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Agarwal A, Barik S, Jain A, Sharma L. Factors influencing correction rate following hemiepiphysiodesis using tension band plates for deformities around the knee: a multivariate analysis study. INTERNATIONAL ORTHOPAEDICS 2024; 48:1411-1417. [PMID: 38351364 DOI: 10.1007/s00264-024-06114-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/04/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE The aim of this study was to appraise various factors influencing the correction rate in temporary hemiepiphysiodesis (THE) around the knee joint. Specifically, the study analysed the relationship of correction rate with age, gender, aetiology, type and location of deformity. METHODS The retrospective study included children who underwent THE for a coronal plane deformity (genu valgus or varum) around the knee joint (distal femur or proximal tibia) over a ten year period (2010-2020). The primary outcome of interest was the correction rate of the deformity. RESULTS Thirty-three children (27 females and 6 males) with a mean age of 8.1 years involving 86 plates were included in the study. The mean correction achieved was 12.2° over a treatment period of 13.3 months. Subgroup analysis showed significant differences between the type (varus (0.8° per month), valgus (1.1° per month)) and the location of deformity femur (1.2° per month) and tibia (0.7° per month)]. On multivariate analysis, the location and the duration of treatment showed significant associations with the correction rate. CONCLUSION The correction of coronal deformities following temporary hemiepiphysiodesis is influenced by several factors. Valgus, femoral and deformities in younger children correct at a faster rate. Location of deformity and duration of treatment emerged as potential factors affecting the correction rate.
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Affiliation(s)
- Anil Agarwal
- , Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | | | - Ankit Jain
- , Chacha Nehru Bal Chikitsalaya, New Delhi, India
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Liang M, Zhang X, Liu H, Gao R, Guo D, Yao Z. Robot-assisted Temporary Hemiepiphysiodesis With Eight-plates for Lower Extremity Deformities in Children. J Pediatr Orthop 2024; 44:260-266. [PMID: 38312109 DOI: 10.1097/bpo.0000000000002631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
PURPOSE This study was performed to compare the radiographic results of robot-assisted and traditional methods of treating lower extremity deformities (LEDs). METHODS From January 2019 to February 2022, 55 patients with LEDs were treated by temporary hemiepiphysiodesis with eight-plates. They were divided into a robot group and a freehand group. The fluoroscopy time and operation time were recorded. The accuracy of screw placement was measured after the operation using the following parameters: coronal entering point (CEP), sagittal entering point (SEP), and angle between the screw and epiphyseal plate (ASEP). The limb length discrepancy (LLD) and femorotibial angle (FTA) were measured before the operation, after the operation, and at the last follow-up. Patients were followed up for 12 to 24 months, and the radiographic results of the 2 groups were compared. RESULTS Among the 55 patients with LEDs, 36 had LLD and 19 had angular deformities. Seventy-six screws were placed in the robot group and 85 in the freehand group. There was no difference in the CEP between the 2 groups ( P >0.05). The robot group had a better SEP (2.96±1.60 vs. 6.47±2.80 mm) and ASEP (3.46°±1.58° vs. 6.92°±3.92°) than the freehand group ( P <0.001). At the last follow-up, there was no difference in the LLD or FTA improvement between the two groups ( P >0.05). The incidence of complications was significantly lower in the robot group than in the freehand group (0/27 vs. 5/28, P <0.05). CONCLUSION Robot-assisted temporary hemiepiphysiodesis with eight-plates is a safe and effective method for treating LEDs in children. Robotic placement of screws is superior to freehand placement with respect to the entering position and direction. Although the correction effect for LLD and angular deformity is similar, screw dislocation is less common when using robot assistance. LEVELS OF EVIDENCE Level-III. Retrospective comparative study.
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Affiliation(s)
- Mingqian Liang
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Tomasevich KM, Kantor AH, Metz AK, Hanson IT, Froerer DL, Rosenthal RM, Aoki SK. Mid-term outcomes of temporary medial distal femoral hemiepiphysiodesis with and without medial patellofemoral ligament repair for recurrent patellar instability in skeletally immature patients with genu valgum. J Pediatr Orthop B 2024; 33:119-129. [PMID: 37610091 DOI: 10.1097/bpb.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Genu valgum contributes to patellar instability, though outcomes following temporary hemiepiphysiodesis via eight plating are less understood. The purpose of this study was to evaluate the outcomes and need for additional procedures following temporary hemiepiphysiodesis for the treatment of pediatric genu valgum and patellar instability, as well as evaluating the utility of a concurrent medial patellofemoral ligament (MPFL) repair. Patients who underwent medial distal femoral epiphysiodesis for the treatment of genu valgum and recurrent patellar instability were identified. Inclusion criteria were minimum 1-year follow-up and lack of concurrent ligamentous reconstruction. Patients were contacted to complete a questionnaire which included the International Knee Documentation Committee (IKDC) form and questions pertaining to knee function and patient satisfaction. Thirty-one patients aged 12.0 ± 1.9 years underwent 47 guided growth procedures and were included in final analysis. Seventeen knees (36%) required subsequent surgery for patellar instability. All patients requiring subsequent surgery were female, compared with 70% of patients not requiring subsequent surgery ( P = 0.017). The MPFL repair group underwent fewer subsequent procedures to address instability, though this difference was NS (17 vs. 46%, P = 0.318). Mean IKDC score at 5.3 years follow-up among 18 survey respondents was 78.6. Medial distal femoral hemiepiphysiodesis may partially address recurrent patellar instability in skeletally immature patients with genu valgum. Concurrent MPFL repair may minimize the need for subsequent procedures to address recurrent instability. While correcting alignment may be helpful, patients should be aware of the potential need for further patellar instability surgery. Level of evidence: IV, case series.
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Affiliation(s)
| | - Adam H Kantor
- Department of Orthopaedic Surgery, University of Utah
| | - Allan K Metz
- Department of Orthopaedic Surgery, University of Utah
| | | | - Devin L Froerer
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Zeng JF, Xie YY, Liu C, Song ZQ, Xu Z, Tang ZW, Wen J, Xiao S. Effective time, correction speed and termination time of hemi-epiphysiodesis in children. World J Orthop 2024; 15:1-10. [PMID: 38293262 PMCID: PMC10824067 DOI: 10.5312/wjo.v15.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 01/16/2024] Open
Abstract
In children with asymmetric growth on the medial and lateral side of limbs, if there still remains growth potential, the guided growth technique of hemi-epiphysiodesis on one side of the epiphysis is recognized as a safe and effective method. However, when the hemi-epiphysiodesis start to correct the deformities, how many degrees could hemi-epiphysiodesis bring every month and when to remove the hemi-epiphysiodesis implant without rebound phenomenon are still on debate. This article reviews the current studies focus on the effective time, correction speed and termination time of hemi-epiphysiodesis.
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Affiliation(s)
- Jian-Fa Zeng
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Yu-Yin Xie
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Can Liu
- Department of Anatomy, Hunan Normal University school of Medicine, Changsha 410003, Hunan Province, China
| | - Zhen-Qi Song
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zheng Xu
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhong-Wen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
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McGinley J, Worrall H, Althoff C, Clark C, Jo CH, Birch JG, Wilson PL, Ellis HB. Faster Rate of Correction with Distal Femoral Transphyseal Screws Versus Plates in Hemiepiphysiodesis for Coronal-Plane Knee Deformity: Age- and Sex-Matched Cohorts of Skeletally Immature Patients. J Bone Joint Surg Am 2023; 105:1252-1260. [PMID: 37418510 DOI: 10.2106/jbjs.22.01122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
