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

Background: 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. Methods: 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. Results: In all cases, each osteotomy healed in an average of 12 weeks (range, 10-14). The mean femoral anteversion by TPAT improved to 12 (range, 5 -30) after surgery from 44 (range, 30 -65) (p < 0.001). There were no complications of deep infection, implant failure, or limb length discrepancy over 1 cm. Conclusions: In skeletally immature patients with cerebral palsy, femoral anteversion can be safely corrected using submuscular plating with a locking compression plate.