TECHNIQUE TIP and ON-LINE CMEs
ON-LINE CMEs
ASOPA members with an active OPA-C credential can earn CME credits toward recertification just by reading the “Technique Tip” contained in each issue of the ASOPA Update and answering a few short questions at the conclusion of the article. Members can either answer the questions in the print version of the newsletter and return them via fax or mail to the ASOPA office or submit answers on-line by clicking on the link at the end of each article and completing the on-line questionnaire.
To receive 1 CME (Category IV) for each article read, you must include:
-Your Full Name
-ASOPA Member Number
-Email Address
-Answers to all Questions
-Certification Number
ASOPA will maintain a database with these CME submissions and provide a record of total CMEs earned at the end of each calendar year to all participating members. Members will still be responsible for logging these hours with NBCOPA at the appropriate time for recertification.
TECHNIQUE TIP
Spring 2009 Update
PEDIATRIC LCP HIP PLATING SYSTEM FOR OSTEOTOMIES AND FRACTURE APPLICATIONS
Submitted by: Penny Meadows, OPA-C
Article content provided by Synthes: Instruments and Implants
This article is based on the latest pediatric hip plates available through Synthes versus the older method of using the angled blade plate that was devised and utilized by Dr. M.E. Müller1. This was the standard used by the AO school of surgeons. This implant combined strength with excellent bone stability, but it required extreme accuracy and some surgeons found them difficult to insert and unforgiving2.
In Pediatric Orthopedics the proximal femoral osteotomy has been a staple operation for many years. Some of the problems that can be addressed with this surgery is Developmental Dysplasia of the Hip (DDH), Legg-Calve-Perthes Disease (LCP), Cerebral Palsy and Slipped Capital Femoral Epiphysis (SCFE).
Surgical options to manage these diseases include:
1) Varus Osteotomies as described by Müller1
2) Varus Osteotomies with excision of the lesser trochanter
3) Valgus and valgus rotation osteotomies for femoral heads
4) Rotation osteotomies above or below the lesser trochanter as required2
Other indications are for fixation of fractures of the proximal femur in children, adolescents and small statured adults. Specific indications include: intertrochanteric rotational and/or varus osteotomies, femoral neck and/or pertrochanteric fractures and the osteotomies addressed above.
The Pediatric LCP Hip Plate System is designed to reproduce the strength and hold of the angle blade plates, combining these with versatility and ease of insertion. The placement of the proximal screw is always preceded by guide wire insertion while the locked nature of the screws provides the necessary rigidity. The decision for external splintage, such as a spica cast may not be necessary, but that decision is left to the surgeon.
The Pediatric LCP Hip Plate System is designed for stable fixation of varus, valgus or rotational osteotomies and trauma applications in pediatric orthopaedics and is designed to meet the specific requirements of pedicatric orthopaedic surgery. The locking compression plate technique has now been specifically developed for pediatric cases.
ANGULAR STABILITY: Angular stability reduces the risk of a primary and secondary loss of correction. Limited contact of the plate with the periosteum minimizes damage to the blood supply. Improved connections between screw and plate, as well as within the cortical bone, makes casting unnecessary to the majority of cases, unlike surgery with the angled blade plate.
INTRAOPERATIVE CORRECTION AND FLEXIBILITY: The Pediatric LCP Hip Plate System allows intraoperative corrections. The range of screw lengths allows an optimal fit to each individual situation and provides a high degree of intraoperative flexibility when compared to angled blade plates.
DESIGN: The LCP hip plates have a universal design for the left and right proximal femur. The head of the plate features two treaded holes for locking screws that angle into the femoral neck, in place of the traditional angled blade. An additional diverging calcar screw ensures fixation in the bone.
The 100 degree and 110 degree plates are designed with an offset for osteotomies. The 3.5 mm plate has an 8mm offset and the 5.0 mm plate has a 10 mm offset. The plate shaft features a limited-contact profile and Combi holes. The Combi hole combines a dynamic compression unit (DCU) hole with a locking screw hole. Combi holes provide the choice of axial compression and locking capability throughout the length of the plate shaft.
This plating system follows the four basis AO principles, which have become the guidelines for internal fixation.
1) ANATOMIC REDUCTION: The system combines adequate reduction and optimal protection of soft tissues. The plates are adapted to the anatomy of children and adolescents. This system allows internal fixation of correctional osteotomies of the proximal femur, as well as stabilization of femoral neck and intertrochanteric fractures.
