Locking-compression plate (LCP) or angled blade plates (ABP) for femoral osteotomies in children with spastic cerebral palsy (CP) gross motor function classification system (GMFCS) III, IV, and V

Purpose To compare hardware-related complications and intraoperative variables between locking compression plates (LCP) and angled blade plates (ABP) used for proximal and/or distal femoral osteotomies in patients with spastic cerebral palsy (CP) classified as Gross Motor Function Classification System (GMFCS) III–V. Methods A retrospective cohort study was conducted, including patients younger than 18 years with spastic CP (GMFCS III–V) who underwent proximal and/or distal femoral osteotomies between 2015 and 2022. Demographic variables, plate type, operative time, blood loss, and hardware-related complications (implant failure, peri-implant fracture, and non-union) were recorded. Comparisons between groups were performed using generalized linear mixed-effects models to account for patients with multiple procedures. Results A total of 285 patients were included, with a mean follow-up of 23 months. Twenty-six complications occurred in 24 patients: 12 in the LCP group (4.9%) and 14 in the ABP group (3.6%). No significant differences were observed in overall complication rates between plate types for femoral osteotomies. All peri-implant fractures, implant failures, and non-unions at the distal femur were with ABP. LCP fixation was associated with longer operative time and greater blood loss. Conclusions LCP and ABP demonstrate comparable hardware-related complication rates in children with CP undergoing femoral osteotomies. Recommendations on hardware selection for distal femoral osteotomy warrant larger studies in non-ambulatory patients. Significance of Findings Proximal femoral osteotomies in patients with CP can be performed with either hardware, with comparable complication rates; however, the focus of future studies should be on plate types for the distal femur.