BACKGROUND Hemiepiphysiodesis (guided-growth) procedures have become the primary method of treatment for coronal-plane knee deformities in skeletally immature patients. Two leading techniques involve the use of a transphyseal screw or a growth modulation plate. However, clinical references for the estimation of correction are lacking, and no consensus has been reached regarding the superiority of one technique over the other. Therefore, the purpose of this study was to compare the rates of correction for distal femoral transphyseal screws and growth modulation plates in age- and sex-matched cohorts with coronal deformities. METHODS Thirty-one knees were included in each cohort on the basis of propensity scoring by chronological age and sex, and radiographic images were retrospectively reviewed preoperatively and postoperatively. Each case was measured for limb length, mechanical axis deviation (MAD), mechanical lateral distal femoral angle (LDFA), and bone age. RESULTS Both the MAD and LDFA rate of correction significantly differed between the screw and plate cohorts. The MAD rate of correction was observed to be 0.42 ± 0.37 mm/week (1.69 mm/month) in the plate cohort and 0.66 ± 0.51 mm/week (2.64 mm/month) in the screw cohort. The LDFA rate of correction was observed to be 0.12° ± 0.13°/week (0.50°/month) in the plate cohort and 0.19° ± 0.19°/week (0.77°/month) in the screw cohort. CONCLUSIONS The current study provides simple clinical references for the rate of correction of MAD and the LDFA for 2 methods of hemiepiphysiodesis. The results suggest that transphyseal screws may correct coronal knee deformities during the initial treatment stage more quickly than growth modulation plates in distal femoral guided growth. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | | | | | | | | | - John G Birch
- Scottish Rite for Children, Frisco, Texas
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Philip L Wilson
- Scottish Rite for Children, Frisco, Texas
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Henry B Ellis
- Scottish Rite for Children, Frisco, Texas
- University of Texas Southwestern Medical Center, Dallas, Texas
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Aksoy T, Bakircioglu S, Ozdemir E, Ramazanov R, Aksoy MC, Yilmaz G. The Fate of Overcorrection After Hemiepiphysiodesis in Valgus Deformities Around the Knee. J Pediatr Orthop 2023:01241398-990000000-00280. [PMID: 37168006 DOI: 10.1097/bpo.0000000000002429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Tension band plating is widely used in the surgical treatment of coronal plane deformities around the knee. The rebound phenomenon after implant removal is a common complication of this technique. Overcorrection of joint orientation angles is a method to minimize the effect of the rebound phenomenon. This study aims to investigate the natural course of overcorrected joint orientation angles after plate removal in patients with genu valgum deformity. METHODS Patients who underwent hemiepiphysiodesis with tension band plating due to genu valgum deformity between 2010 and 2019 were retrospectively analyzed. Mechanical lateral distal femoral angles (mLDFA) and mechanical medial proximal tibial angles were calculated before plate application, before implant removal, and at the last follow-up. At the implant removal, mLDFA>90 degrees and mechanical medial proximal tibial angles <85 degrees were accepted as overcorrected. RESULTS Seventy-two segments from 45 patients were included. For femoral valgus deformities (n=59), the mean mLDFAs at index surgery, implant removal, and the last follow-up were 79.8±3.9 degrees, 95.5±3.7 degrees, and 87.3±5.1 degrees, respectively. In the more and less than 10 degrees rebound groups, the median age of patients at index surgery were 66 and 101 months (P=0.04), the mLDFA during implant removal were 97.8 degrees and 94.4 degrees (P=0.005), and the mean amount of correction in mLDFA was 17 degrees and 13 degrees (P=0.001), respectively. At the last follow-up, joint orientation angles were found to be still overcorrected in 16 (22%), within normal limits in 36 (50%), and undercorrected in 20 (28%) segments. Ten (13%) segments required additional surgery due to residual deformity. CONCLUSIONS Overcorrection with tension band plating is an effective modality in the treatment of genu valgum deformity. Rebound after plate removal increases as the age at index surgery decreases and the amount of conscious overcorrection increases. Most segments return to normal joint orientation angle limits after overcorrection. We recommend a mean of 5 degrees routine overcorrection in patients with genu valgum deformity to overcome the rebound phenomenon and to make future interventions easier if ever needed. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Taha Aksoy
- Hacettepe University Department of Orthopedics and Traumatology
| | | | - Erdi Ozdemir
- Karabuk Training and Research Hospital, Department of Orthopedics and Traumatology, Karabuk, Turkey
| | - Rafik Ramazanov
- Private Cankaya Hospital, Orthopedics and Traumatology, Ankara
| | | | - Guney Yilmaz
- Hacettepe University Department of Orthopedics and Traumatology
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Feng WJ, Dai ZZ, Xiong QG, Wu ZK. Temporary hemiepiphysiodesis using eight-plates for angular deformities of the lower extremities in children with X-linked hypophosphataemic rickets. INTERNATIONAL ORTHOPAEDICS 2023; 47:763-771. [PMID: 36646902 DOI: 10.1007/s00264-023-05688-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/22/2022] [Indexed: 01/18/2023]
