A surgical cut is made in the pelvis, above the socket. Intraarticularly, surgical hip dislocation was used to perform labral takedown, acetabular rim resection and reattachment as well as cam decompression. It may or may not be associated with femoral derotation, which allows the use of an. Total knee replacement for a varus deformity duration. As the amount of shortening is affected by both the degree of varus and the size of the bone wedge removed, preoperative assessment for preexisting leglength discrepancy may be indicated for further consideration during surgical planning. Distal femoral osteotomy system dfos orthopediatrics.
Numerous surgical techniques have been described, and their outcomes vary a lot. Osteotomy definition of osteotomy by medical dictionary. Innominate osteotomy and varus derotational osteotomy in. The described procedure is a minimally invasive singleincision technique based on an intramedullary saw. A significant consequence of varus osteotomy is leg shortening. However, as these surgical procedures are aimed at correcting midfoot cavus deformity rather than varus deformity, we highlighted the midfoot derotational osteotomy, which myerson et al.
The locking cannulated blade lcb plate system offers comprehensive treatment options for pediatric hip deformity, fixed knee flexion deformity, and trauma. The purpose of this study was to perform a derotational osteotomy at the distal femur, as is done in cases of patellofemoral instability, and demonstrate the predictability of threedimensional 3d changes on axes in a cadaveric model by the use of a new mathematical approach. The technique for distal femoral varus osteotomy was based on the method described by mcdermott et al. Le fort osteotomy transverse sectioning and repositioning of the maxilla. The first involves the damaging effect of spasticity on the hip joint. For valgus osteotomy, the blade plate can be inserted before completing the osteotomy while the bone is still stable. These procedures have been considered inadequate because of extraarticular fai. Since its inception, it has undergone many iterations with a variety of techniques described to achieve the same goal. But exact guidance on frontal and sagittal view of. With regards to the surgical technique employed for extraction most cases were difficult requiring osteotomy with tooth sectioning n89, 51.
Complications of varus derotation osteotomies in the treatment of congenital hip displacement chd are reported. Derotational osteotomy of the distal femur for the. Twentyfour patients 30 hips with an average age of 9. Percutaneous pelvic osteotomy and intertrochanteric varus.
The plate is then moved with the proximal fragment to the lateral side of the femur causing automatic varus correction. Only true complications were considered, that is, those related to errors in technique, while those related to errors in indications were excluded. The purpose of the present study is to evaluate a new method, which combines varus derotational subtrochanteric osteotomy vdso and external osteosynthesis. Advances in modern imaging and surgical techniques have improved. Varus distal femoral osteotomy in young adults with valgus. The instrumentation includes a pin guide and cut guides to assist with more precise osteotomies and implant placement. Percutaneous femoral derotational osteotomy for excessive. Provincial health services authority phsa improves the health of british columbians by seeking provincewide solutions to specialized health care needs in. Surgical technique this publication is not intended for distribution in the usa. Each offers the ability to insert a locking or nonlocking screw into femoral neck to dynamically compress the fracture and osteotomy sites to create a stable construct. Proximal femoral varus derotation osteotomy in children with.
Ten human cadaveric femurs, with increased antetorsion, underwent a visually observed derotational osteotomy at the. Osteotomy article about osteotomy by the free dictionary. Single cut distal femoral osteotomy for correction of. This spasticity involving the hip muscles, mostly in the groin, can cause the hips to. A varus derotation osteotomy vdro may be done to place the ball back into the socket. We may also correct turning in of the femur at the same time. The authors devised a simple modification of surgical technique using. Proximal femoral osteotomies in children sciencedirect. The plate is then used to help obtain the correction. The primary operation was performed for subluxation in 19 patients.
Varus derotation osteotomy how is varus derotation. It is done during the same operative time as any work on the femur and or muscles around the hip. Tension band wiring for proximal femoral varus osteotomy. A vdro is performed by cutting through the upper end of the thigh bone femur. Theoretically, an osteotomy perpendicular to the mechanical axis on both planes will not affect alignment on frontal and sagittal axis. The average age at operation for varus derotational osteotomy and innominate osteotomy was 5.
