NDLI: Correction of anteversion in skeletally immature patients: percutaneous osteotomy and transtrochanteric intramedullary rod.

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Correction of anteversion in skeletally immature patients: percutaneous osteotomy and transtrochanteric intramedullary rod.

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Correction of anteversion in skeletally immature patients: percutaneous osteotomy and transtrochanteric intramedullary rod.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Stevens, Peter M. Anderson, Dustin
Description	Country affiliation: United States Author Affiliation: Stevens PM ( Department of Orthopaedics, University of Utah, PO: 58246, Salt Lake City, UT 84158, USA. peter.stevens@hsc.utah.edu)
Abstract	BACKGROUND: There has been reluctance by some surgeons to accept antegrade femoral nailing in children and adolescents due to concerns about producing iatrogenic osteonecrosis or growth disturbance of the femoral neck. Others believe that with the recent advent of pediatric transtrochanteric intramedullary nails, femoral fracture and osteotomy fixation may now safely be accomplished using these devices. Extrapolating from experience treating mature patients, the senior author (P.S.) has adopted the technique of percutaneous femoral osteotomy and transtrochanteric intramedullary fixation in skeletally immature patients as a standard approach for the correction of anteversion, combining this with concomitant surgery as indicated. METHODS: With the institutional review board approval, we reviewed our experience using the Phillips intramedullary rod (EBI/Biomet, Inc, Warsaw, Ind), to secure femoral osteotomies in a series of 30 patients with 40 femoral osteotomies (10 bilateral). The etiologies of anteversion included idiopathic and neuromuscular. There were 10 boys and 20 girls, ranging in age from 8 to 16 years and in weight from 32 to 60 kg. Additional surgical bony and soft tissue procedures were combined as indicated. These included supramalleolar osteotomy, hindfoot stabilization, tendon lengthening or transfers, and hemiepiphysiodesis in select patients. Two of the femoral rotational corrections were combined with shortening. RESULTS: Despite early mobilization without casts, each osteotomy healed primarily in an average of 3 months, and the complication rate was exceedingly low. One patient had removal of a loose distal interlocking screw at 6 weeks postinsertion. By that time, he had formed good callus and had rotational stability; thus, the outcome was not compromised. Importantly, we have not observed osteonecrosis, growth disturbance of the femoral neck, or limb length discrepancy resulting from this treatment method. CONCLUSIONS: In the skeletally immature patient, femoral anteversion can safely be corrected using the Phillips/Biomet antegrade locked intramedullary rod, placed through a transtrochanteric approach; growth disturbance has not been encountered. This device is well tolerated, with a low complication rate. Compared with alternative techniques, recuperation is rapid and fixation problems seen with plates or crossed pins/spica are largely circumvented. The advantages include quadriceps sparing, minimal blood loss, and the use of a load-sharing, low-profile implant. LEVEL OF EVIDENCE: IV (retrospective, clinical).
File Format	HTM / HTML
ISSN	02716798
Issue Number	3
Volume Number	28
e-ISSN	15392570
Journal	Journal of Pediatric Orthopaedics
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2008-04-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Orthopedics Bone Diseases, Developmental Surgery Femur Osteotomy Instrumentation Adolescent Child Equipment Design Female Humans Male Methods Journal Article Multicenter Study
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Pediatrics, Perinatology and Child Health

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