Asian Journal of Orthopaedic Research

Proximal Femoral Derotational Osteotomy in a 14-Year-old Patient with Cerebral Palsy: Osteosynthesis Material Failure Three Weeks Postoperative

Nader Fadi *

Orthopaedics and Trauma, Universite Paris Cite, Paris, France and Orthopedic Surgery, Faculty of Medical Science, Lebanese University, Lebanon.

Yazbeck Rime

General Pediatrics, Saint George Hospital University Medical Center, Lebanon.

H. Fares Ali

Sport Surgery, Clinique Du Sport, Ramsay Sante, Paris, France and Orthopedic Surgery, Grenoble Alpes University, Grenoble, France.

Sleiman Mohamad Ali

Orthopedic Surgery, Faculty of Medical Science, Lebanese University, Lebanon.

Massaad Dounia

Orthopaedic Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Massaad Antonella

Orthopaedic Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Massaad Raymond

Orthopedic Surgery, West Bekaa General Hospital, Sohmor, Lebanon.

*Author to whom correspondence should be addressed.

---

Abstract

Cerebral palsy (CP) is a group of disorders that affect a person's ability to move and maintain balance and posture. Excessive femoral internal rotation is one of the gait problems encountered and can be corrected by femoral derotation osteotomy.

We present here the case of 14 years old boy, known to have cerebral palsy, with increased femoral anteversion treated with proximal subtrochanteric femoral de-rotation osteotomy fixed with plate and screws.

He experienced a catastrophic failure of the plate. First time revision was done with a dynamic hip screw sliding plate, second time revision was done for pseudarthrosis and consisted  of adding a dynamic compression plate (DCP) on the anterior cortex to increase the fixation stability.

As a conclusion, a robust system should be utilized when trying to osteosynthesis fractures near spastic muscles, and tenotomy should be added whenever needed without hesitation.

Keywords: Cerebral palsy, Femoral Derotation Osteotomy, plate osteosynthesis, failure, children

---

---

---

References

Hallman-Cooper JL, Rocha Cabrero F. Cerebral Palsy. 2022 Oct 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 30844174.

Schwartz MH, Rozumalski A, Novacheck TF. Femoral derotational osteotomy: surgical indications and outcomes in children with cerebral palsy. Gait Posture. 2014;39(2):778-83. DOI: 10.1016/j.gaitpost.2013.10.016. Epub 2013 Oct 27. PMID: 24268697

Gage JR, Novacheck TF. An update on the treatment of gait problems in cerebral palsy. J Pediatr Orthop B. 2001 Oct;10(4):265-74. PMID: 11727367

Nelitz M. Femoral Derotational Osteotomies. Curr Rev Musculoskelet Med. 2018 Jun;11(2):272-279. doi: 10.1007/s12178-018-9483-2. PMID: 29696606; PMCID: PMC5970118.

Shore BJ, Zurakowski D, Dufreny C, Powell D, Matheney TH, Snyder BD. Proximal Femoral Varus Derotation Osteotomy in Children with Cerebral Palsy: The Effect of Age, Gross Motor Function Classification System Level, and Surgeon Volume on Surgical Success. J Bone Joint Surg Am. 2015 Dec 16;97(24):2024-31. DOI: 10.2106/JBJS.O.00505

PMID: 26677236.

Hau R, Dickens DR, Nattrass GR, O'Sullivan M, Torode IP, Graham HK. Which implant for proximal femoral osteotomy in children? A comparison of the AO (ASIF) 90 degree fixed-angle blade plate and the Richards intermediate hip screw. J Pediatr Orthop. 2000 May-Jun;20(3):336-43. PMID: 10823601.

Ruzbarsky JJ, Swarup I, Garner MR, Meyers KN, Edobor-Osula F, Widmann RF, et al. Biomechanical comparison of two pediatric blade plate designs in proximal femoral osteotomies. HSS Journal ®. 2019;16(1):81–5.

Chung MK, Kwon SS, Cho BC, Lee GW, Kim J, Moon SJ, Lee JW, Chung CY, Sung KH, Lee KM, Park MS. Incidence and risk factors of hardware-related complications after proximal femoral osteotomy in children and adolescents. J Pediatr Orthop B. 2018 May;27(3):264-270. DOI: 10.1097/BPB.0000000000000448 PMID: 28277416.

Scorcelletti M, Reeves ND, Rittweger J, Ireland A. Femoral anteversion: significance and measurement. J Anat. 2020 Nov;237(5):811-826. DOI: 10.1111/joa.13249. Epub 2020 Jun 24 PMID: 32579722 PMCID: PMC7542196

Loh B, Coates A, Woollett E. Paediatric rotational abnormalities: A Primer. Australian Journal of General Practice. 2021;50(3):132–5.

Dong C, Hao K, Zhao C, Wang F. A new factor predicting excessive femoral anteversion in patients with recurrent patellar dislocation. Journal of Orthopaedic Surgery and Research. 2022;17(1).

Steensen RN, Bentley JC, Trinh TQ, Backes JR, Wiltfong RE. The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation: a magnetic resonance imaging study. Am J Sports Med. 2015 Apr;43(4): 921-7. DOI: 10.1177/0363546514563904 Epub 2015 Jan 13 PMID: 25587185.