Blade plate versus locking plate fixation of proximal femoral varus osteotomy in children with cerebral palsy.

The hip is commonly affected in children with cerebral palsy (CP), requiring proximal femoral varus derotational osteotomies. Novel locking plates afford a popular alternative to traditional blade plates. The purpose of this study was to compare the effectiveness of blade plate versus locking plate fixation in children with CP undergoing proximal femoral osteotomy. We conducted a retrospective review of patients who underwent proximal femoral osteotomy over an 8-year period. Incidence of healing, failure of the procedure, and loss of varus correction were compared between the two groups (blade plate vs. locking plate). Independent samples t -tests and Chi-square analysis were employed to compare differences between continuous and categorical variables, respectively. A total of 268 hips [137 right (51.1%)] met inclusion criteria. Ninety-eight hips (36.6%) were fixed with blade plates [170 (63.4%) locking plates]. Although those in the blade plate cohort were more likely to achieve complete radiographic healing by 6 weeks postoperatively (41.09% vs. 18.84%; P < 0.050), there was no significant difference ( P > 0.050) between the two groups for healing at 3, 6, and 12 months ( P > 0.050). There was no significant difference between the two cohorts regarding the number of patients experiencing migration percentage at least 50% at 6 (3.06% vs. 3.53%) and 12 (3.06% vs. 5.88%) months ( P > 0.050) or in those undergoing revision surgery at 12 (5.33% vs. 1.18%) and 24 (2.04% vs. 1.76%) months ( P > 0.050). The findings of this retrospective study show similar outcomes between blade plate and proximal femoral locking plates in proximal femoral varus osteotomy in children with CP.

Reconstructive hip surgery in children with cerebral palsy: factors influencing risk of femoral head avascular necrosis.

Femoral head avascular necrosis (AVN) is a complication of hip reconstruction in children with cerebral palsy (CP) with uncertain incidence. The purpose of this study was to establish the rate of AVN in children undergoing hip reconstruction and to identify the factors associated with AVN. Medical records and radiographs of patients aged 1-18 with a diagnosis of CP who have undergone hip reconstruction over a 9-year period (2010-2018) with at least 1-year follow-up were reviewed. Age at time of surgery, sex, Gross Motor Function Classification System (GMFCS), procedure(s), preoperative migration percentage (MP), and signs of AVN on anterioposterior pelvis radiographs at routine follow-up visits (3 months, 6 months, and years 1-9, annually) according to the Bucholz-Ogden (BO) and Kalamchi-MacEwen (KM) classification systems were recorded. Univariate analysis was used to test for significance. Three hundred forty-nine hips in 209 patients met our inclusion criteria. Eleven hips (rate; 3%), in 11 patients, developed AVN. Classification of AVN was found to consist of: class I-4 (36%), class II-1 (9%), class III-[BO: 4 (36%)] [KM: 3 (27%)], and Class IV-[BO: 2 (18%)] [KM: 3 (27%)]. Average follow-up was of 3.5 years. The AVN cohort displayed older age (11.0 ± 2.8 vs. 8.1 ± 3.4; P = 0.005). Open reduction was associated with increased AVN, occurring in 9% of the hips (P = 0.004). No significant association was found between preoperative MP, GMFCS, or acetabular osteotomy. The method of open reduction (anterior vs. medial) was not significantly associated with AVN (P = 0.4471). In this large series, the observed rate of AVN was 3%, associated with open reductions at time of hip reconstruction. If possible, closed reduction would be preferred at time of hip reconstruction in children with CP to lower the risk of AVN. Level of evidence: III.

Tibia fractures: what should be fixed?

PURPOSE: The purpose of this study is to provide a summary of the absolute and the relative surgical indications for both closed and operative treatment of tibial shaft fractures. METHODS: A literature review of the pertinent literature was undertaken, and a limited number of the most significant papers are cited. Recommendations are provided for fractures that are most likely to need surgical intervention and relative indications for fractures that may benefit from surgical stabilization. RESULTS: Successful closed treatment can be achieved either by casting and conventional 3-point molding or by utilizing the Sarmiento technique of casting. Either technique depends on soft tissues to maintain bony alignment. The reported results are significantly improved after surgical stabilization after open tibial shaft fractures and tibial shaft fractures associated with ipsilateral femoral fractures. Relative indications for surgical stabilization include comminuted fractures, displaced fractures with an intact fibula, and displaced fractures in adolescents. Compartment syndrome remains the most significant early complication encountered when treating tibial shaft fractures in children and adolescents by either closed or surgical methods and should be considered in the face of pain out of proportion to the injury or increasing narcotic requirements. CONCLUSIONS: Tibial fractures are one of the more common injuries treated by orthopedic surgeons. Although most can be treated by closed techniques, certain fractures benefit significantly from surgical stabilization.