Femoral rotational osteotomy proximal and distal robert m. In that study loss of position at the osteotomy site was reported as a specific complication associated with the use. This surgery is used to treat a number of conditions, including congenital and acquired hip deformities. 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. Of 55 treated hips, 31 had a varus derotation osteotomy alone, and 24 had a combination of varus derotation osteotomy and an acetabular procedure. Distal femoral osteotomy system dfos orthopediatrics.
She was treated with an open reduction and bracing in infancy. The varus derotational osteotomy is an acceptable treatment option for leggcalveperthes disease. Femoral derotation osteotomy fdo what is the procedure. Femoral opening wedge osteotomy surgical technique arthrex. The vdro is designed to tip the ball of the femur into the hip socket. Proximal femoral osteotomies in children sciencedirect. The described procedure is a minimally invasive singleincision technique based on an intramedullary saw. When a hip starts to move out of joint, the ball head of the femur is no longer pointing directly into the socket acetabulum. Modified technique for varus derotation osteotomy of the proximal. Pedinail pediatric femoral im nail bilateral femoral. This procedure can be used at any age but is seldom performed before 1 year of age. After performing the osteotomy, the femur is rotated to achieve the desired correction.
It may or may not be associated with femoral derotation, which allows the use of an angled blade plate. In select patients, surgery is indicated to improve femoral head coverage or better reduce the hip joint. Increased femoral antetorsion is one important risk factor for patellofemoral instability and anterior knee pain syndrome in teenagers and young adults 1,2,3,4,5. It has been utilized since the early 20th century, and. Modified technique for varus derotation osteotomy of the. Derotational subtrochanteric osteotomy and external. Distal femoral varus osteotomy for osteoarthritis of the knee. Since its inception, it has undergone many iterations with a variety of techniques described to achieve the same goal. A varus osteotomy should not result in a femoral neckshaft angle of less than 110.
Proximal femoral varus osteotomy using angled blade plate. Since its description by axer in 1965, it has been a mainstay in the treatment algorithm. Femoral osteotomy is done when the upper end of the thigh bone needs to be tipped so the ball points deeper into the socket. Apr 25, 2018 knee pain and activity outcomes after femoral derotation osteotomy for excessive femoral anteversion. Ten human cadaveric femurs, with increased antetorsion, underwent a visually observed derotational osteotomy at the. Femoral varusderotation osteotomy in spastic cerebral palsy. The results of the paper demonstrate good clinical results after derotational osteotomy in patients with symptomatic excessive femoral anteversion. The surgical technique refers to screw holes where applicable. Femoral derotational osteotomy why does my child need this surgery. Femoral varus derotational osteotomy surgery information. This spasticity involving the hip muscles, mostly in the groin, can cause the hips to gradually come out of their sockets. The first involves the damaging effect of spasticity on the hip joint. Dega osteotomy pelvic osteotomy why does my child need this surgery. The term femoral torsion may be used in lieu of femoral anteversion and is favored by those who believe.
The varus derotational osteotomy and volumereducing pelvic osteotomy are the workhorses of reconstruction of this disorder. High impact sports such as tennis, basketball, football and. Our elearning platform contains high resolution images and a certified cme of the proximal femoral varus osteotomy. In orthopedics, the correction of a rotation deformity by turning or rotating the deformed structure toward a normal position. Longterm effects of intertrochanteric varusderotation osteotomy on femur and acetabulum in spastic cerebral palsy. The ideal treatment for hip displacement dislocation or subluxation is hip reconstruction combining soft tissue release, varus derotational osteotomy of the femur, and pelvic osteotomy 58. The second common indication for this procedure is for the child who walks with hisher feet severely turned in.
Femoral varus derotation osteotomy with or without acetabuloplasty. The lcb system is offered in three size ranges infant, child, and adolescent. Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome. Jul 11, 2018 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. Principles of valgus intertrochanteric osteotomy vito. When children have spasticity, the effect on the hip joint can result in severe deformity and pain. In neurologically diseased hips, femoral shortening relaxes the muscles and the joint. Knee pain and activity outcomes after femoral derotation osteotomy for excessive femoral anteversion. How to avoid unintended valgus alignment in distal femoral. The length of stay for this surgery is typically 45 days, again dependent upon what other procedures may have been done at the same time. A vdro is performed by cutting through the upper end of the thigh bone femur. Derotational osteotomy, a procedure involving external rotation of the distal femur, is a reliable option for correction of torsional pathologies 6,7,8,9. Pain in the hip has been present for over 1 year, limiting activities. Meidan o, mcconkey mo, bravman jt, young da, pascualgarrido c.
