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Stief F, Holder J, Braun S, Brenneis M, van Drongelen S, Byrnes SK, Layher F, Dussa CU, Meurer A, Böhm H. Relevance of instrumented gait analysis in the prediction of the rebound phenomenon after guided growth intervention. Sci Rep 2024; 14:16060. [PMID: 38992006 PMCID: PMC11239906 DOI: 10.1038/s41598-024-66169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024] Open
Abstract
Predictors of rebound after correction of coronal plane deformities using temporary hemiepiphysiodesis (TH) are not well defined. The following research questions were tested: (1) Is the dynamic knee joint load useful to improve rebound prediction accuracy? (2) Does a large initial deformity play a critical role in rebound development? (3) Are BMI and a young age risk factors for rebound? Fifty children and adolescents with idiopathic knee valgus malalignment were included. A deviation of the mechanical femorotibial angle (MFA) of ≥ 3° into valgus between explantation and the one-year follow-up period was chosen to classify a rebound. A rebound was detected in 22 of the 50 patients (44%). Two predictors of rebound were identified: 1. reduced peak lateral knee joint contact force in the first half of the stance phase at the time of explantation (72.7% prediction); 2. minor initial deformity according to the MFA (70.5% prediction). The best prediction (75%) was obtained by including both parameters in the binary logistic regression method. A TH should not be advised in patients with a minor initial deformity of the leg axis. Dynamic knee joint loading using gait analysis and musculoskeletal modeling can be used to determine the optimum time to remove the plates.
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Affiliation(s)
- Felix Stief
- Department of Trauma Surgery and Orthopedics, University Hospital, Goethe University Frankfurt, Marienburgstraße 2, 60528, Frankfurt/Main, Germany.
- Berufsgenossenschaftliche Unfallklinik Frankfurt/Main, Friedberger Landstraße 430, 60389, Frankfurt/Main, Germany.
| | - Jana Holder
- Department of Trauma Surgery and Orthopedics, University Hospital, Goethe University Frankfurt, Marienburgstraße 2, 60528, Frankfurt/Main, Germany
- Department of Sport and Exercise Science, University of Salzburg, Schlossallee, 5400, Hallein, Salzburg, Austria
| | - Sebastian Braun
- Department of Trauma Surgery and Orthopedics, University Hospital, Goethe University Frankfurt, Marienburgstraße 2, 60528, Frankfurt/Main, Germany
- Center for Musculoskeletal Surgery, University Hospital, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charité -Universitätsmedizin Berlin, Rahel-Hirsch-Weg 5, 10117, Berlin, Germany
| | - Marco Brenneis
- Department of Trauma Surgery and Orthopedics, University Hospital, Goethe University Frankfurt, Marienburgstraße 2, 60528, Frankfurt/Main, Germany
| | - Stefan van Drongelen
- Department of Trauma Surgery and Orthopedics, University Hospital, Goethe University Frankfurt, Marienburgstraße 2, 60528, Frankfurt/Main, Germany
| | - S Kimberly Byrnes
- Orthopaedic Children's Hospital, Bernauer Straße 18, 83229, Aschau I. Chiemgau, Germany
- Institute for Conservative and Rehabilitative Orthopedics, Department of Sports and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Frank Layher
- Orthopedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Chakravarthy U Dussa
- Orthopaedic Children's Hospital, Bernauer Straße 18, 83229, Aschau I. Chiemgau, Germany
- Department of Trauma and Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Andrea Meurer
- Department of Trauma Surgery and Orthopedics, University Hospital, Goethe University Frankfurt, Marienburgstraße 2, 60528, Frankfurt/Main, Germany
- Medical Park St. Hubertus Klinik, Sonnenfeldweg 29, 83707, Bad Wiessee, Germany
| | - Harald Böhm
- Orthopaedic Children's Hospital, Bernauer Straße 18, 83229, Aschau I. Chiemgau, Germany
- PFH Private University of Applied Sciences, Weender Landstraße 3-7, 37073, Göttingen, Germany
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2
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Karami M, Ebrahimpour A, Keihani S, Jafari Kafiabadi M, Etemadi R. Outcomes of Temporary Hemi-Epiphysiodesis Using a New Device for The Treatment of Pediatric Valgus Knee Deformity: a Preliminary Report. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:536-542. [PMID: 34692936 DOI: 10.22038/abjs.2020.49544.2460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/27/2020] [Indexed: 11/06/2022]
Abstract
Background This study aimed to evaluate the efficacy of hemi-epiphysiodesis using a new device (X-plate) for the correction of genu valgum. Methods In total, 22 children with a total of 34 pathologic knee valgus deformities underwent the procedure and were followed up 25.3 months on average. Results The mean time to clinical correction of genu valgum was 10.9±2.2 months. Furthermore, the mean preoperative anatomic Lateral Distal Femoral Angle (aLDFA) and mechanical Tibia Femoral angle (mTFA) were obtained at 75.1±3.8 and 6±2.8 degrees, respectively. When clinical correction of the deformity was achieved, the mean of aLDFA and mTFA corrections were determined at 8.9±5.3 and 6.5±3.2 degrees, respectively. The mean speed of aLDFA and mTFA corrections were estimated at 0.8±0.45 and 0.6±0.3 degrees per month, respectively. The postoperative aLDFA and mTFA were measured at 84±4.2 and -0.8±2.9 on average. With a mean of 25.3±14.5 months at final follow-up, there were 6 (17.6%) mild valgus knees, 26 (75.5%) normal alignment knees, and only 2 (5.9%) mild varus knee within an acceptable clinical limit. Conclusion Hemi-epiphysiodesis using X-plate at the distal physis of the femur is an effective and safe method for the treatment of valgus knee deformity in children.
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Affiliation(s)
- Mohsen Karami
- Department of orthopedics, Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Adel Ebrahimpour
- Department of orthopedics, Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Keihani
- Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Jamil K, Yahaya MY, Abd-Rasid AF, Ibrahim S, Abdul-Rashid AH. Angular Deformities of the Knee in Children Treated with Guided Growth. Malays Orthop J 2021; 15:26-35. [PMID: 34429819 PMCID: PMC8381675 DOI: 10.5704/moj.2107.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 04/05/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: The guided growth technique is an alternative to corrective osteotomy for treating angular deformities of the extremities. It has the advantage of being minimally invasive and is effective in a growing child. This study reports on the outcome of guided growth technique using a plate in correcting knee angular deformities. Material and Methods: We conducted a retrospective study of children with angular deformity of the knee treated by the guided growth technique from January 2010 to December 2015 in a tertiary centre. The guided growth technique was done using either the flexible titanium plate (8-plate) or the 2-hole reconstruction plate. Correction of deformity was assessed on radiographs by evaluating the mechanical axis deviation and tibiofemoral angle. The implants were removed once deformity correction was achieved. Results: A total of 17 patients (27 knees) were evaluated. Twenty-two knees (81.5%) achieved complete correction of the deformity. The median age was 4.0 (interquartile range 3.0-6.0) years and the median Body Mass Index (BMI) was 26.0 (25.0-28.0). There were 7 unilateral and 10 bilateral deformities with different pathologies (14 tibia vara, 3 genu valgus). The median rate of correction was 0.71° per month. One patient (1 knee) had screw pull-out and two patients (4 knees) had broken screws in the proximal tibia. Three patients (5 knees) failed to achieve complete correction and were subsequently treated with corrective osteotomies. Out of five patients (8 knees) who were followed-up for at least 12 months after removal of hardware, two had rebound deformities. No permanent growth retardation occurred in our patients. Conclusion: Our outcome for guided growth to correct knee angular deformity was similar to other studies. Guided growth is safe to perform in children below 12 years old and has good outcome in idiopathic genu valgus and Langeskiold II for tibia vara. Patients should be observed for recurrence until skeletal maturity following implant removal.