The osteotomy was performed through a medial incision with removal of a 5 to 10mm medially based wedge of bone from the distal part of the femur. Varus and valgusproducing osteotomies were aimed at maximizing joint congruity and redistributing the weightbearing load across the femoral head to a less affected area. Modified technique for varus derotation osteotomy of the proximal. Complications of varus derotation osteotomy in the. However, in these studies, midfoot derotational osteotomy. Varus derotational osteotomy how is varus derotational osteotomy abbreviated. Proximal femoral osteotomy was a technique used in adults in the early part of the 20th century for the treatment of hip dysplasia and osteoarthritis. Varus derotational osteotomy how is varus derotational. Prior to the varus osteotomy, 1 patient underwent salter osteotomy and 2 patients underwent arthrodiastasis. Clinical and radiological outcomes of midfoot derotational. The dega osteotomy is a particular procedure that has been very successful in treating the hips of children with cerebral palsy. Since its description by axer in 1965, it has been a mainstay in the treatment algorithm.
Derotational subtrochanteric osteotomy and external. Osteotomy definition of osteotomy by the free dictionary. Reconstruction with a proximal varus derotational osteotomy with blade plate fixation and a volume reducing pelvic. Instruments and implants approved by the ao foundation. For varusproducing osteotomies, the bone is cut before the blade plate is inserted because of impingement of the plate on the femoral shaft, and the seating chisel is used.
A single system of osteotomy blade plates and cannulated instrumentation. Twentyone nonambulatory children and adolescents 22 hips were consecutively treated with percutaneous pelvic osteotomy, which was used in conjunction with varus, derotational, shortening femoral osteotomy and soft tissue release, to correct. Several studies describe their surgical technique on how to perform a distal femur derotational osteotomy 3, 4, 7, 10, 21. The intertrochanteric osteotomy which is marked by a pin perpendicular to the femoral axis fig. The fellowshiptrained norton childrens orthopedics of louisville surgeons regularly perform. Adjusting the correct cutting plane in vivo is challenging in derotational osteotomy at the femur. The second common indication for this procedure is for the child who walks with hisher feet severely turned in. Reconstruction with a proximal varus derotational osteotomy with blade plate fixation and a volume reducing pelvic osteotomy for neuromuscular hip dysplasia. Modified technique for varus derotation osteotomy of the proximal femur in. Percutaneous pelvic osteotomy in cerebral palsy patients. Several descriptions of the surgical technique of distal femoral, or supracondylar, derotational osteotomy can be found in the recent literature. The vdro is designed to tip the ball of the femur into the hip socket. Surgical hip dislocation and varus derotation osteotomy.
Femoral derotation osteotomy in adults for version. For children who are at risk of a hip dislocation a varus derotation osteotomy vdro is considered. Femoral derotation osteotomy bc childrens hospital. Femoral derotational osteotomy is an acceptable treatment for excessive femoral torsion. Femoral varus osteotomy the hip joint is a ball and socket joint made up of the acetabulum the socket which is part of the pelvis and the femoral head the ball which is the top part of the thigh bone. A varus osteotomy should not result in a femoral neckshaft angle of less than 110.
The purpose of this study was to compare isolated varus derotational osteotomy vdro and vdro combined with open hip reduction andor pelvic osteotomy in children with cp and hip subluxation. Your childs surgeon will make a cut on the outside of your childs hip. The technique of diaphyseal osteotomies has been reported by several authors 26, 27, 2832 typically using interlocking screws. Several conditions of the hip can be improved by a surgery to redirect the head of the femur into the. But exact guidance on frontal and sagittal view of their performed cut cannot be found. Reconstructive hip surgery typically includes proximal femoral varus.
How to avoid unintended valgus alignment in distal femoral. Femoral opening wedge osteotomy surgical technique arthrex. A subtrochanteric derotation femoral osteotomy may also be performed by plating, but it requires a much more invasive approach. To describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy methods. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity.