The Pediatric LCP Hip Plate for Fixation of Proximal Femoral Osteotomy in Cerebral Palsy and Severe Osteoporosis


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Abstract

BackgroundHip dislocation or subluxation together with poor nutrition, reduced weight bearing, and osteoporosis is a frequent condition in severe cerebral palsy (CP). Severe osteoporosis may cause difficulties in fixing a proximal femoral osteotomy with a conventional blade plate. The Pediatric locking compression plate (LCP) Hip Plate system offers better grip and more stable fixation.MethodsFifty-three proximal femoral osteotomies, alone or as part of a more complex surgical intervention, were performed in 28 patients (17 boys and 11 girls, age at surgery average 10.4 y, 3 to 19 y). All children suffered from CP (24 quadriplegics, 2 diplegics, and 2 hemiplegics) with Gross Motor Function Classification System levels: 3× III, 3× IV, and 22× V. This cohort was compared with a historical (conventional AO blade plate) group (38 patients with 53 operative interventions, 24 girls and 14 boys, age at surgery average 9.8 y, 3 to 18.5 y, Gross Motor Function Classification System levels: 4× III, 5× IV, and 29× V; 34 quadriplegics, 3 diplegics, and 1 hemiplegic).ResultsThe operative interventions of both cohorts that are performed are comparable considering the average amount of varisation and derotation. Operations with the conventional AO blade plate were 17.2 minutes shorter on average and the blood loss was 45.6 mL less on average. Radiologically, 19.6% of the patients had signs of complete consolidation with the LCP Hip Plate 6 weeks after surgery (vs. 91.1% of the patients of the historical cohort, P <0.001) but all osteotomies in both groups were completely consolidated by 12 weeks. In the LCP cohort in 3 patients (10.7%) full weight bearing was allowed immediately after the operation.ConclusionsBoth implants, the Pediatric LCP Hip Plate and the conventional AO blade plate, produce similar results regarding fixation and correction of the neck-shaft angle. The consolidation rate 6 weeks postoperatively using the LCP plate is lower than with the conventional blade plate, whereas equivalent healing at 3 months was found. Hence, LCP plate removal is recommended not earlier than 6 months after surgery despite good callus formation on x-ray.Level of EvidenceLevel III.

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