title: Rotational osteotomy with submuscular plating in skeletally immature patients with cerebral palsy.
abstract: BACKGROUND
  In cerebral palsy, intoeing gait with increased femoral anteversion is not uncommon and often requires surgical intervention. Although several conventional methods have been used, complications are common. We applied a new technique of rotational osteotomy with submuscular plating in skeletally immature patients with cerebral palsy.
  
  
  METHODS
  Eighteen patients (26 femora, 8 bilateral) with a mean age of 8.7 years (range, 6-16) were prospectively treated with this technique. The anatomic distribution of patients was hemiplegia (n = 7), diplegia (n = 8), and asymmetric diplegia (n = 3). Percutaneous osteotomy was performed at the middle of the femoral shaft. After rotational correction, submuscular plating was done using a locking compression plate. Femoral anteversion was evaluated by a trochanteric prominence angle test (TPAT) and computed tomography.
  
  
  RESULTS
  In all cases, each osteotomy healed in an average of 12 weeks (range, 10-14). The mean femoral anteversion by TPAT improved to 12° (range, 5°-30°) after surgery from 44° (range, 30°-65°) (p < 0.001). There were no complications of deep infection, implant failure, or limb length discrepancy over 1 cm.
  
  
  CONCLUSIONS
  In skeletally immature patients with cerebral palsy, femoral anteversion can be safely corrected using submuscular plating with a locking compression plate.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu 700-721, Korea.
authors.forename: Hyun-Joo
authors.initials: HJ
authors.lastname: Lee
authors.forename: Chang-Wug
authors.initials: CW
authors.lastname: Oh
authors.forename: Kwang-Soon
authors.initials: KS
authors.lastname: Song
authors.forename: Joon-Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Jae-Wook
authors.initials: JW
authors.lastname: Jung
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Park
authors.forename: Joon-Young
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D001860:Bone Plates; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D005260:Female; D005269:Femur / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies