Correction of complex three-dimensional deformities at the proximal femur using indirect reduction with angle blade plate and patient-specific instruments: a technical note

Background Corrective osteotomies for complex proximal femoral deformities can be challenging; wherefore, subsidies in preoperative planning and during surgical procedures are considered helpful. Three-dimensional (3D) planning and patient-specific instruments (PSI) are already established in different orthopedic procedures. This study gives an overview on this technique at the proximal femur and proposes a new indirect reduction technique using an angle blade plate. Methods Using computed tomography (CT) data, 3D models are generated serving for the preoperative 3D planning. Different guides are used for registration of the planning to the intraoperative situation and to perform the desired osteotomies with the following reduction task. A new valuable tool to perform the correction is the use of a combined osteotomy and implant-positioning guide, with indirect deformity reduction over an angle blade plate. Results An overview of the advantages of 3D planning and the use of PSI in complex corrective osteotomies at the proximal femur is provided. Furthermore, a new technique with indirect deformity reduction over an angle blade plate is introduced. Conclusion Using 3D planning and PSI for complex corrective osteotomies at the proximal femur can be a useful tool in understanding the individual deformity and performing the aimed deformity reduction. The indirect reduction over the implant is a simple and valuable tool in achieving the desired correction, and concurrently, surgical exposure can be limited to a subvastus approach.

8-Year-Old Child with Cerebral Palsy Treated with Pelvic Osteotomies Using 3.5 MM Blade Plate Having Subsequent Bilateral Implant Aseptic Loosening: A Case Report

Background: Cerebral palsy (CP) is a central problem of the brain due to neurological insult that affects muscle posture, tone, and movement, resulting in poor motor control and dysfunctional muscle balance affecting hip joints in the growing child. Surgical treatment of hip and, if present, acetabular dysplasia addresses the femoral neck-shaft angle, appropriate muscle lengthening, and deficiency of acetabular coverage, as necessary. The surgeons perform proximal femoral osteotomies (PFOs) mostly with fixed angled blade plates (ABP) with proven success. The technique using an ABP is common and requires detailed attention to perform and to teach. The Case: In this case, an eight-year-old ambulatory patient with CP underwent bilateral proximal varus femoral derotational and pelvic osteotomies for the neuromuscular hip condition with a 3.5 mm Locking Cannulated Blade System (OP-LCP) by OrthoPediatrics Corp instead of the use of the conventional 4.5 mm ABP procedure, resulting in aseptic loosening. Conclusion: Due to the child’s underdeveloped posture, the surgeon utilized the 3.5 mm instrumentation for a child-size implant, which worked sufficiently for the surgery but may not have loosened if a similar child-size blade plate system of 4.5 mm screws was implanted. While the ABP and OP-LCP systems are fruitful and safe for internal corrections of PFOs, the OP-LCP system may aid the residents in learning the procedure with higher confidence, fewer technical inaccuracies, and refined outcomes. Both systems are safer and viable for the treatment of neuromuscular hip conditions.

COMPARISON OF FUNCTIONAL OUTCOME OF DYNAMIC CONDYLAR SCREW AND CONDYLAR BLADE PLATE IN TYPE A FRACTURES OF DISTAL FEMUR IN SKELETALLY MATURUE PATIENTS

ABSTRACT BACKGROUND & OBJECTIVE: Distal femur fractures are increasingly common injuries in today’s orthopedic practice. Early treatment with suitable implant brings in promising functional outcomes. There is a growing debate over the type of implant used in these injuries. Therefore, we have compared two commonly used implants to determine the functional outcomes in search of an implant that has less post op complications, less technically demanding and produces better results. To compare the functional outcome of dynamic condylar screw with condylar blade plate in treatment of distal femur fractures. METHODOLOGY: A total of 372 skeletally mature patients aging 18-60 years of both gender with fracture distal femur (Type A, according to OTA classification) presented within 3 weeks of fracture time were included. Patients meeting inclusion criteria were stratified into two groups having 186 patients each. Group A and Group B. Group A received dynamic condylar screw fixation and in group B, condylar blade plate fixation was preferred. Patients were followed for 3 years and their Functional outcome was evaluated with the help of Lysholm Knee Score. RESULTS: Lysholm knee score after 3 years in group A (Dynamic condylar screw) was excellent (95-100) in 173 patients (76.9%), Good in 33 (17.7 %), Fair in 8 (4.3%), poor in 2 (1.1%).However, group B had Excellent in 57(30.6%), Good in 59(31.7%), Fair in 38 (20.4%), and poor in 32 (17.2%). CONCLUSION: Dynamic condylar screw can be used as an effective treatment with better functional outcome as compared to condylar blade plate in type A fractures of distal femur.

Role of Valgus Osteotomy and Fixation with Double Angle Blade Plate in the Management of Neglected and Ununited Femoral Neck Fracture

Introduction: Femoral neck fracture non union in young patients is a challenging complication as joint replacement is not readily recommended and hip salvageable procedures are relatively unsatisfactory. Valgus intertrochanteric osteotomy described by Pauwels F is one of the treatment options for management of non union of femoral neck in young patients, which was later reciprocated by other surgeons. Aim: To assess the efficacy of valgus osteotomy and fixation with double angle blade plate in the management of neglected and ununited femoral neck fracture. Materials and Methods: This was a prospective cohort study, which included 30 patients of femoral neck fracture non union in whom intertrochanteric valgus osteotomy was performed and fixed with 120° double angled blade plate. The preoperative and postoperative neck-shaft angle was compared using the paired t-test. A p-value of <0.05 indicated statistically significant result. Results: There were 22 males (73.3%) and 8 females (26.7%). Mean age of patients was 35 years. Delay in presentation ranged from 8 weeks to 58 weeks (mean 24 weeks). By Pauwel’s classification, there were 13 Type II fractures and 17 Type III fractures. Mean follow- up was 18 months (12 to 36 months). The mean preoperative neck- shaft angle of 95° (range 80-110°) increased to 132° (range 120- 140°) after surgery. In all patients, there was improvement in leg length discrepancy after osteotomy. Femoral neck fractures united in 25 patients (83.3%). Conclusion: Valgus osteotomy and fixation with 120° double angle blade plate is a reliable method for treating non union femoral neck fracture in young adults. It provides rigid internal fixation and good results.