Extraarticular causes of fai should be suspected in every refractory case. Femoral derotational osteotomy is an established treatment for patients with symptomatic excessive anteversion of the femur. However, femoral varus osteotomy is associated with many complications including articular fractures, nerve and vessel injuries, loss of correction, and failure of bone healing 7 8 9. Derotation definition of derotation by medical dictionary. This surgery is almost exclusively done in conjunction with a femoral derotational osteotomy. Kay definitions femoral anteversion is the angle in the transverse rotational plane between the neck of the femur and the distal femur, as defined by the intercondylar axis. Several conditions of the hip can be improved by a surgery to redirect the head of the femur into the.
Interpretation of diagnostic studies for to measure varus valgus of hip on xr and femoral torsion on ct. This allows the surgeon to address both the underlying pathoanatomy and the resultant intraarticular sequelae. Louis, missouri the pediloc femur locked plate system is the first and only anatomic plate system dedicated e. Your childs surgeon will make a cut on the outside of your childs hip. Distal femoral varus osteotomy is a procedure that is performed for the treatment of lateralcompartment osteoarthritis of the knee as well as for correction of the associated valgus deformity.
May 16, 2020 a femoral osteotomy fo is a surgical procedure in which a surgeon cuts into the femur and repositions it before pinning it in place. Low impact sports such as golf, swimming, skating, rollerblading and cycling 6 to 8 months. At the beginning of the new year i will be having a femoral rotational osteotomy on my left leg to counteract a femoral acetabular impediment which has cause a 30 degree retroversion and in turned caused a patellofemoral malalignment. Several descriptions of the surgical technique of distal femoral, or supracondylar, derotational osteotomy can be found in the recent literature. Sep 26, 2016 varus derotation intertrochanteric osteotomy with femoral retroversion. Research article femoral derotation osteotomy in adults for.
T he distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. The fdo is usually stabilised with plates and screws to hold the bone in its new. 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. Modified technique for varus derotation osteotomy of the proximal femur in children. Femoral varus derotation osteotomy used to treat 12 patients with 14 hips 2 bilateral with perthes disease. This spasticity involving the hip muscles, mostly in the groin, can cause the hips to. A radiographic examination was performed with the affected hip abducted and internally rotated, on the basis of this examination, hips were assessed as contained or not and if. For varusproducing osteotomies, the bone is cut before the blade plate is inserted because of impingement of the plate on the femoral shaft. Advances in modern imaging and surgical techniques have improved. Nonunion is a relatively rare, yet challenging problem after fracture of the femoral neck. The technique of femoral derotation osteotomy, for the left leg. 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 proximal femoral osteotomy is commonly used to treat a. Pediloc locking proximal femur plate system varus osteotomy. Femoralderotationosteotomy upperleg surgery whatwe. Risk factors include verticality of the fracture line and presence of comminution of the posteromedial calcar, as well as quality of reduction. Apr 27, 2018 for proximal femoral varus osteotomy on hips in patients in early stages of leggcalveperthes disease, kim et al recommend achieving 1015. Subtrochanteric femoral osteotomy with biplanar correction. Treatment options consist of valgus intertrochanteric osteotomy versus arthroplasty. In children who are walking with their legs turned in, a femoral derotation osteotomy fdo is considered. Proximal femoral osteotomy in children with cerebral palsy. Clinical and radiographic outcomes after femoral varus derotation osteotomy for leggcalveperthes disease at 25 years followup. A varus producing proximal femoral osteotomy with derotation of the anteverted neck improves femoral. A varus proximal femoral osteotomy is commonly used to treat a variety of abnormal conditions of the hip by realigning the femoral head within the acetabulum.
Treatment should be tailored to the individual patient, taking into account. In this deformity correction module we explain the method for proximal femoral osteotomy. This chapter describes the technique of management of the reconstructible neuromuscular hip with blade plate fixation. Percutaneous femoral derotational osteotomy for excessive femoral torsion. Symptoms after surgery following a femoral derotational osteotomy your child will initially experience pain and stiffness but this will be well controlled with pain killers and muscle relaxants. Suggestions for positioning and orientation of the osteotomy to the shaft.