Abstract
PURPOSES Temporary hemiepiphysiodesis (TH) using eight-plates is one of the most frequently performed surgeries for correcting angular deformities of the lower extremities in adolescents. Rarely have studies examined children with X-linked hypophosphataemic rickets (X-LHPR) treated with TH using eight-plates. This study was conducted to investigate the efficacy, the endpoint, and the complications of TH using eight-plates to correct angular deformities of the lower extremities in skeletally immature children. METHODS We reviewed a total of 26 children (86 physes, 52 knees) with X-LHPR (mean age of 6.2 years, range from 2 to 13 years) who underwent TH using eight-plate to correct angular deformities of the lower extremities. Radiographs and clinical records of these patients were evaluated for demographic data and related clinical factors. RESULTS The average correction of the mechanical lateral distal femoral angle (mLDFA) was 11.7 ± 8.7° (range from 1.0 to 29.7°), and the average correction of the mechanical medial proximal tibial angle (mMPTA) was 8.4 ± 5.0° (range from 0.3 to 16.7°). The mean deformity correction time was 22.7 months (range from 7 to 60 months), and the mean follow-up after eight-plate removal was 43.9 months (range from 24 to 101 months). Overall, 76.9% (20/26 patients) of the angular deformities of the knee were completely corrected and 15.4% (4/26) of the patients received osteotomy surgery. The femoral correction velocity (0.9° per month) was significantly higher than the proximal tibial (0.6° per month) (p = 0.02). The correction velocity of the mLDFA and mMPTA with the TH procedure was faster than that in the absence of intervention (0.9° vs. 0.2°, 0.7° vs. 0.4° per month, p < 0.05). The correction velocity of the mLDFA (1.2° vs. 0.5° per month, [Formula: see text]) and mMPTA (0.7° vs. 0.5° per month, p = 0.04) of patients whose age ≤ five years old was faster than that of patients whose age > five years old. A total of 69.2% (18/26) patients experienced one TH procedure using eight-plates only. Two patients had screw loosening (2/26, 7.7%). One patient (1/26, 3.8%) had a rebound phenomenon after the removal of eight-plate and had the TH procedure again. There was no breakage, infection, physis preclosure, or limited range of movement found in the follow-up. CONCLUSION TH using eight-plates is a safe and effective procedure with a relatively low incidence of complication and rebound, and it could be used as part of a streamlined treatment for younger X-LHPR patients with resistant or progressive lower limb deformity despite optimal medical treatment. Early intervention can achieve better results.
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Affiliation(s)
- Wei-Jia Feng
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen-Zhen Dai
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing-Guang Xiong
- Department of Orthopedics, Maoming People's Hospital, Maoming, Guangdong, China.
| | - Zhen-Kai Wu
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Indications and Timing of Guided Growth Techniques for Pediatric Upper Extremity Deformities: A Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020195. [PMID: 36832323 PMCID: PMC9954695 DOI: 10.3390/children10020195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Osseous deformities in children arise due to progressive angular growth or complete physeal arrest. Clinical and radiological alignment measurements help to provide an impression of the deformity, which can be corrected using guided growth techniques. However, little is known about timing and techniques for the upper extremity. Treatment options for deformity correction include monitoring of the deformity, (hemi-)epiphysiodesis, physeal bar resection, and correction osteotomy. Treatment is dependent on the extent and location of the deformity, physeal involvement, presence of a physeal bar, patient age, and predicted length inequality at skeletal maturity. An accurate estimation of the projected limb or bone length inequality is crucial for optimal timing of the intervention. The Paley multiplier method remains the most accurate and simple method for calculating limb growth. While the multiplier method is accurate for calculating growth prior to the growth spurt, measuring peak height velocity (PHV) is superior to chronological age after the onset of the growth spurt. PHV is closely related to skeletal age in children. The Sauvegrain method of skeletal age assessment using elbow radiographs is possibly a simpler and more reliable method than the method by Greulich and Pyle using hand radiographs. PHV-derived multipliers need to be developed for the Sauvegrain method for a more accurate calculation of limb growth during the growth spurt. This paper provides a review of the current literature on the clinical and radiological evaluation of normal upper extremity alignment and aims to provide state-of-the-art directions on deformity evaluation, treatment options, and optimal timing of these options during growth.
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Artioli E, Mazzotti A, Ramacci V, Zielli SO, Digennaro V, Ruffilli A, Faldini C. Indications and timing in isolated medial femoral hemiepiphysiodesis for idiopathic genu valgum: A systematic review. Knee 2023; 40:52-62. [PMID: 36410251 DOI: 10.1016/j.knee.2022.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/16/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Temporary isolated medial femoral hemiepiphysiodesis (TIMFH) represents a safe and effective technique widely used to treat idiopathic genu valgum. Recent studies mainly concentrated on comparing outcomes of different implants, while less attention has been reserved to the proper indications and timing for surgery. The aim of this systematic review was to provide evidence-based guidelines about indications for device implant and removal and postoperative management. METHODS A comprehensive literature search was performed across three databases to select articles concerning TIMFH in the treatment of idiopathic genu valgum. Studies involving other etiologies or concomitant surgical procedures were excluded. Quality assessment of the included studies was conducted through the Newcastle-Ottawa Scale. RESULTS Ten studies involving 237 patients for a total of 446 knees were included in the analysis. Mean age at surgery was 11,4 years. Patients were considered for surgery using various clinical and radiological parameters. Intermalleolar distance (IMD) and mechanical lateral distal femoral angle (mLDFA) were the most common evaluated. Mean treatment time was 12 months. Rebound of the deformity occurred in 6,7% of cases. CONCLUSION Results of this review showed good consensus among authors. Patients undergoing TIMFH for IGV should be minimum 8 years old, with an IMD greater than 8 cm and a mLDFA lower than 87°. Postoperative management should comprise of quarterly clinic evaluations, and follow-up should last until skeletal maturity. The application of more uniform parameters in clinical practice may improve the establishment of the optimal timing for implant removal.
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Affiliation(s)
- Elena Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology clinic - University of Bologna, Italy.
| | - Antonio Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology clinic - University of Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy.
| | - Vanina Ramacci
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology clinic - University of Bologna, Italy.
| | - Simone Ottavio Zielli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology clinic - University of Bologna, Italy.
| | - Vitantonio Digennaro
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology clinic - University of Bologna, Italy.
| | - Alberto Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology clinic - University of Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy.
| | - Cesare Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology clinic - University of Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy.
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SAĞLAM YAVUZ, DEMIREL MEHMET, YILDIRIM AHMETMUÇTEBA, BILGILI FUAT, ŞEN CENGIZ. CORONAL PLANE GROWTH MODULATION FOR GENU VALGUM IN SKELETAL DYSPLASIA. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e249113. [PMID: 36561480 PMCID: PMC9757729 DOI: 10.1590/1413-785220223006e249113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
Objective To investigate the efficiency and rates of correction by hemiepiphysiodesis using 8-plate to manage genu valgum deformity in children with skeletal dysplasia. Methods Eleven children with skeletal dysplasia (three female, eight male; mean age = 10.5 years; age range = 7-13) who underwent temporary hemiepiphysiodesis using 8-plates for genu valgum deformity were retrospectively reviewed. There were nine bilateral cases and two unilateral cases. The mean follow-up time from the index surgery to the final follow-up was 45 (ranging from 24 to 72) months. Radiographical assessment including preoperative and final follow-up measurements of joint orientation angles and mechanical axis deviation (MAD) were conducted. Results Deformities were completely corrected in nine lower extremities (45%) and partially corrected in seven extremities (35%). In four extremities of two children with Morquio syndrome, MAD worsened. The correction rate of MAD was 1.25 ± 1.62 mm/mo. Conclusion Though hemiepiphysiodesis using 8-plate requires a longer treatment period, it seems to be an effective treatment for correction of genu valgum in children with skeletal dysplasia. Level of Evidence IV, Case Series.
