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. 2018 Oct 10;53(6):674-680.
doi: 10.1016/j.rboe.2017.09.009. eCollection 2018 Nov-Dec.

The use of pediatric locked plates in the paralytic hip: preliminary results of 61 cases

Frederico Coutinho de Moura Vallim  1   2 , Henrique Abreu da Cruz  1 , Ricardo Carneiro Rodrigues  1 , Caroline Sandra Gomes de Abreu  1 , Eduardo Duarte Pinto Godoy  1 , Marcio Garcia Cunha  1
Affiliations

The use of pediatric locked plates in the paralytic hip: preliminary results of 61 cases

Frederico Coutinho de Moura Vallim et al. Rev Bras Ortop. .

Abstract
in English, Portuguese

Objective: To evaluate the clinical and radiologic results of proximal femoral varus derotational and shortening osteotomy (OVRF) (Port., doesn't match name) with the use of a locked plate in patients with cerebral palsy, classified by the gross motor functional classification system as class IV or V.

Methods: A retrospective study of 42 patients (61 hips) with cerebral palsy, gross motor functional classification system class IV or V, submitted to OVRF. The minimal follow up was 24 months. This study evaluated clinical (age at surgery, gender, Gross Motor Functional Classification System class, anatomical cerebral palsy classification, and motor pattern), pre- and post-operative radiological (neck shaft angle, acetabular index, Reimers migration index and time until bone healing) characteristics, as well as post-operative complications.

Results: Mean pre-operative cervicodiaphyseal angle, acetabular index, and Reimers migration index were respectively 121.6°, 22.7°, and 65.4% in uncomplicated cases, and 154.7°, 20.4°, and 81.1% in complicated ones. All parameters were statistically significant difference between pre- and postoperative values (p < 0.05). The patients with postoperative complications had a greater cervicodiaphyseal angle and Reimers migration index (p < 0.0001). There were no differences in clinical characteristics, time of immobilization, or bone healing. Fourteen patients had postoperative complications (33.3%), but only six required surgical treatment.

Conclusion: The locked plate is a safe resource, with low complication rates and reproducible technique for OVRF in the cerebral palsy population classified as gross motor functional classification system IV and V. Greater cervicodiaphyseal angles and Reimers migration index are associated with greater chances of postoperative complications, as well as gross motor functional classification system V classification.

Objetivo: Avaliar os resultados clínicos e radiológicos da osteotomia varizante, de rotação e encurtamento da extremidade proximal do fêmur (OVRF) com uso de placa bloqueada em pacientes com paralisia cerebral classificados pela escala Gross Motor Functional Classification System como IV e V.

Métodos: Estudo retrospectivo de 42 pacientes (61 quadris) com paralisia cerebral, Gross Motor Functional Classification System IV e V, submetidos a OVRF. O seguimento mínimo pós-operatório foi de 24 meses. Foram avaliadas as características clínicas (idade na data da cirurgia, sexo, Gross Motor Functional Classification System, classificação geográfica da paralisia cerebral, padrão de acometimento motor), radiológicas pré e pós-operatórias (ângulo cérvico-diafisário [ACD], índice acetabular [IA], índice de Reimers [MP] e tempo até a consolidação radiológica) e complicações pós-operatórias.

Resultados: O ângulo cérvico-diafisário, índice acetabular e o índice de Reimers médios pré-operatórios foram respectivamente de 121,6 o, 22,7 o e 65,4% nos casos não complicados, vs. 154,7 o, 20,4 o e 81,1% nos que evoluíram com complicações pós-operatórias. Todos os parâmetros apresentaram diferença significativa entre os valores pré e pós-operatórios (p < 0,05). O ângulo cérvico-diafisário e o índice de Reimers foram maiores no grupo com complicações (p < 0,0001). Não houve diferenças nas características clínicas, no tempo de imobilização ou consolidação, exceto em relação ao grau Gross Motor Functional Classification System V (p < 0,0001). Foram observadas complicações pós-operatórias em 14 pacientes (33,3%). Desses, somente seis necessitaram reintervenção cirúrgica.

Conclusão: A placa bloqueada é um recurso seguro, com baixa taxa de complicações cirúrgicas e de técnica reprodutível para a OVRF na paralisia cerebral Gross Motor Functional Classification System IV e V. Maiores ângulos cérvico-diafisário, índices de Reimers e graus de Gross Motor Functional Classification System V estão ligados a maiores chances de complicações pós-operatórias.

Keywords: Cerebral palsy; Femur; Hip dislocation; Osteotomy; Reconstructive surgical procedures.

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Figures

Fig. 1
Fig. 1
Anteroposterior radiographic images in the preoperative period (left) and at 2 years postoperative (right) of a patient undergoing bilateral hip reconstruction (VDSO + open reduction + bilateral Dega type supra-acetabular osteotomy).
Fig. 2
Fig. 2
Association of radiological factors with the incidence of postoperative complications. CDA, cervicodiaphyseal angle; AI, acetabular index; RMI, Reimers’ migration index. Percentage of lateral migration of the femoral head. aStatistically significant difference between groups with and without complication (p < 0.0001). bStatistically significant difference between pre and postoperative values (p < 0.05).
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