Femoral Rotational Osteotomy

  Our daughter, Nicole, age 4.5 was born with CP..specifically Spastic Diplegia. She has endured a Selective Dorsal Rhizotomy performed in Feb. 1998. Our Orthopedic Surgeon has since recommended a Femoral Rotational Osteotomy to correct Nicole's severe in-toeing. Could you describe this (FRO) procedure and possible complications ?
  Thanks in advance,
  Dave

[HFHS.RN-AM]

Dear Dave,
There can be a number of causes of in-toeing in a child with spastic diplegia. The primary cause is internal tibial torsion, that a Femoral Derotational Osteotomy wont correct.  The surgery in this case would be a Tibial Derotational Osteotomy. If the problem is indeed at the hip level, a Femoral Derotational Osteotomy is usaully performed near the upper thigh bone.  The surgeon externally rotates the length of the leg by cutting through the femur and externally rotating the lower segment to correct the rotational abnormality. Usually internal fixation with a blade plate and screws is used and the child is immobilized in a hip spica cast for 4-6 weeks.
Potential complications include loss of the internal fixation, failure of union of the bone, infection, and complications from anesthesia.
HFHS.RN-AM
*KEYWORD: Spastic Diplegia, Femoral Derotational Osteotomy, Tibial Derotational Osteotomy, Cerebral Palsy, Orthopedic Surgery