Femoral derotation osteotomy in adults for version. Femoral derotation osteotomy technique for excessive femoral. Surgical hip dislocation and varus derotation osteotomy for. Any patient with a varus derotation osteotomy that subsequently had an acetabular procedure or a repeat femoral osteotomy to improve coverage, were rated as failures even if the individual had a. Distal femoral osteotomy system dfos the dfos system includes implants to correct several distal femoral conditions, such as flexion contractures and varus valgus deformities. Femoral derotation osteotomy technique for excessive. Twenty children twenty hips with spastic cerebral palsy underwent femoral varusderotation osteotomy for which the principal indication was inadequate. Femoral derotation osteotomy in adults for version abnormali. We may also correct turning in of the femur at the same time. Single cut distal femoral osteotomy for correction of femoral.
Higher impact sports such as running, jogging and aerobics 8 to 12 months. Jun, 2016 a varus proximal femoral osteotomy is commonly used to treat a variety of abnormal conditions of the hip by realigning the femoral head within the acetabulum. Apr 27, 2018 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. 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. With time, a huge amount of knowledge on the indications and on the limitations of this treatment has accumulated. Femoral derotational osteotomy is an acceptable treatment for excessive femoral torsion. A fdo is performed by cutting through the thigh bone femur at its upper end and turning it so that the knee is facing forwards when the child walks. The thigh bone often needs to be shortened when the hip is dislocated high above the socket. Goals of management include maintaining a mobile painless located hip. The osteotomy is then stabilized with an intramedullary nail to maintain the correction while the bone heals.
A varus derotation osteotomy vdro may be done to place the ball back into the socket. The hip joint is composed of the femur thigh bone and the pelvis. Varus and valgusproducing osteotomies were aimed at maximizing joint congruity and redistributing the weightbearing load across the femoral head to a less affected area. The patient is a 19yearold female who was born with a dislocated right hip. The instrumentation includes a pin guide and cut guides to assist with more precise osteotomies and implant placement. Proximal femoral osteotomy deformity correction planning. This technique details how to perform a femoral derotation osteotomy for excessive femoral anteversion after addressing intraarticular pathology with hip arthroscopy in one surgical intervention. It may or may not be associated with femoral derotation, which allows the use of an. The perspective of the trainee 8 j child orthop 2017. Derotational osteotomy of the distal femur for the. Percutaneous femoral derotational osteotomy for excessive. The term derotational femoral osteotomy dfo refers to a procedure designed to treat severe rotational abnormalities of the femur.
Varus derotation osteotomies vdros for hip displacement surgery were undertaken to correct excessive valgus and anteversion in the proximal femur, hip. Learn the proximal femoral varus osteotomy using angled blade plate fixation surgical technique with step by step instructions on orthoracle. Louis, missouri the pediloc femur locked plate system is the first and only anatomic plate. In a preliminary report in 1965, axer 1 proposed femoral varus derotation osteotomy as an alternative method for treating leggcalveperthes disease lcpd. When the femoral head is severely deformed and the acetabulum is too shallow for. Louis, missouri bilateral femoral derotation osteotomy over an intramedullary femoral nail. Derotational osteotomy of the distal femur for the treatment. Apr 25, 2018 nelitz m, dreyhaupt j, williams sr, dornacher d.
Distal femoral varus osteotomy for osteoarthritis of the. Thereafter, this became one of the most popular operative methods in the treatment of the disease. Jan 01, 2019 the varus derotational osteotomy is an acceptable treatment option for leggcalveperthes disease. Femoral varus derotation osteotomy, when combined with muscle releases, can allow children with spastic cerebral palsy to maintain their ambulatory status and may decrease pain about the hip. Case log guidelines for pediatric orthopaedic surgery. Femoral varus osteotomy in leggcalveperthes disease. Femoral varus derotation osteotomy with surgical hip dislocation is a rational and appropriate solution in patients with extraarticular fai, which is refractory to arthroscopic fai surgery. For children who are at risk of a hip dislocation a varus derotation osteotomy vdro is considered. Single cut distal femoral osteotomy for correction of. Surgical technique surgical steps identify osteotomy site elevate periosteum multiple drill holes ream exfix osteotomy. Twentyseven hips 49% underwent concomitant surgery with the index femoral derotation osteotomy, including hip arthroscopy with labral debridement and chondroplasty in 16 29%, 6 hip arthroscopies with an additional femoral osteochondroplasty 11%, a tibial derotation osteotomy in 7 %, and an ipsilateral periacetabular osteotomy with 3.
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