations often require PFO for anatomical restoration.
- Understanding of pediatric hip disorders has advanced with improved imaging and surgical techniques.
Purpose of the Study:
- To restore normal hip anatomy and joint congruency in pediatric patients.
- To prevent medium and long-term degenerative hip deterioration.
- To refine indications for PFO based on architectural defects and femoroacetabular impingement.
Main Methods:
- Description of intertrochanteric osteotomies (varus, valgus, flexion, extension) and greater trochanter osteotomies.
- Utilizing new implants, such as locking compression plates (LCP), for stable osteosynthesis.
- Association of PFO with other intra- or extraarticular procedures when necessary.
Main Results:
- New implants (LCP plates) enhance primary stability, addressing osteopenia-related issues.
- Geometrically precise osteotomies and more stable fixation are achieved with modern techniques.
- PFO alone may not always achieve articular congruence, necessitating adjunctive acetabular procedures.
Conclusions:
- PFO is a vital surgical intervention for pediatric hip disorders.
- Advances in implants and techniques have improved the efficacy and stability of PFO.
- Combined surgical approaches may be required for optimal hip joint restoration and long-term function.
Abstract:
The aim of proximal femoral osteotomies (PFO) in children is to restore normal anatomy and optimal joint congruency to prevent medium and long-terms degenerative deterioration of the hip. They play an important role in the treatment of neurological subluxations or dislocations of the hip. Advances in modern imaging and surgical techniques have improved understanding of the anatomical factors associated with a number of disorders of the growing hip and their sequelae. The indications for isolated PFO or associated with other intra- or extraarticular procedures have become more rational and better adapted to the various architectural defects and the femoroacetabular impingements. Two types of osteotomies are described: intertrochanteric osteotomies (varus and valgus correction, valgisation, flexion, extension), and osteotomies of the greater trochanter, either simple or double with lengthening of the femoral neck. Primary stability of the osteosynthesis is the major problem, as it is often affected by osteopenia. The development of new implants (LCP plate) avoids this inconvenience, resulting in geometrically precise osteotomies and a more stable fixation. Even when it is correctly performed, articular congruence is not always managed by PFO alone, it is sometimes necessary to associate acetabular procedures.
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