title: Proximal femoral osteotomy in neurologic pediatric hips using the locking compression plate.
abstract: BACKGROUND
  Proximal femoral osteotomy (PFO) is a widely performed reconstructive surgery in pediatric patients with diagnosis of neurologic abnormalities. Many implants have been used for the fixation of these osteotomies. These devices have been evolved to provide stable fixation. A novel fixation system, the proximal femoral locking compression plate (LCP), which has a low lateral profile system, has been developed to address the problem of loosening in the osteoporotic bone, and to reach a more precise angular reduction and fixation stability through the use of locking screws. In this study, we report the surgical technique and results of PFO in children with a neurologic diagnosis.
  
  
  METHODS
  Fifty-two children with a primary neurologic diagnosis had a femoral osteotomy with the LCP device. Clinical records and radiographs, neck-shaft angle (NSA), acetabular slope, the Reimer migration percentage, and healing of the osteotomy site were studied. Among the 70 operated hips, 59 operated hips had a follow-up superior to 1 year and were included in this study.
  
  
  RESULTS
  Among the 59 operated hips, 25 operated hips presented with subluxations. NSA improved from 145 degrees (130 degrees to 165 degrees) to 120 degrees (110 degrees to 125 degrees) and to 125 degrees (115 degrees to 130 degrees) on last follow-up. The Reimer migration percentage improved from 60% (35% to 90%) to 25% (15% to 35%). Ten operated hips presented with dislocations. Their NSA improved from 150 degrees (145 degrees to 170 degrees) to 122 degrees (115 degrees to 125 degrees) and to 125 degrees (118 degrees to 130 degrees) at last follow-up. The stability of the operative reduction was maintained and full range of motion was preserved. Five operated hips presented with dysplastic hips with NSA>130 degrees without associated subluxation, 6 operated hips presented with windswept deformities, 10 operated hips presented with excessive femoral anteversion, and 3 operated hips presented with pseudarthrosis after earlier PFO were also treated and neither presented angular loosening at last follow-up. No major complications were observed.
  
  
  CONCLUSIONS
  The LCP system may be used for a wide range of indications if precise preoperative planning was achieved. Rigid primary fixation allows early mobilization and weight bearing in ambulant patient. LEVEL OF EVIDENCE LEVEL IV: Therapeutic study investigating the results of a treatment studying a case series.
authors.affiliation: Department of Pediatric Orthopaedic Surgery, Armand Trousseau Hospital, Paris, France. nejib.khouri@trs.aphp.fr
authors.forename: Nejib
authors.initials: N
authors.lastname: Khouri
authors.forename: Rami
authors.initials: R
authors.lastname: Khalife
authors.forename: Eric
authors.initials: E
authors.lastname: Desailly
authors.forename: Camille
authors.initials: C
authors.lastname: Thevenin-Lemoine
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Damsin
mesh_terms: D000293:Adolescent; D001860:Bone Plates; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D005270:Femur Head / Q000601:surgery*; D006621:Hip Joint / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D007592:Joint Diseases / Q000209:etiology* / Q000601:surgery*; D008297:Male; D009422:Nervous System Diseases / Q000150:complications; D010027:Osteotomy / Q000379:methods*