New femoral derotation technique based on guided growth in children

Abstract

Derotation osteotomy is the only available treatment for medial femoral torsion in paediatric patients. To eliminate the need for postoperative immobilisation and to allow immediate weight bearing, we suggest a new technique that guides femoral growth. The goal is to convert part of the axial growth into rotation by placing a system composed of two screws and a cable around the distal femoral physis. We used this percutaneous technique to treat 20 knees in 11 children. The preliminary outcomes indicate good efficacy with about 1.2° of derotation per month and a total mean derotation of 25° over 22 months. Postoperative stiffness was the main complication but resolved with physical therapy. This technique may therefore constitute an alternative to derotation osteotomy.

Keywords: Children; Guiding rotational growth; Torsional growth modulation.