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Modified technique for varus derotation osteotomy of the proximal femur in children

Authors


Professor H. K. Graham, Department of Orthopaedics, Royal Children’s Hospital, Flemington Road, Parkville, Vic. 3052, Australia.

Abstract

Background:  The results of a study in which the Richards’ intermediate hip screw and the AO (Association for the Study of­­Internal Fixation (ASIF)) 908 fixed-angle blade plate were compared for use in proximal femoral osteotomy in children have previously been reported. In that study loss of position at the osteotomy site was reported as a specific complication associated with the use of the Richards’ intermediate hip screw.

Methods:  The authors devised a simple modification of surgical technique using the Richards’ intermediate hip screw to enhance the stability of the fixation. In the present article the results of a prospective study of that modified technique are reported and compared with the results of the previous study.

Results:  During a 2-year period 24 proximal femoral osteotomies were performed on 12 children with cerebral palsy, using the modified technique by two surgeons. Only two of the 12 patients (16%) required postoperative immobilization in a hip spica cast. This represents a significant reduction in the level of spica casting when compared with the previous cohort study (61%).

Conclusion:  A simple modification of surgical technique improves the stability of fixation in proximal femoral osteotomy in children who have cerebral palsy. This resulted in a decreased need for supplementary hip spica casting and may reduce morbidity.

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