Introduction Reorientational osteotomy of the proximal part of the femur for children with arthrogryposis repositions the various arcs of hip motion into a more functional sphere of motion, addressing the hip contractures that otherwise are the main mechanical impediments to ambulation.
Indications & Contraindications
Step 1: Preoperative Assessment Determine hip range of motion clinically and obtain radiographs to confirm that the hips are located and there are no unusual structural abnormalities.
Step 2: Patient Positioning and Draping Position the patient supine with a bump at the sacrum, and drape to allow access to both hips simultaneously.
Step 3: Initial Percutaneous Anterior Hip Release Perform an initial anterior hip release for patients with a palpable soft-tissue flexion contracture.
Step 4: Surgical Approach to the Proximal Part of the Femur Make a standard approach to the lateral aspect of the proximal part of the femur.
Step 5: Blade-Plate Positioning Position a guidewire for the appropriate correction; then cut a track for the blade plate with a seating chisel.
Step 6: Wedge-Shaped Intertrochanteric Osteotomy Perform 2 intertrochanteric osteotomy cuts to provide cut surfaces that, when joined together, will position the lower extremity optimally.
Step 7: Applying the Blade Plate and Closure Impact the blade plate into the proximal fragment and secure it to the distal fragment.
Step 8: Postoperative Management Apply a Petrie cast, and instruct the parents on how to maintain hip motion.
Step 9: Plate Removal Remove the blade plate on an outpatient basis 12 to 18 months after the osteotomy, through the smallest incision possible to allow a quicker recovery.
Results We performed reorientational osteotomies on 68 consecutive children with arthrogrypotic multiplanar hip contractures over a 5-year span, and 65 were followed for at least 2 years; 54 of these patients had a bilateral hip contracture, for a total of …
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