[Modified neck-lengthening osteotomy after Morscher in children and adolescents].

OBJECTIVE

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.

INDICATIONS

All symptomatic deformities of the proximal femur with a shortened femoral neck and a proximal displacement of the greater trochanter.

CONTRAINDICATIONS

Bacterial coxitis within the last two years; elevated infections parameters. Acetabular dysplasia with a lack of femoral head containment.

SURGICAL TECHNIQUE

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).

POSTOPERATIVE MANAGEMENT

Full weight bearing to a body weight of 55 kg; partial weight bearing with a body weight >55 kg for 6 weeks.

RESULTS

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.