Theddy F Slongo1. 1. Abteilung für Pädiatrische Chirurgie, Universitätskinderklinik, Inselspital, Bern, Schweiz. theddy.slongo@insel.ch
Abstract
OBJECTIVE: Intertrochanteric osteotomy of the proximal femur in a safe way and following the preoperative planning to achieve sufficient stability for free movement and partial weight bearing. INDICATIONS: These depend on the underlying disease and the deformity. Partial dislocation of the femoral head in case of residual hip dysplasia. Loss of containment in Perthes' disease. Partial dislocation of the femoral head in neuromuscular disease. Rotational failures of the proximal femur (coxa antetorta/ retrotorta). Posttraumatic deformities. CONTRAINDICATIONS: In principle, none; the decision between indication and contraindication requires knowledge of the respective disease and deformity. SURGICAL TECHNIQUE: We know two different planning and surgical techniques, the so-called center-center technique and the calculated technique. Center-center technique:the guide wire is inserted parallel and in the center of the femoral neck in anteroposterior and axial view. The correction is determined by the screw/plate angle (100 degrees /110 degrees and 150 degrees , respectively). Planned/calculated technique:the guide wire is inserted in the preoperatively planned angle in relation to the chosen plate (100 degrees , 110 degrees or 150 degrees ) using the angular aiming device for the anteroposterior view; in the axial view the guide wire is also placed parallel and into the center of the femoral neck. POSTOPERATIVE MANAGEMENT: Depending on the child's age, the underlying disease and the chosen implant, a hip spica cast-free treatment should be striven for: children < or = 5 years normally in a "buggy" or wheelchair, children > 5 years mobilization with crutches. RESULTS: The results depend on the experience, the accuracy of the planning and the performance of the osteotomy. Correction losses are described and reported. A faultlessly planned correction and an uncomplicated/good healing do not always have to be accompanied by an optimal functional result.
OBJECTIVE: Intertrochanteric osteotomy of the proximal femur in a safe way and following the preoperative planning to achieve sufficient stability for free movement and partial weight bearing. INDICATIONS: These depend on the underlying disease and the deformity. Partial dislocation of the femoral head in case of residual hip dysplasia. Loss of containment in Perthes' disease. Partial dislocation of the femoral head in neuromuscular disease. Rotational failures of the proximal femur (coxa antetorta/ retrotorta). Posttraumatic deformities. CONTRAINDICATIONS: In principle, none; the decision between indication and contraindication requires knowledge of the respective disease and deformity. SURGICAL TECHNIQUE: We know two different planning and surgical techniques, the so-called center-center technique and the calculated technique. Center-center technique:the guide wire is inserted parallel and in the center of the femoral neck in anteroposterior and axial view. The correction is determined by the screw/plate angle (100 degrees /110 degrees and 150 degrees , respectively). Planned/calculated technique:the guide wire is inserted in the preoperatively planned angle in relation to the chosen plate (100 degrees , 110 degrees or 150 degrees ) using the angular aiming device for the anteroposterior view; in the axial view the guide wire is also placed parallel and into the center of the femoral neck. POSTOPERATIVE MANAGEMENT: Depending on the child's age, the underlying disease and the chosen implant, a hip spica cast-free treatment should be striven for: children < or = 5 years normally in a "buggy" or wheelchair, children > 5 years mobilization with crutches. RESULTS: The results depend on the experience, the accuracy of the planning and the performance of the osteotomy. Correction losses are described and reported. A faultlessly planned correction and an uncomplicated/good healing do not always have to be accompanied by an optimal functional result.