2) STABLE FIXATION: The LCP plate and locking screws create a fixed angle construct, providing angular stability.
3) PRESERVATION OF BLOOD SUPPLY: A limited-contact design reduces plate-to-bone contact and helps to preserve the periosteal blood supply.
4) EARLY, ACTIVE MOBILIZATION: Plate features combined with AO technique create an environment for bone healing and eliminate the need for postoperative casting, expediting return to function.
As with most surgeries, preoperative planning is necessary. When using this system, there are two surgical techniques for applying this plating system.
Option A: Fixed Neck/Shaft Angle Technique
Under Option A, the plate/screw angle defines the final neck shaft angle as the screws are inserted parallel to the axis of the femoral neck. This technique should be followed when the final degree of correction to be achieved corresponds to one of the existing plate angles. Preoperative planning determines the neck/shaft angle correction to be achieved. Further calculations are not necessary. A Varus Osteotomy: 100 degree or 110 degree plate or the Valgus osteotomy would use the 150 degree plate. The plate size is determined on the basis of the patient’s age, weight and anatomy.
Option B: Calculated Neck/Shaft Angle Technique
Under Option B: This technique is used when the desired final neck shaft angle differs from one of the plate/screw angles. The technique is derived from the original “Müller” osteotomy technique. Determine the preoperative and the desired neck/shaft angle prior to surgery and calculate the correction angle. To prevent rotational error, the angle must be defined on a view with neutral version. Correction angle = neck/shaft angle postoperative. This correction angle calculation will be necessary, when positioning the K-wire with the adjustable wire guide. Again, the plate size is determined on the basis of the patient’s age, weight, and anatomy
OPERATIVE POSITIONING: Position the patient supine or lateral on a radiolucent operating table. Obtain AP views of the hip under image intensification. Also obtain frogleg lateral views of the hip by flexing and abducting the leg.
APPROACH: Use a standard lateral approach to the proximal femur.3
As with any new technology, it is advisable to have contacted your Synthes Representative and advise him/her of your preoperative planning, surgery time, location and any addition information that may help him to have available the instrumentation that will be necessary for a positive outcome.
If anyone would like any additional information on this Pediatric Plating System, please contact Penny Meadows at catpenny18@aol.com and she will be happy to see that you get it.
 |
 |
| X-ray, Case 1: 11-year old female with severe in-toeing. Anterior-Posterior and Abduction Internal Rotation (AIR) views demonstrate coax valga with poor coverage of the femoral heads. Varus rotational intertrochanteric osteotomies were preformed using 110°, 5.0 mm Pediatric LCP Hip Plates (02.108.321). Full weight bearing was allowed 6 weeks postoperative. |
X-ray, Case 2: 3-year old female with progressive hip subluxation secondary to a neuromuscular condition. Radiographs show bilateral acetabular dysplasia, subluxation of the femoral head, and marked femoral neck valgus. Bilateral varus osteotomies were preformed with 110°, 3.5 mm Pediatric LCP Hip Plates (02.108.311), combined with a triple osteotomy of the right pelvis. No hip spica was used and full weight bearing was allowed 5 weeks postoperative. |
REFERENCES:
1) ME Müller, “Intertrochanteric Osteotomy: Indication, PreOperative Planning Technique. In: Schatzker J, ed. The Intertrochanteric Osteotomy Berlin: Springer Ver, 1984, 25-66. Foreword written by James B. Hunter, BA, FRCSEd (Orth) Consultant Trauma and Pediatric Orthopedic Surgeon, Queen’s Medical Centre, Nottingham, UK
2) ME Müller, M. Allgower, R. Schneider, H. Willenegger: AO Manual of Internal Fixation, 3rd Edition. Berlin; Springer-Verlag. 1991
3) Raymond T. Morrissy, Atlas of Pediatric Orthopedics Surgery. Philadelphia: J. B. Lippincott Company 1992
This article/information has been provided by Synthes: Instruments and Implants approved by the AO Foundation for the Pediatric LCP Hip Plate. For osteotomty and trauma applications in the proximal femur.
CLICK HERE TO ANSWER QUESTIONS ABOUT THIS ARTICLE AND OBTAIN 1 CME CREDIT
|
