Blade plate

At our institution, hip reconstructive surgery including FVO is performed in displaced hips with a migration percentage (MP) of > 33%. All patients underwent medial soft tissue release of the adductor longus tendon; if the abduction angle obtained was not > 30°, additional soft-tissue release, including of the adductor brevis, gracilis, and pectineus, was performed [16 (link)]. For the contralateral stable hip (MP ≤ 33%), prophylactic FVO was routinely performed. All patients underwent FVO and the osteotomy site was internally fixated with a pediatric locking compression plate (Synthes, Zuchwil, Switzerland) or a blade plate (Stryker, Selzach, Switzerland) according to the surgeon’s preference. After FVO, if concentric reduction was not achieved on intraoperative fluoroscopic examination, open reduction of the hip joint including capsulorrhaphy, removal of the ligamentum teres and pulvinar, and resection of the transverse acetabular ligament was additionally performed. In cases of radiographic findings of acetabular defects preoperatively, a modified Dega pelvic osteotomy was performed [18 (link), 19 (link)]. Postoperatively, a short leg cast and abduction bar were applied to maintain hip abduction position for 4–6 weeks. Hardware removal was performed more than 6 months after the initial operation.

At our hospital, hip reconstructive surgeries, including Dega pelvic osteotomy and FVO, were performed in displaced hips by two pediatric orthopedic surgeons. Hip reconstructive surgery was indicated in patients with a migration percentage (MP) of more than 33%. For FVO, the osteotomy site at the intertrochanteric level was fixated using a blade plate (Stryker, Selzach, Switzerland) or a pediatric locking compression plate (Depuy Synthes, MA, USA). For Dega pelvic osteotomy, the osteotomy site was widened using a laminar spreader until sufficient coverage of the femoral head was achieved under C-arm fluoroscopy. A tricortical iliac crest allograft was trimmed and inserted into the osteotomy site. Internal fixation of the bone graft was not performed. After surgery, bilateral short leg cast with an abduction bar were applied to maintain hip abduction position for 6 weeks. [20 (link)] Thereafter, all patients returned to a local rehabilitation center to begin standing and weight-bearing exercises.