title: Modified technique for varus derotation osteotomy of the proximal femur in children.
abstract: BACKGROUND
  The results of a study in which the Richards' intermediate hip screw and the AO (Association for the Study of Internal 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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedics, Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Wilkinson
authors.forename: G R
authors.initials: GR
authors.lastname: Nattrass
authors.forename: H K
authors.initials: HK
authors.lastname: Graham
mesh_terms: D001860:Bone Plates; D001863:Bone Screws; D002370:Casts, Surgical; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D005260:Female; D005269:Femur / Q000601:surgery*; D006617:Hip Dislocation / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011446:Prospective Studies