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Affiliation(s)
- K Jamil
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - M Y Yahaya
- Department of Orthopaedics, Universiti Teknologi Mara, Batu Caves, Malaysia.,Faculty of Medicine, Universiti Teknologi Mara, Sungai Buloh, Malaysia
| | - A F Abd-Rasid
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - S Ibrahim
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - A H Abdul-Rashid
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Zhang W, Wang Z, Chen M, Li Y. Risk factors for ankle valgus in children with hereditary multiple exostoses: a retrospective cross-sectional study. J Child Orthop 2021; 15:372-377. [PMID: 34476027 PMCID: PMC8381398 DOI: 10.1302/1863-2548.15.210032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/12/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this study was to identify risk factors for ankle valgus in children with hereditary multiple exostoses (HME). METHODS We retrospectively reviewed the medical records of patients with HME who were examined at our hospital between 2010 and 2020. Patients' age and sex were recorded along with radiographic variables including mechanical axis deviation (MAD), mechanical lateral distal tibia angle (LDTA), fibula/tibia length ratio (F/T); distal fibula station according to Malhotra's classification, location of exostoses at the ankle joint and fibular neck/physis width (N/P) ratio, which were measured from radiographs. Binary logistic regression analysis was performed to identify significant independent risk factors for ankle valgus. RESULTS There were 61 children (20 girls and 41 boys; 122 ankles) who met the inclusion criteria. The mean age was 10.4 years (sd 3.4) and mean LDTA was 83° (sd 7°). Ankle valgus was found in 64 ankles (52%). In addition to younger age, exostoses involving the lateral aspects of the distal tibial and the medial aspect of the distal fibula (odds ratio (OR) = 4.091; 95% confidence interval (CI) 1.065 to 15.712; p = 0.040), F/T ratio < 0.96 (OR = 4.457; 95% CI 1.498 to 13.261; p = 0.007) and N/P ratio > 1.6 (OR = 2.855; 95% CI 1.031 to 7.907; p = 0.043) were associated with an increased risk of developing ankle valgus, while sex and MAD were unrelated to its occurrence. CONCLUSION Young age, exostoses involving both the distal tibia and fibula, the F/T ratio < 0.96 and fibular N/P width ratio > 1.6 seemed to be risk factors of developing ankle valgus. LEVELS OF EVIDENCE Prognostic studies, IV.
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Affiliation(s)
- Wanglin Zhang
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China,These authors contributed equally and should be considered as senior co-authors
| | - Zhigang Wang
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China,These authors contributed equally and should be considered as senior co-authors
| | - Mu Chen
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuchan Li
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China,Correspondence should be sent to Yuchan Li Shanghai Childrens Medical Center, Shanghai Jiaotong University School of Medicine. 1678 Dongfang Road, Shanghai 200127, P.R China. E-mail:
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5
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Abdelaziz A, ElAshry SM, Awadh MM, Khaja A, Alsaifi S. Efficacy of Percutaneous Retrograde Transphyseal Guided Growth Screw in Distal Femoral Angular Deformity Correction: A New Technique. J Pediatr Orthop 2021; 41:e533-e539. [PMID: 34155176 PMCID: PMC8270510 DOI: 10.1097/bpo.0000000000001835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We modified the original technique for percutaneous transphyseal screw which was described in 1998 by Metaizeau and colleagues for distal femoral coronal angular deformity correction; the modification is related to the screw direction, whereas the screw is administered in a retrograde pattern, starting from the epiphysis and directed toward the metaphysis. This technique opposes the original technique that was started with a metaphyseal entry point which aimed toward the epiphysis. This study evaluates the efficacy of the newly suggested surgical technique regarding the rate of correction and growth resumption after screw removal. METHODS This prospective study looked at 40 patients (65 distal femoral physes), who underwent a percutaneous retrograde transphyseal guided growth screw procedure, from October 2017 to September 2019. All the patients included had distal femoral coronal angular deformities; 52 in valgus and 13 in varus deformities. The study included 17 females with an average age of 11.75 (range: 8.4 to 14.5 y) for 29 femurs and 23 males with an average age of 13.75 (range: 11.75 to 15.6 y) for 36 femurs. The mechanical lateral distal femoral angle was measured initially, and then again was measured after reaching the desired corrected orientation. The patients were then followed up after the screw removal and followed up to maturity, if the physis had continued to grow postcorrection. The degree of correction per month was calculated, and the consequence of screw removal was detected. Follow-up average time was 12.6 months (range: 30 to 6 mo). RESULTS The average correction in the distal femur was 1.3 degrees per month (range: 0.5 to 1.857 degrees/mo). In all of the 65 segments (61 femurs had significant growth remaining and 4 femurs had reached skeletal maturity with suboptimal mechanical lateral distal femoral angle correction), the screws were removed at the time of angular correction. Rebound growth was observed in 15 physes with an average of 1.8 degrees (range: 2 to 3 degrees); they were stable in 42 physes and progressed in 4 physes with an average of 1.6 degrees (range: 1 to 2 degrees). Complications were minor and related to entrapment of soft tissue under the screw washer. CONCLUSION Percutaneous retrograde transphyseal guided growth screw for distal femur coronal angular deformity is a minimally invasive procedure, with a statistically significant correction rate when compared with the original transphyseal screw technique. The new technique has proven to have growth resumption after screw removal with minimal complication risk. LEVEL OF EVIDENCE Level III-prospective observational study.
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Affiliation(s)
| | | | | | - Aliaa Khaja
- Department of Orthopaedics, Al-Razi Hospital
| | - Saleh Alsaifi
- Orthopedics, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait
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6
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Vogt B, Frommer A, Gosheger G, Toporowski G, Tretow H, Rödl R, Laufer A. [Growth modulation through hemiepiphysiodesis : Novel surgical techniques: risks and progress]. DER ORTHOPADE 2021; 50:538-547. [PMID: 34170353 DOI: 10.1007/s00132-021-04122-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
The correction of angular deformities of the lower limb is a key task in paediatric orthopaedic surgery. The growth potential of the physis can be employed for the correction of these malalignments in childhood and adolescence. Hemiepiphysiodesis (HED) is a surgical technique used for growth modulation by permanent or temporary asymmetrical arrest of the growth plate. In permanent HED, exact timing of the procedure is mandatory to achieve optimal correction. Temporary HED through tension band devices such as two-hole-plates or flexible staples has been established as the treatment of choice for growth guidance with excellent results. Implant-associated complications have been significantly reduced through implant modifications. Several experimental procedures have the potential to achieve growth modulation even without the requirement of surgical intervention.
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Affiliation(s)
- B Vogt
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Münster, Deutschland.
| | - A Frommer
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - G Gosheger
- Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster, Münster, Deutschland
| | - G Toporowski
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - H Tretow
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - R Rödl
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - A Laufer
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Münster, Deutschland
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7
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Bayrak A, Duramaz A, Kızılkaya C, Çelik M, Kural C, Altınay S, Kural A, Başaran SH. Comparison of two types of fixation for proximal tibial epiphysiodesis: An experimental study in a rabbit model. Jt Dis Relat Surg 2021; 32:468-477. [PMID: 34145826 PMCID: PMC8343849 DOI: 10.52312/jdrs.2021.80219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives
In this study, we describe a novel hemiepiphysiodesis technique to prevent implant-related perichondrial ring injury in a rabbit model. Materials and methods
Proximal tibial epiphyseal plates of a total of 16 white New Zealand rabbits were used for this animal model. The subjects were divided into three equal groups as follows: Group 1 (Kirschner wire [K-wire]/cerclage), Group 2 (8-plate) right-hind legs, Group 3 (Control) left hind legs. Using anteroposterior radiography, the medial slope angle (MSA), articular line-diaphyseal angle (ALDA), and the angle between screws of 8-plate in lateral X-ray tibial slope angle (TSA) were measured. The radiographs were taken early postoperative (Day 1) and on sacrification day (Week 8). The histological evaluation of the perichondrial ring was made on a 7-mm axial section that stained with Safranin O/fast green at X10 magnification. Results
In both K-wire and 8-plate groups, the early postoperative ALDA and TSA were greater than the sacrification ALDA and TSA (p=0.028 and p<0.001, respectively). The early postoperative MSA was lower than the sacrification MSA in groups, (p<0.001). The MSA in the control group was lower than the K-wire and 8-plate groups (p<0.001 and p=0.009; respectively). The perichondrial ring thickness of the K-wire group was greater than the 8-plate group in histological evaluation (p<0.001). Conclusion
Both of the K-wire and 8-plate groups showed similar angulation effects in the proximal tibia, although histologically less damage to the perichondrial ring was observed in the K-wire group, compared to the 8-plate group.
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Affiliation(s)
- Alkan Bayrak
- SBÜ Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği, 34147 Bakırköy, İstanbul, Türkiye.
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Lim C, Shin CH, Yoo WJ, Cho TJ. Acute correction of proximal tibial coronal plane deformity in small children using a small monolateral external fixator with or without cross-pinning. J Child Orthop 2021; 15:255-260. [PMID: 34211602 PMCID: PMC8223093 DOI: 10.1302/1863-2548.15.200187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Surgical correction of proximal tibia deformity in small children can be challenging. We present the surgical technique and outcome of proximal tibia osteotomy fixed with small monolateral external fixator in this patient group. METHODS A total of 17 cases in eight patients younger than nine years of age were study subjects. A proximal tibia osteotomy was fixed with a small monolateral external fixator with or without cross-pinning. Outcome was evaluated by changes of radiographic parameters such as medial proximal tibia angle (MPTA), metaphyseal diaphyseal angle (MDA) and clinical findings of complications, time interval until weight bearing and fixator removal time. RESULTS MPTA improved from a preoperative mean of 73° (sd 4°; 66° to 78°) to an immediate postoperative mean of 90° (sd 3°; 85° to 96°) in varus tibiae, and from 104° (sd 1°; 103° to 105°) to 89° (sd 1°; 88° to 89°) in valgus tibiae. In all, 15 of the 17 cases (88.3 %) achieved postoperative MPTA within the normal range (85° to 90°). MDA improved from a preoperative mean of 19° (sd 5°; 11° to 24°) to an immediate postoperative mean of 0° (sd 4°; -6° to 7°) in varus tibiae, and from -25° (sd 2°; -22° to -24°) to 2° (SD 1°; 1° to 3°) in valgus tibiae. Full weight bearing was possible at mean 1.7 months (0.5 to 3.0). Mean follow-up period was 6.5 years (sd 5.4; 1.0 to 16.0). No complications developed during the follow-up. CONCLUSION Proximal tibia osteotomy fixed with small monolateral external fixator provides accurate, safe and efficient correction in the management of coronal plane angular deformity in small children. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Chaemoon Lim
- Division of Pediatric Orthopaedics, Seoul National University Children’s Hospital, Seoul, Korea,Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Republic of Korea
| | - Chang Ho Shin
- Division of Pediatric Orthopaedics, Seoul National University Children’s Hospital, Seoul, Korea
| | - Won Joon Yoo
- Division of Pediatric Orthopaedics, Seoul National University Children’s Hospital, Seoul, Korea
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics, Seoul National University Children’s Hospital, Seoul, Korea,Correspondence should be sent to Tae-Joon Cho, Division of Pediatric Orthopaedics, Seoul National University Children’s Hospital 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea. E-mail:
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9
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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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10
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Correction of coronal plane deformities around knee in children with two-hole tension band plates. Jt Dis Relat Surg 2021; 32:177-184. [PMID: 33463434 PMCID: PMC8073465 DOI: 10.5606/ehc.2021.78879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/16/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to present the 10-year results and complications of two-hole tension band plate hemiepiphysiodesis for coronal deformities around knee in a large population from a single center. Patients and methods
Seventy-seven patients (46 boys, 31 girls; mean age 93±36 months; range, 22 to 181 months) who underwent temporary hemiepiphysiodesis around knee between January 2009 and January 2019 with two-hole tension band plates were retrospectively evaluated. Improvement of joint orientation angles and mechanical axis deviations, deformity correction rates, etiology groups, and complications were noted. Results
A total of 166 bone segments (93 femurs, 73 tibias) were included in the study. Mean follow-up duration after the implantation was 36±17 (range, 12 to 88) months. Plates were removed at mean 18±8 (range, 7 to 47) months of implantation. Of the bone segments, 95.2% (n=158) responded successfully to the plates. Mean correction rate of mechanical lateral distal femoral angle in femoral valgum deformity was 0.94±0.43° (range, 0.17 to 2.22)/month and mean correction rate of mechanical medial proximal tibial angle in tibial valgum deformity was 0.62±0.36° (range, 0.11 to 1.55)/month. Mean correction rate of mechanical lateral distal femoral angle in femoral varum deformity was 1.3±0.8° (range, 0.48 to 2.92)/month and mean correction rate of mechanical medial proximal tibial angle in tibial varum deformity was 0.94±0.49° (range, 0.26 to 1.67)/month. The most common complication observed was rebound deformity seen in 41.2% (n=70) of the bone segments. Nine bone segments had persistent hemiepiphysiodesis despite plate removal. Four screw breakages (three metaphysial and one epiphysial) were observed. Conclusion
Two-hole tension band plate hemiepiphysiodesis appears to be an effective and safe method for the correction of coronal deformities around knee.
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Gordon JE, Schoenecker PL, Lewis TR, Miller ML. Limb lengthening in the treatment of posteromedial bowing of the tibia. J Child Orthop 2020; 14:480-487. [PMID: 33204357 PMCID: PMC7666791 DOI: 10.1302/1863-2548.14.200111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Posteromedial bowing of the tibia is an uncommon but recognized congenital lower extremity deformity in children that can lead to limb length discrepancy (LLD) and residual angulatory deformity. The purpose of this study is to report a series of children at a single institution with posteromedial bowing treated by lengthening. METHODS A retrospective review was carried out at our institution identifying 16 patients who were treated with limb lengthening for posteromedial bowing of the tibia and followed to skeletal maturity. Projected LLD was a mean of 7.7 cm (range 5.0 cm to 14.2 cm). Three patients were treated in a staged fashion with lengthening and deformity correction at age three to four years and subsequent definitive tibial lengthening. The remaining 13 patients were treated with limb lengthening approaching adolescence using circular external fixation. RESULTS All patients were pain free and ambulated without a limp at final follow-up. The mean final LLD was 0.3 cm short. In spite of correction of distal tibial shaft valgus in 11 of the 16 patients, eight of the 16 (50%) required later correction of persistent, symptomatic ankle valgus by either hemiepiphyseodesis (seven patients) or osteotomy (one patient). CONCLUSIONS Children with posteromedial bowing of the tibial with projected LLD over 5cm can be effectively treated with lengthening. Patients with severe valgus of more than 30° of shaft valgus and difficulty ambulating at age three years can be successfully treated with a two-stage lengthening procedure. Attention should be paid in patients with posteromedial bowing to ankle valgus. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J. Eric Gordon
- Washington University School of Medicine Department of Orthopaedic Surgery in St. Louis, St. Louis, Missouri, USA,St. Louis Children’s Hospital, St. Louis, Missouri, USA,St. Louis Shriners Hospital, St. Louis, Missouri, USA,Correspondence should be sent to J. Eric Gordon, St. Louis Shriners Hospital for Children, 4400 Clayton Ave., St. Louis, Missouri 63110, USA. E-mail:
| | - Perry L. Schoenecker
- Washington University School of Medicine Department of Orthopaedic Surgery in St. Louis, St. Louis, Missouri, USA,St. Louis Children’s Hospital, St. Louis, Missouri, USA,St. Louis Shriners Hospital, St. Louis, Missouri, USA
| | - Thomas R. Lewis
- Washington University School of Medicine Department of Orthopaedic Surgery in St. Louis, St. Louis, Missouri, USA,St. Louis Children’s Hospital, St. Louis, Missouri, USA,St. Louis Shriners Hospital, St. Louis, Missouri, USA
| | - Mark L. Miller
- Washington University School of Medicine Department of Orthopaedic Surgery in St. Louis, St. Louis, Missouri, USA,St. Louis Children’s Hospital, St. Louis, Missouri, USA,St. Louis Shriners Hospital, St. Louis, Missouri, USA
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12
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Rethlefsen SA, Hanson AM, Wren TAL, Abousamra O, Kay RM. Anterior distal femoral hemiepiphysiodesis with and without patellar tendon shortening for fixed knee flexion contractures in children with cerebral palsy. J Child Orthop 2020; 14:415-420. [PMID: 33204349 PMCID: PMC7666790 DOI: 10.1302/1863-2548.14.200154] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Surgery is often required for fixed knee flexion contractures in patients with neuromuscular conditions. Anterior distal femoral hemiepiphysiodesis (ADFH) is an alternative to distal femoral extension osteotomy (DFEO) in skeletally immature patients. ADFH is typically not accompanied by patellar tendon shortening surgery (PTS). Our purpose was to compare ADFH alone versus ADFH with PTS for treatment of fixed knee flexion contractures and crouched gait in children with cerebral palsy (CP). METHODS Retrospective review of pre- and postoperative gait analysis data for children with CP who underwent ADFH alone, or ADFH with PTS. Data were analysed using linear mixed models to control for covariates. RESULTS In total, 25 participants (42 limbs) were included, 17 male and eight female, mean age at surgery 12.9 (sd 1.9) years. Both groups experienced significant improvement in popliteal angle, knee extension range of motion (ROM) and knee extension in stance phase. Greater improvement was seen for all variables in the ADFH/PTS group, mainly due to greater popliteal angle and knee flexion during gait preoperatively in that group (p ≤ 0.02) rather than the procedure performed (p ≥ 0.19). There was no difference between groups postoperatively. Rate of contracture resolution was 0.5° to 1.0° per month, faster in larger contractures (p = 0.02). CONCLUSIONS ADFH with and without PTS is effective in improving knee extension in skeletally immature patients with CP, correcting contractures at a rate of 0.5° to 1.0° per month. Combined ADFH and PTS surgery may be preferable in patients with larger contractures of up to 30° to 35°. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Susan A. Rethlefsen
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard MS#69, Los Angeles, CA 90027, USA,Correspondence should be sent to Susan Rethlefsen, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd., MS 69, Los Angeles, CA 90027, USA. E-mail:
| | - Alison M. Hanson
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard MS#69, Los Angeles, CA 90027, USA
| | - Tishya A. L. Wren
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard MS#69, Los Angeles, CA 90027, USA,Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
| | - Oussama Abousamra
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard MS#69, Los Angeles, CA 90027, USA,Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
| | - Robert M. Kay
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard MS#69, Los Angeles, CA 90027, USA,Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
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Narayana Kurup JK, Shah HH. Hemiepiphysiodesis using 2-holed reconstruction plate for correction of angular deformity of the knee in children. J Orthop 2020; 20:54-59. [PMID: 32042230 DOI: 10.1016/j.jor.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/06/2020] [Indexed: 12/21/2022] Open
Abstract
Background This study assesses the outcome of hemi epiphysiodesis with a 2-holed reconstruction plate using the tension band principle in angular deformities of the knee and variables influencing the outcome. Methods Prospective study from 2012 to 2016 included 23 children with coronal deformities of the knee joint. IMD, ICD, BMI, mLDFA, mMPTA, mTFA, Mechanical axis deviation, Perpendicular mechanical axis ratio, and screw angle measured. Correction and rate of correction compared with BMI, age, etiology, PMAR and MAD, deformity, a segment of bone and the screw angle. Results Total 65 segments operated in 23 children with 40 knees. Out of the total 65, 36 plates were kept in distal femur physis and 29 in the proximal tibial physis. Thirteen knees had genu varum and 27 had genu valgum. The mean age at the time of surgery was 11.25 months. The mean follow-up of 36 months and the average time for correction was 18.64 months. 77.5% correction achieved with ROC maximum in the initial 6 months. ROC in TFA per year were 7.80(femur), 50(tibia), and 120(femur with tibia). Complications included broken implant, screw back out, screw irritation and rebound phenomenon. Conclusions 2-holed reconstruction plate gives similar correction to that of the 8-plate within a comparable period without additional complications. It has the advantage of being cost effective and readily available. Age, BMI, type of deformity, amount of initial deformity, do not play a significant role in the outcome of correction. Screw placement may have a role in the final correction of the deformity. Level of evidence Level 3.
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Affiliation(s)
| | - Hitesh H Shah
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Stiel N, Babin K, Vettorazzi E, Breyer S, Ebert N, Rupprecht M, Stuecker R, Spiro AS. Anterior distal femoral hemiepiphysiodesis can reduce fixed flexion deformity of the knee: a retrospective study of 83 knees. Acta Orthop 2018; 89:555-559. [PMID: 29902104 PMCID: PMC6202731 DOI: 10.1080/17453674.2018.1485418] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Fixed knee flexion deformity in children is a common problem in various diseases including myelomeningocele and cerebral palsy. Until now, only a few studies focusing on the surgical procedure of anterior distal femoral hemiepiphysiodesis have been published. We analyzed outcome and correction rate in the largest case series to date of patients treated by staples or 8-plates. Patients and methods - We reviewed the medical records of all patients with fixed knee flexion deformity who were treated with anterior distal femoral hemiepiphysiodesis using either staples or 8-plates between the years 2002 and 2017 (73 patients; 130 knees). 49 patients (83 knees) had completed treatment with implant removal at the time of full correction of the deformity or at skeletal maturity and were included. The average age at operation was 12 years (6-20). Patients were assigned to 3 different groups based on their diagnosis: cerebral palsy, myelomeningocele, and the "other" group.d Results - Mean fixed knee flexion deformity improved from 21° (10-60°) to 8° (0-50°) (p < 0.001) with an average correction rate of 0.44° per month (range -2.14° to 1.74°). The correction rate per month was lowest for patients with cerebral palsy (0.20°), followed by the myelomeningocele group (0.50°), and the "other" group (0.58°). Implant loosening occurred in 10% of the treated knees with consecutive re-implantation in 5% of the cases. Interpretation - Anterior distal femoral hemiepiphysiodesis is an effective and safe method for the treatment of fixed knee flexion deformity in children. The optimal timing depends on the remaining individual growth potential, the underlying disease, and the extent of the deformity.
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Affiliation(s)
- Norbert Stiel
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Kornelia Babin
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Breyer
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Nicola Ebert
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Martin Rupprecht
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Ralf Stuecker
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Alexander S Spiro
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; ,Correspondence:
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Danino B, Rödl R, Herzenberg JE, Shabtai L, Grill F, Narayanan U, Segev E, Wientroub S. Guided growth: preliminary results of a multinational study of 967 physes in 537 patients. J Child Orthop 2018; 12:91-96. [PMID: 29456760 PMCID: PMC5813131 DOI: 10.1302/1863-2548.12.170050] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Guided growth by tension band plating is commonly used to correct coronal plane deformity. The purpose of this study was to measure the effect and further define parameters that influence results in coronal plane deformity around the knee. METHODS The retrospective multicentre study included data on 967 physes in 537 patients, with an average follow-up of 16 months after plate insertion. Alignment analysis was compared preoperatively and in at least two measurements postoperatively, as well as with parameters that influence the rate and amount of correction. RESULTS Average age at plate implantation was 11.35 years (SD 3.29).Of those with femoral deformities, 85% of the patients finished the treatment and of those, 70% were corrected to standard alignment, while 14% have not yet achieved correction, and are still growing.Of those with tibial deformities, 75% of the patients finished the treatment and of those 80% were corrected to standard alignment, while 25% have not yet achieved correction and are still growing.The calculated rate of correction was 0.77°/month for the femur and 0.79°/month for the tibia.In terms of complications, the overall rate of infection was 1.48%. In three patients (0.55%) screw breakage was recorded.Factors found to significantly influence the amount of correction were age at plate implantation and direction of deformity. CONCLUSION Temporary hemiepiphysiodesis takes the advantage of physiological physeal growth to effectively treat angular deformities. Success of treatment is influenced by the age of the patient at plate implantation and direction of deformity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- B. Danino
- Department of Paediatric Orthopaedics, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
Correspondence should be sent to B. Danino, Department of Paediatric Orthopaedics, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel. E-mail:
| | - R. Rödl
- Klinik und Poliklinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster, Münster, Germany
| | - J. E. Herzenberg
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, USA
| | - L. Shabtai
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, USA
| | - F. Grill
- Orthopedic Hospital Speising, Vienna, Austria
| | - U. Narayanan
- Department of Pediatric Orthopaedic Surgery, Sickkids Hospital Toronto, Toronto, Canada
| | - E. Segev
- Department of Paediatric Orthopaedics, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S. Wientroub
- Department of Paediatric Orthopaedics, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
In paediatric orthopaedics, deformities and discrepancies in length of bones are key problems that commonly need to be addressed in daily practice. An understanding of the physiology behind developing bones is crucial for planning treatment. Modulation of the growing bone can be performed in a number of ways. Here, we discuss the principles and mechanisms behind the techniques. Historically, the first procedures were destructive in their mechanism but reversible techniques were later developed with stapling of the growth plate being the gold standard treatment for decades. It has historically been used for both angular deformities and control of overall bone length. Today, tension band plating has partially overtaken stapling but this technique also carries a risk of complications. The diverging screws in these implants are probably mainly useful for hemiepiphysiodesis. We also discuss new minimally invasive techniques that may become important in future clinical practice.
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Abstract
Blount's disease is commonly attributed to an intrinsic, idiopathic defect in the posteromedial proximal tibial physis resulting in progressive bowing of the leg, intoeing, and lateral knee thrust. Treatment has historically included bracing, physeal stapling, or corrective osteotomy, and was determined primarily by age at presentation. As we feel the pathology is not necessarily age dependent, we have elected to use the technique of guided growth using a lateral tension band plate to correct limb alignment as a first-line treatment in all patients presenting to our clinic as long as they had growth remaining and no evidence of a physeal bar.We identified 17 patients with tibia vara (27 limbs) who were managed by means of guided growth of the proximal tibia, from age 1.8 years to 15.1 years. Clinical and radiographic parameters were followed pre- and postoperatively. The response to guided growth was documented as were any related complications.Twenty-one (78%) limbs had complete normalization of their mechanical axis (middle 50% of knee). Time to correction averaged 13.5 months (8-19 months). There were no peri-operative complications. We observed hardware failure in 3 patients; 2 with screw breakage and 1 patient with hardware migration, none requiring subsequent osteotomy or further treatment. Two patients had rebound varus: one is being observed and another has undergone a repeat procedure.Patients with pathologic tibia vara present at various ages and have historically undergone various treatments ranging from bracing to tibial osteotomy based on age at presentation. We have found that guided growth utilizing tethering plates can be used effectively as first-line treatment in all patients with growth remaining. This minimally invasive method is predictable and well tolerated. Recurrent deformity, though unlikely, is easily remedied by repeating the process and does not preclude osteotomy if eventually needed. Concomitant resolution of ligamentous laxity and inward torsion can be anticipated as the mechanical axis is restored to neutral. The only contraindications for guided growth include an unresectable physeal bar or skeletal maturity.
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Affiliation(s)
- John A. Heflin
- University of Utah School of Medicine Department of Orthopaedics, Salt Lake City, UT
- Correspondence: John A. Heflin, University of Utah School of Medicine Department of Orthopaedics, Primary Childrens Hospital, 100 N Mario Capecchi Dr, Suite 4550, Salt Lake City, UT 84113 (e-mail: )
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18
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Kumar A, Gaba S, Sud A, Mandlecha P, Goel L, Nayak M. Comparative study between staples and eight plate in the management of coronal plane deformities of the knee in skeletally immature children. J Child Orthop 2016; 10:429-37. [PMID: 27417295 PMCID: PMC5033777 DOI: 10.1007/s11832-016-0758-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/05/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To compare two commonly used methods of temporary hemiepiphysiodesis (staples and figure of eight plate) in the management of coronal plane deformities of the knee in skeletally immature children. METHODS This prospective study was conducted between November 2012 and November 2015. A total of 40 patients with 67 affected knee joints, having at least 1 year of skeletal growth remaining, were included in the study. Angular correction was measured by recording the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and anatomical tibio-femoral angle (TFA) (for the overall alignment of lower limbs). Implant removal was done after 5° of overcorrection was achieved. The rate of correction (° per month) and complications related to each technique were recorded. RESULTS The most common diagnosis was idiopathic genu valgum. The overall rate of correction (TFA) was 1.2° for staples and 1.4° for eight plate (p = 0.70, not statistically significant). The correction in mLDFA was statistically better in the eight plate group, whereas an opposite trend was recorded in mMPTA. Implant-related complications were present in two cases of the staples group. CONCLUSION Although the overall correction rate was similar in both groups, implant-related complications were lower with figure of eight plate. In idiopathic genu valgum (the most common diagnosis), the correction was statistically better in the eight plate group. We recommend figure of eight plate over staples in managing these deformities.
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Affiliation(s)
- Arvind Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Gaba
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Sud
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | | | - Lakshay Goel
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | - Mayur Nayak
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Kulkarni RM, Ilyas Rushnaiwala FM, Kulkarni GS, Negandhi R, Kulkarni MG, Kulkarni SG. Correction of coronal plane deformities around the knee using a tension band plate in children younger than 10 years. Indian J Orthop 2015; 49:208-18. [PMID: 26015611 PMCID: PMC4436488 DOI: 10.4103/0019-5413.152484] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Guided growth through temporary hemiepiphysiodesis has gained acceptance as the preferred primary treatment in treating pediatric lower limb deformities as it is minimally invasive with a lesser morbidity than the traditional osteotomy. The tension band plate is the most recent development in implants used for temporary hemiepiphysiodesis. Our aim was to determine its safety and efficacy in correcting coronal plane deformities around the knee in children younger than 10 years. MATERIALS AND METHODS A total of 24 children under the age of 10 were operated for coronal plane deformities around the knee with a single extra periosteal tension band plate and two nonlocking screws. All the children had a pathological deformity for which a detailed preoperative work-up was carried out to ascertain the cause of the deformity and rule out physiological ones. The average age at hemiepiphysiodesis was 5 years 3 months (range: 2 years to 9 years 1 month). RESULTS The plates were inserted for an average of 15.625 months (range: 7 months to 29 months). All the patients showed improvement in the mechanical axis. Two patients showed partial correction. Two cases of screw loosening were observed. In the genu valgum group, the tibiofemoral angle improved from a preoperative mean of 19.89° valgus (range: 10° valgus to 40° valgus) to 5.72° valgus (range: 2° varus to 10° valgus). In patients with genu varum the tibiofemoral angle improved from a mean of 28.27° varus (range: 13° varus to 41° varus) to 1.59° valgus (range: 0-8° valgus). CONCLUSION Temporary hemiepiphysiodesis through the application of the tension band plate is an effective method to correct coronal plane deformities around the knee with minimal complications. Its ease and accuracy of insertion has extended the indication of temporary hemiepiphysiodesis to patients younger than 10 years and across a wide variety of diagnosis including pathological physis, which were traditionally out of the purview of guided growth.
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Affiliation(s)
- Ruta M Kulkarni
- Department of Orthopaedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India
| | - Faizaan M Ilyas Rushnaiwala
- Department of Orthopaedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India
| | - GS Kulkarni
- Department of Orthopaedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India
| | - Rajiv Negandhi
- Department of Orthopaedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India
| | - Milind G Kulkarni
- Department of Orthopaedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India
| | - Sunil G Kulkarni
- Department of Orthopaedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India
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Determining the best treatment for coronal angular deformity of the knee joint in growing children: a decision analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:603432. [PMID: 25276801 PMCID: PMC4167958 DOI: 10.1155/2014/603432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/11/2014] [Indexed: 01/28/2023]
Abstract
This study aimed to determine the best treatment modality for coronal angular deformity of the knee joint in growing children using decision analysis. A decision tree was created to evaluate 3 treatment modalities for coronal angular deformity in growing children: temporary hemiepiphysiodesis using staples, percutaneous screws, or a tension band plate. A decision analysis model was constructed containing the final outcome score, probability of metal failure, and incomplete correction of deformity. The final outcome was defined as health-related quality of life and was used as a utility in the decision tree. The probabilities associated with each case were obtained by literature review, and health-related quality of life was evaluated by a questionnaire completed by 25 pediatric orthopedic experts. Our decision analysis model favored temporary hemiepiphysiodesis using a tension band plate over temporary hemiepiphysiodesis using percutaneous screws or stapling, with utilities of 0.969, 0.957, and 0.962, respectively. One-way sensitivity analysis showed that hemiepiphysiodesis using a tension band plate was better than temporary hemiepiphysiodesis using percutaneous screws, when the overall complication rate of hemiepiphysiodesis using a tension band plate was lower than 15.7%. Two-way sensitivity analysis showed that hemiepiphysiodesis using a tension band plate was more beneficial than temporary hemiepiphysiodesis using percutaneous screws.
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Growth guidance of angular lower limb deformities using a one-third two-hole tubular plate. J Child Orthop 2013; 7:289-94. [PMID: 24432089 PMCID: PMC3799937 DOI: 10.1007/s11832-013-0520-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 08/06/2013] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The eight-plate system for angular deformity correction is well known, reliable and effective at any age during growth. Due to high implant costs, we sought to evaluate the effectiveness and safety of a less expensive alternative. METHODS Between 2006 and 2011, 41 children with angular deformities were managed using a two-hole one-third tubular plate in cases where an eight plate would normally be indicated. Inclusion criteria in this retrospective study were: genu valgum and genu varum. X-ray documentation was performed before and after surgery and patients were followed clinically every 3 months after surgery. The cost per implant was 361.40 Sfr (Swiss Francs) compared to the eight plate at 737 Sfr. RESULTS Mean time for correction was 13 months. A mean LDFA/MPTA after correction of 89.9°/86.8° was recorded, as well as a mean correction angle of 6.8°/6.6°. The complication rate was 6.6 % (one superficial wound infection and one insufficient correction in an older child). These results compare favourably with published data on the eight plate. CONCLUSION The two hole one-third tubular plate seems to be a clinically and also cost effective alternative to the eight plate. Full deformity correction is gained for a fraction of the cost. LEVEL OF EVIDENCE Level III.
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Lauge-Pedersen H, Hägglund G. Eight plate should not be used for treating leg length discrepancy. J Child Orthop 2013; 7:285-8. [PMID: 24432088 PMCID: PMC3799924 DOI: 10.1007/s11832-013-0506-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 06/15/2013] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The Blount staple has been widely used for treating angular deformities and leg length discrepancy (LLD) of the lower limbs. In recent years, the Eight plate has replaced the Blount staple for treating angular deformities in many centres. Although not described in the literature, it has been proposed that the Eight plate could also be used for treating LLD. We studied the effectiveness of the device for this indication. METHODS Ten patients with LLD were included prospectively. Medial and lateral plates were inserted for symmetrical growth reduction and the patients were followed by radiostereometric analysis (RSA) 0, 3, 6, 9, 12, 24, 52 and 80 weeks postoperatively. The error of measurement with this technique is less than 0.05 mm. RESULTS Case 1 continued to grow an average of 0.08 mm per week (6.7 mm longitudinal growth in 1.5 years) postoperatively, while Case 2 showed 0.07 mm longitudinal growth per week (5.6 mm longitudinal growth in 1.5 years). The longitudinal growth, in both children, showed only slight growth retardation throughout the follow-up period. The study was interrupted and no further subjects were included after the results indicated that only minor growth reduction had occurred in both patients. CONCLUSION The Eight plate does not significantly reduce growth when applied both medially and laterally in a symmetrical way at the proximal tibial physis.
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Affiliation(s)
| | - Gunnar Hägglund
- Department of Orthopaedics, University Hospital, 221 85 Lund, Sweden
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Gottliebsen M, Rahbek O, Hvid I, Davidsen M, Hellfritzsch MB, Møller-Madsen B. Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling: a randomized clinical trial on guided growth for idiopathic genu valgum. Acta Orthop 2013; 84:202-6. [PMID: 23485073 PMCID: PMC3639343 DOI: 10.3109/17453674.2013.782526] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In children with angulating deformities of the lower limbs, hemiepiphysiodesis can be used to guide growth to achieve better alignment at skeletal maturity. Traditionally, this has been performed with staples. The tension-band plating technique is new and it has been advocated because it is believed to reduce the risk of premature closure of the growth plate compared to stapling. The benefit of the tension-band plating technique has not yet been proven in experimental or randomized clinical studies. METHODS We performed a randomized clinical trial in which 26 children with idiopathic genu valgum were allocated to stapling or tension-band plating hemiepiphysiodesis. Time to correction of the deformity was recorded and changes in angles on long standing radiographs were measured. Pain score using visual analog scale (VAS) was recorded for the first 72 h postoperatively. Analgesics taken were recorded by the parents. RESULTS Mean treatment times for stapling hemiepiphysiodesis (n = 10) and for tension-band plating hemiepiphysiodesis (n = 10) were similar. Postoperative VAS scores and consumption of analgesics were also similar in both groups. No hardware failure or wound-related infection was observed. INTERPRETATION Treatment time for the 2 treatment modalities was not significantly different in this randomized clinical trial. Tension-band plating and stapling appeared to have a similar effect regarding correction of genu valgum. We cannot rule out type-II error and the possibility that our study was underpowered. ClinicalTrials.gov Identifier: NCT01641354.
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Affiliation(s)
| | | | - Ivan Hvid
- Department of Children’s Orthopaedics
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24
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Spiro AS, Stenger P, Hoffmann M, Vettorazzi E, Babin K, Lipovac S, Kolb JP, Novo de Oliveira A, Rueger JM, Stuecker R. Treatment of fixed knee flexion deformity by anterior distal femoral stapling. Knee Surg Sports Traumatol Arthrosc 2012; 20:2413-8. [PMID: 22307752 DOI: 10.1007/s00167-012-1915-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 01/23/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE The treatment of fixed knee flexion deformity through anterior distal femoral stapling has been investigated in only two studies so far, with promising results. The aim of the present study was to determine whether this technique might improve fixed knee flexion deformity in a series of growing children and adolescents with different conditions. Follow-up examinations were continued after staple removal in terms of a possible impairment of this deformity. METHODS We reviewed the medical records of all patients with fixed knee flexion deformity who had been treated by anterior distal femoral stapling at our institution. Twenty patients (37 knees) with a mean age of 12.7 years met the inclusion criteria (>12 months of follow-up; no additional procedures to correct fixed knee flexion deformity such as hamstring lengthening or posterior capsulotomy) and were evaluated in this study. RESULTS The mean fixed knee flexion deformity significantly improved from 21.4° (SD = 11.6) preoperatively to 7.0° (SD = 9.8) after a mean follow-up of 35.3 months. Young patients (<12 years) revealed superior improvement of this deformity, and especially children with distinct fixed knee flexion deformity of 30° or greater had benefit from early treatment. Impairment of flexion deformity was only seen in one patient (2 knees) after staple removal. CONCLUSIONS Our results demonstrate that anterior distal femoral stapling is an effective method for the treatment of fixed knee flexion deformity in growing children and adolescents. Rare complications, immediate mobilization, and a low recurrence rate after staple removal provide obvious advantages of this minimally invasive procedure. LEVEL OF EVIDENCE Retrospective therapeutic study, Level IV.
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Affiliation(s)
- Alexander S Spiro
- Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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25
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The 8-plate versus physeal stapling for temporary hemiepiphyseodesis correcting genu valgum and genu varum: a retrospective analysis of thirty five patients. INTERNATIONAL ORTHOPAEDICS 2011; 36:599-605. [PMID: 21983939 DOI: 10.1007/s00264-011-1369-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 09/14/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE In skeletally immature patients, treatment of malalignment about the knee is possible by performing temporary hemi-epiphyseodesis. Following the well-established procedure of physeal stapling, the 8-plate was introduced as a new device. The purpose of this study was to compare physeal stapling with 8-plate hemi-epiphyseodesis. We focused on evaluating deformity correction, complication rate and duration of the procedures. METHODS We retrospectively analysed 35 patients (61 extremities, age 2.9-16.0 years) who were treated by temporary hemi-epiphyseodesis about the knee for correction of genu varum or genu valgum by using Blount staples (32 extremities) or the 8-plate (29 extremities). Plain radiographs were analysed at the time of operation and at hardware removal that included measurement of mechanical axis deviation, mechanical lateral distal femoral angle and mechanical medial proximal tibial angle. Time until hardware removal, operation time and complications were recorded. RESULTS A statistically significant improvement of all radiographic measurements could be achieved with comparable results in both groups. Complications were similar in both groups with no relevant differences in amount and severity. In the 8-plate group, however, the surgical time was significantly shorter by an average of ten minutes for implantation and 12 minutes for explantation. CONCLUSIONS Both Blount stapling and the 8-plate technique are methods for correction of genu varum and valgum deformity in skeletally immature patients; however, a shorter operating time for implantation and explantation was noted for the 8-plate technique.
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26
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Macwilliams BA, Harjinder B, Stevens PM. Guided growth for correction of knee flexion deformity: a series of four cases. Strategies Trauma Limb Reconstr 2011; 6:83-90. [PMID: 21785910 PMCID: PMC3150644 DOI: 10.1007/s11751-011-0110-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 07/05/2011] [Indexed: 12/02/2022] Open
Abstract
Fixed knee flexion deformity can present as an insidious and significant problem in diverse etiologies, most commonly in cerebral palsy. Traditional surgical intervention has included posterior capsulotomy and supracondylar femoral osteotomy, both of which carry significant associated morbidity and risks. In the skeletally immature patient, guided growth may be used to correct or substantially diminish the deformity. We are presenting our early experience encompassing four subjects who completed instrumented gait analysis both prior to and after distal femoral anterior guided growth (hemiepiphysiodesis). Changes in gait and function resulting from surgery in each individual are reported. Outcomes indicate improved knee range of motion and alleviation of crouch at the knee with secondary improvements in the ankle, hip and pelvis. Three subjects with initially slow gait velocity improved to within normal limits by demonstrating increased stride length. A measure of overall gait kinematics showed improvements in all limbs. Anterior guided growth (hemiepiphysiodesis) of the distal femur resulted in positive quantitative changes in all four patients, though degree and types of changes were variable in this small series. Encouraged by these findings, we now prefer guided growth to extension supracondylar osteotomy for the skeletally immature patient with fixed knee flexion deformity.
