The Locking Compression Paediatric Hip Plate: technical guide and critical analysis

Abstract

Purpose: Osteotomies of the proximal femur and stable fixation of displaced femoral neck fractures are demanding operations. An LCP Paediatric Hip Plate was developed to make these operations safer and less demanding. The article focuses on the surgical technique and critically analyses the device.

Methods: Between 2006 and 2008, 30 hips in 22 patients underwent surgery. Patients' demographics, perioperative details, postoperative outcome and complications were retrospectively collected and analysed.

Results: Patients' diagnoses included persistent congenital hip dysplasia (n = 4), neuropathic hip dysplasia (n = 9), idiopathic ante/retroversion (n = 8), femoral neck fracture (n = 3), Perthes' disease (n = 2), deformity after slipped capital femoral epiphysis (SCFE), congenital femoral neck pseudarthrosis, deformity after pelvic tumour resection and malunion following proximal femoral fracture (one each). In 21 of 22 patients, the postoperative radiographs showed corrections as planned. Two cases had to be revised for screw loosening. Intraoperative handling using the plate was excellent in all cases.

Conclusions: In our case series of 30 hip operations, the LCP Paediatric Hip Plate was shown to be safe and applicable in the clinical setting with excellent results and a low complication rate. We consider that the LCP Paediatric Hip Plate is a valuable device for correction of pathological conditions of the proximal femur and for fixation of displaced femoral neck fractures in children. Larger studies should be carried out to better quantify the risk of clinically relevant complications.

Fig. 1

a, b Correct placement of the so-called anteversion Kirschner wire. c How to set the preoperative calculated positioning wire angle on the positioner for the aiming block. d Correct placement of the aiming block and the positioning Kirschner wire on the lateral aspect of the proximal femur

Fig. 2

a, b Insertion of the Kirschner guide wires with the help of the aiming block in the femoral shaft. c Optimal positioning of the osteotomy. d Fixation of the proximal fragment to the plate (to a 3.5 varus plate in this bone model). The two Kirschner wires in the ventral aspect of the femur in the proximal and distal fragments are inserted in case a derotation is planned together with the varus correction

Fig. 3

Additional medialisation by using the medialisation device. a Fixation of both devices on the plate. b, c After medialisation, stepwise refixation of the plate by refixation of the locking screws. d Final result

Fig. 4

A 4-year-old girl with cerebral palsy. a Bilateral subluxation due to valgus deformity of the femoral shaft. b A bilateral intertrochanteric varus osteotomy together with a derotation was performed. c The postoperative course was uneventful, and the plates could be removed bilaterally 5 months after the initial operation

Fig. 5

a A 9.5-year-old girl with bilateral idiopathic retroversion of 10°. b A bilateral derotation osteotomy was done and fixed by a 3.5-mm 120° LCP Paediatric Hip Plate. c Two weeks after the operation, the girl complained of right-sided pain in the proximal femur. The X-ray showed loosening of the femoral shaft screws from the DC holes. d A revision was performed to change and refix the plate. The further course was uneventful with plate removal 10 months after the initial operation