Rotational osteotomy with submuscular plating in skeletally immature patients with cerebral palsy

In cerebral palsy, intoeing gait with increased femoral anteversion is not uncommon and often requires surgical intervention. Although several conventional methods have been used, complications are common. We applied a new technique of rotational osteotomy with submuscular plating in skeletally immature patients with cerebral palsy. Eighteen patients (26 femora, 8 bilateral) with a mean age of 8.7 years (range, 6-16) were prospectively treated with this technique. The anatomic distribution of patients was hemiplegia (n = 7), diplegia (n = 8), and asymmetric diplegia (n = 3). Percutaneous osteotomy was performed at the middle of the femoral shaft. After rotational correction, submuscular plating was done using a locking compression plate. Femoral anteversion was evaluated by a trochanteric prominence angle test (TPAT) and computed tomography. In all cases, each osteotomy healed in an average of 12 weeks (range, 10-14). The mean femoral anteversion by TPAT improved to 12A degrees (range, 5A degrees-30A degrees) after surgery from 44A degrees (range, 30A degrees-65A degrees) (p < 0.001). There were no complications of deep infection, implant failure, or limb length discrepancy over 1 cm. In skeletally immature patients with cerebral palsy, femoral anteversion can be safely corrected using submuscular plating with a locking compression plate.