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Affiliation(s)
- B A Macwilliams
- Motion Analysis Laboratory, Shriners Hospitals for Children-Salt Lake City, Fairfax Rd. @ Virginia St., Salt Lake City, UT, 84103, USA,
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27
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Boero S, Michelis MB, Riganti S. Use of the eight-Plate for angular correction of knee deformities due to idiopathic and pathologic physis: initiating treatment according to etiology. J Child Orthop 2011; 5:209-16. [PMID: 22654982 PMCID: PMC3100457 DOI: 10.1007/s11832-011-0344-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 04/20/2011] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Angular deformities of the knee resulting from idiopathic, congenital, or acquired causes are commonly encountered in pediatric orthopedics. Whereas physiological deformities should be treated expectantly, the remaining often progress enough to warrant operative treatment, despite attempted bracing. Historical methods of surgical treatment (e.g., epiphysiodesis and stapling) have yielded to the increasingly popular method of reversible guided growth using the eight-Plate. METHODS We studied 58 patients with knee angular deformities managed with eight-Plate guided growth. All etiologies except physiological deformities and those with very slow growth rate were included. Each patient was under appropriate medical management during the entire duration of treatment and after plate removal. RESULTS In the dysplasia/syndrome group, we noted complete correction in 22 patients (78.5%), partial correction in 5 (17.9%), and no correction in 1 patient (3.6%). All cases of idiopathic deformities resolved. Patients with osteochondral dysplasias and genetic syndromes underwent earlier intervention and slower correction than those with idiopathic genu varum or valgum. The time difference in reaching a neutral mechanical axis between the two groups (11 months in idiopathic versus 18 months in pathological physis) could be explained by a significant difference in growth speeds (P = 0.003). CONCLUSION Results indicate that early intervention is advisable for patients with osteochondral dysplasias/syndromes as subsequent correction takes longer. If rebound growth causing recurrent deformity occurs, guided growth can be safely repeated. Additionally, complications reported with other techniques such as hardware failure, physeal violation by the implant, premature physeal closure, and overcorrection were not reported while using the eight-Plate.
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Affiliation(s)
- Silvio Boero
- Department of Pediatric Orthopedics, Istituto Giannina Gaslini, Largo G. Gaslini, 5, 16147 Genoa, Italy
| | - Maria Beatrice Michelis
- Department of Pediatric Orthopedics, Istituto Giannina Gaslini, Largo G. Gaslini, 5, 16147 Genoa, Italy
| | - Simone Riganti
- Department of Pediatric Orthopedics, Istituto Giannina Gaslini, Largo G. Gaslini, 5, 16147 Genoa, Italy
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28
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Jung HJ, Cho TJ, Choi IH, Chung CY, Yoo WJ, Park MS, Bae JY. Change in effective leg length after angular deformity correction by hemiepiphyseal stapling. Clin Orthop Surg 2010; 2:85-9. [PMID: 20514265 PMCID: PMC2867203 DOI: 10.4055/cios.2010.2.2.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 03/21/2009] [Indexed: 11/06/2022] Open
Abstract
Background The hemiepiphyseal stapling has both positive and negative effects on effective leg length. The purpose of this study was to analyze change in effective leg length after angular correction by hemiepiphyseal stapling, and to validate in clinical cases. Methods Mathematical analysis of a hemiepiphyseal stapling model was conducted. The induced formula was validated in 6 cases fulfilling the assumptions of the model. Anatomical parameters involved in this formula were measured in additional 21 cases undergoing hemiepiphyseal stapling or hemiepiphysiodesis. Results Effective leg length increased or decreased according to three parameters in this model: 1) limb length distal to the operated physis (L), 2) width of the operated physis (d), and 3) the amount of angular deformity to be corrected (θ). Actual change in effective leg length of 6 cases similar to this model coincided with the predicted change at least in its direction. L/d ratio was 4.82 ± 0.51. Conclusions Considering the narrow range of the L/d ratio, hemiepiphyseal stapling is likely to decrease effective leg length if the amount of angular correction is less than 10°, whereas to increase it if the amount of angular correction is larger than 16°. This should be taken into consideration when selecting the surgical method for angular deformity correction in skeletally immature patients.
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Affiliation(s)
- Ho-Joong Jung
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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29
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Epiphyseal stapling of the proximal tibia for idiopathic genu valgum. J Child Orthop 2009; 3:217-21. [PMID: 19415361 PMCID: PMC2686818 DOI: 10.1007/s11832-009-0178-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 04/18/2009] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study is to evaluate the clinical and radiological outcomes of hemiepiphysiodesis with a single medial staple of the proximal tibia in idiopathic genu valgum angular correction. METHODS A retrospective review was performed identifying nine adolescents (18 knees) treated for idiopathic adolescent genu valgum by means of a bilateral hemiepiphysiodesis with a single staple of the proximal tibia. The intermalleolar distance (IMD) and hip-knee-ankle angle were measured at skeletal maturity. RESULTS The IMD and hip-knee-ankle angle were reduced in all patients at skeletal maturity. CONCLUSION Hemiepiphysiodesis with a single medial staple of the proximal tibia seems to be a reliable and safe alternative method to achieve correction of an idiopathic genu valgum.
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30
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Burghardt RD, Herzenberg JE, Standard SC, Paley D. Temporary hemiepiphyseal arrest using a screw and plate device to treat knee and ankle deformities in children: a preliminary report. J Child Orthop 2008; 2:187-97. [PMID: 19308576 PMCID: PMC2656802 DOI: 10.1007/s11832-008-0096-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 02/29/2008] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Traditionally, angular deformities are treated by means of osteotomy. In patients who are skeletally immature, this major intervention can be avoided by influencing or guiding the growth of the affected physis. Recently, a new device was presented as an alternative to the widely used Blount staple. Stevens developed a technique using a two-hole, non-locking plate with two screws to perform temporary hemiepiphysiodesis in children. We studied the effectiveness of this new device in correcting angular deformities in children even younger than 5 years of age. METHODS We evaluated our first series of 11 patients (17 eight-Plates) who underwent treatment for angular deformities of various origins and were followed to completion of correction. The average age at hemiepiphysiodesis was 10 years and 2 months (age range 4 years and 11 months-13 years and 8 months). The device was inserted in the lateral distal femur (two cases), the medial distal femur (eight cases), the lateral proximal tibia (two cases), the medial proximal tibia (four cases), and the medial distal tibia (one case). RESULTS The eight-Plate was inserted for an average of 9.5 months (range 5-13 months). The joint orientation angles and the mechanical axis improved in all patients, with the exception of one 13-year and 8-month-old boy with a resected osteosarcoma and a compromised growth plate. In valgus cases (12 limbs, 13 eight-Plates), the mechanical axis deviation improved by an average of 30.7 mm (range 13-55 mm). In varus cases (four limbs, four eight-Plates), the mechanical axis deviation improved by an average of 38.8 mm (range 0-74 mm). No hardware failures, extrusion, growth arrest, or other complications were observed. None of our patients required an osteotomy or repeat eight-Plate insertion. CONCLUSIONS We consider the eight-Plate to be an ideal tool for treatment of angular deformities in growing children. It allows for precise insertion and is reliable. It is also less likely to extrude like the Blount staple.
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Affiliation(s)
- Rolf D. Burghardt
- Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - John E. Herzenberg
- The International Center for Limb Lengthening at the Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Shawn C. Standard
- The International Center for Limb Lengthening at the Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Dror Paley
- The International Center for Limb Lengthening at the Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
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