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Vogt B, Rölfing JD, Rödl R, Tretow H. [Options and limits of leg length correction in paediatric orthopaedics]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:719-728. [PMID: 37561147 DOI: 10.1007/s00132-023-04420-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/11/2023]
Abstract
For paediatric orthopaedic surgeons treating leg length discrepancy, knowledge of the available procedures and their options and limits is just as important as mastery of the very different surgical methods and implants, as well as the possible complications, in order to be able to advise and treat the children and adolescents and their parents comprehensively and in the best interests. Both the growth inhibiting procedures and the complex bone lengthening procedures require a great deal of experience to successfully guide patients and families through what is often a lengthy and sometimes complicated treatment process. Careful preoperative indications and planning, precise surgical techniques with suitable instruments and implants, and attentive postoperative check-ups are mandatory prerequisites for the desired therapeutic success.
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Affiliation(s)
- Björn Vogt
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland.
| | - Jan Duedal Rölfing
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland
- Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Aarhus, Dänemark
| | - Robert Rödl
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland
| | - Henning Tretow
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland
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Vogt B, Hvidberg E, Rölfing JD, Gosheger G, Møller-Madsen B, Abood AA, Weyer-Elberich V, Laufer A, Toporowski G, Roedl R, Frommer A. Radiographic reference values of the central knee anatomy in 8-16-year-old children. Acta Orthop 2023; 94:393-398. [PMID: 37522246 PMCID: PMC10388364 DOI: 10.2340/17453674.2023.15336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND AND PURPOSE For correction of leg-length discrepancy or angular deformity of the lower limb in skeletally immature patients temporary or permanent (hemi-)epiphysiodesis can be employed. These are reliable treatments with few complications. Recently, radiographic analysis of treatment-related alterations of the central knee anatomy gained interest among pediatric orthopedic surgeons. To date the comparison and adequate interpretation of potential changes of the central knee anatomy is limited due to the lack of defined standardized radiographic references. We aimed to establish new reference values of the central knee anatomy. PATIENTS AND METHODS A retrospective analysis of calibrated longstanding anteroposterior radiographs of 254 skeletally immature patients with a chronological age ranging from 8 to 16 years was conducted. The following radiographic parameters were assessed: (1) femoral floor angle, (2) tibial roof angle, (3) width at femoral physis, and (4) femoral notch-intercondylar distance. RESULTS All observed radiographic parameters were normally distributed with a mean age of 12.4 years (standard deviation [SD] 2, 95% confidence interval [CI] 12.2-12.6). Mean femoral floor angle was 142° (SD 6, CI 141.8-142.9), mean tibial roof angle was 144° (SD 5, CI 143.7-144.1), mean width at femoral physis was 73 mm (SD 6, CI 72.8-73.9), and mean femoral notch-intercondylar distance was 8 mm (SD 1, CI 7.5-7.7). The estimated intraclass correlation coefficient values were excellent for all measurements. CONCLUSION This study provides new radiographic reference values of the central knee anatomy for children between 8 and 16 years and we suggest considering values within the range of 2 SD as the physiological range.
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Affiliation(s)
- Bjoern Vogt
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany.
| | - Emma Hvidberg
- Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark
| | - Jan Duedal Rölfing
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark
| | - Georg Gosheger
- General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Bjarne Møller-Madsen
- Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark
| | - Ahmed A Abood
- Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark
| | | | - Andrea Laufer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Gregor Toporowski
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Robert Roedl
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | - Adrien Frommer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
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Frommer A, Niemann M, Gosheger G, Eveslage M, Toporowski G, Laufer A, Ackmann T, Roedl R, Vogt B. Temporary Proximal Tibial Epiphysiodesis for Correction of Leg Length Discrepancy in Children-Should Proximal Fibular Epiphysiodesis Be Performed Concomitantly? J Clin Med 2021; 10:jcm10061245. [PMID: 33802874 PMCID: PMC8002647 DOI: 10.3390/jcm10061245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/04/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022] Open
Abstract
The need for concomitant proximal fibular epiphysiodesis (PFE) when correcting leg length discrepancy (LLD) with temporary proximal tibial epiphysiodesis (PTE) in children is controversially discussed. This single center, retrospective cohort study analyzes proximal fibular growth in patients treated by PTE with and without concomitant PFE. Radiographic measurements were conducted before implantation and at implant removal. The position of the fibular head in relation to the tibia was assessed with recently established radiographic reference values. All patients (n = 58, 19 females) received PTE to treat LLD at a mean age of 12.2 years (range 7 to 15). In 27/58 (47%) concomitant PFE was performed. Mean follow-up was 36.2 months (range 14.2 to 78.0). The position of the proximal fibula at implant removal was within physiological range in 21/26 patients (81%) with PFE and in 21/30 patients (70%) without PFE. Proximal fibular overgrowth newly developed in 2/26 patients (8%) treated with PFE and in 5/30 patients (17%) treated without PFE (p = 0.431). Peroneal nerve injury or discomfort due to proximal fibular overlength was not reported. The position of the proximal fibula should be critically assessed preoperatively under consideration of reference values before PTE. In consequence of this study, the authors do not routinely perform PFE concomitantly with PTE for correction of moderate LLD in children if the proximal fibula is localized within physiological radiographic margins determined by the established reference values.
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Affiliation(s)
- Adrien Frommer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany; (M.N.); (G.T.); (A.L.); (R.R.); (B.V.)
- Correspondence: ; Tel.: +49-251-83-47909
| | - Maike Niemann
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany; (M.N.); (G.T.); (A.L.); (R.R.); (B.V.)
| | - Georg Gosheger
- General Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, Germany; (G.G.); (T.A.)
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany;
| | - Gregor Toporowski
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany; (M.N.); (G.T.); (A.L.); (R.R.); (B.V.)
| | - Andrea Laufer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany; (M.N.); (G.T.); (A.L.); (R.R.); (B.V.)
| | - Thomas Ackmann
- General Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, Germany; (G.G.); (T.A.)
| | - Robert Roedl
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany; (M.N.); (G.T.); (A.L.); (R.R.); (B.V.)
| | - Bjoern Vogt
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany; (M.N.); (G.T.); (A.L.); (R.R.); (B.V.)
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