Modified neck-lengthening osteotomy after Morscher in children and adolescents

• Published in: Operative Orthopädie und Traumatologie 2018-10, Vol.30 (5), p.379-386
• Main Authors: Placzek, R, Gathen, M, Koob, S, Jacobs, C, Ploeger, M M
• Format: Article
• Language: ger
• Subjects: Adolescent; Arthritis, Infectious - complications; Arthritis, Infectious - surgery; Biomechanical Phenomena; Bone Plates; Child; Female; Femur - abnormalities; Femur - physiopathology; Femur - surgery; Femur Neck - abnormalities; Femur Neck - physiopathology; Femur Neck - surgery; Hip Dislocation, Congenital - complications; Hip Dislocation, Congenital - surgery; Hip Joint - surgery; Humans; Legg-Calve-Perthes Disease - complications; Legg-Calve-Perthes Disease - surgery; Osteotomy - methods; Treatment Outcome
• ISSN: 1439-0981
• DOI: 10.1007/s00064-018-0561-9

Growth disorders (e. g. caused by congenital hip dislocation, Perthes disease or bacterial coxitis) often lead to an infantile deformity of the proximal femur with a shortened femoral neck and displaced grater trochanter. In 1988, Morscher and Buess described a femoral neck lenghtening osteotomy for treatment of adults. For the first time, we show a modification of this osteotomy for children and adolescents with a locking plate system. The aim is to restore the normal anatomy of the femoral neck and biomechanics of the proximal femur. All symptomatic deformities of the proximal femur with a shortened femoral neck and a proximal displacement of the greater trochanter. Bacterial coxitis within the last two years; elevated infections parameters. Acetabular dysplasia with a lack of femoral head containment. Two osteotomies: one at the level of the greater trochanter to transfer it. The second osteotomy at the level of the distal femoral neck. Stabilization with a locking plate system (LCP Pediatric Hip Plate 130°, Synthes, Oberdorf, Switzerland). Full weight bearing to a body weight of 55 kg; partial weight bearing with a body weight >55 kg for 6 weeks. No intraoperative or postoperative complications were observed in 5 female patients (mean age 11.67 years). After a follow-up of 6-12 weeks, none of the patients presented a Trendelenburg's sign. After 3-6 months, full range of motion was possible.