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Affiliation(s)
- YAVUZ SAĞLAM
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - MEHMET DEMIREL
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - AHMET MUÇTEBA YILDIRIM
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - FUAT BILGILI
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - CENGIZ ŞEN
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
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Temporary hemiepiphysiodesis for correction of genu valgum due to cystinosis: a preliminary interventional study in children. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ulusaloglu AC, Asma A, Rogers KJ, Thacker MM, Mackenzie WGS, Mackenzie WG. Risk Factors for Rebound After Correction of Genu Valgum in Skeletal Dysplasia Patients Treated by Tension Band Plates. J Pediatr Orthop 2022; 42:190-194. [PMID: 35051956 DOI: 10.1097/bpo.0000000000002053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Growth modulation using tension band plates (TBPs) is increasingly important for lower limb deformity correction in patients with skeletal dysplasia (SKD). Development of rebound deformity is a concern after TBP removal. Data regarding this complication are rare; therefore, we evaluated the prevalence and risk factors for rebound deformity in children with SKD undergoing correction of genu valgum using TBP. METHODS All patients with SKD with genu valgum treated by TBP at the distal femur or/and proximal tibia at a single center were reviewed. Inclusion criteria were: (1) minimum 2-year follow-up after TBP removal or having revision surgery for rebound deformity and (2) implant removal age for girls 14 years and below and boys 16 years and below. Exclusion criteria were any femoral/tibial osteotomies during TBP treatment or follow-up. A change of ≥3 degrees of mechanical lateral distal femoral and/or medial proximal tibial angle was accepted as rebound deformity and analyzed statistically. RESULTS Thirty-three patients (59 limbs; 52 femur and 29 tibia physes) met our criteria. Mean follow-up after implant removal was 43.7 months. Rebound deformities were seen in 43 limbs (39 femurs and 13 tibias). Boys had more rebound than girls; however, this was not influenced by body mass index. Femurs had more rebound than tibias. Patients in the rebound group were younger than the nonrebound group. Time from application to removal of TBP was shorter in the rebound versus nonrebound group. Overcorrected limbs had more rebound deformity than not overcorrected. The difference in growth velocity of lower limbs in the rebound versus nonrebound group was statistically significant. Patients with epiphyseal dysplasia had more rebound than metaphyseal dysplasia, but this was not statistically significant. CONCLUSION Risk factors for developing a rebound deformity after correction of genu valgum using TBP in SKD included male sex, TBP surgery at a young age, short duration of TBP implantation, overcorrected extremity (mechanical axis deviation ≤1), and high percent growth velocity after TBP removal. LEVEL OF EVIDENCE Level IV-retrospective study.
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Affiliation(s)
- Armagan C Ulusaloglu
- Department of Orthopaedics, Nemours Childrens Hospital, Delaware, Wilmington, DE
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13
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Schagemann J, Kudernatsch N, Russlies M, Mittelstädt H, Götze M, Horter M, Paech A, Behnke B. Prediction of loss of correction after hemiepiphysiodesis for the alignment of lower limb angular deformities. Medicine (Baltimore) 2022; 101:e28626. [PMID: 35060540 PMCID: PMC8772648 DOI: 10.1097/md.0000000000028626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/29/2021] [Indexed: 01/05/2023] Open
Abstract
Guided growth by temporary hemiepiphysiodesis (HEPD) is established for the alignment of lower limb angular deformities. This retrospective cohort study was designed to assess the effect of HEPD in idiopathic coronal plane deformities around the knee and on the frontal knee joint line orientation, and to test the frontal knee joint line as predictive means for recurrence.Fourty-four patients (78 deformities: valgus n = 64, varus n = 14) were enrolled in the retrospective observational study. Mechanical axis deviation, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle were assessed prior to surgery and during follow-up. The facultative frontal knee joint line angle (FKJLA) was used as predictive tool. Cases of remaining growth potential (n = 45/78) after implant removal were followed to assess rebound deformity.Pre-operative angles of the mechanical axis were corrected average 9.0 months after HEPD. Pre-operative assessment of the frontal knee joint line revealed a mean of 3.9° in valgus, and -1.0° in varus deformities. At time of complete deformity correction, mean FKJLA was -0.2° in valgus, and -0.8° in varus deformities. Mean shift of FKJLA was significantly higher after singleHEPD compared to combiHEPD (P < .001). Patients having an unphysiological FKJLA (>/<0°-3°) after correction of mechanical axis had a significantly higher risk of rebound deformity (P = .01). Regression analysis showed a 60.5% higher risk of rebound deformity per each degree deviating from the FKJLA physiological range. Age, gender, or body mass index had no impact.Temporary HEPD offers great potential for the correction of the mechanical axis and the frontal knee joint line. An unphysiological change of the frontal knee joint line is associated with a high risk of recurrent angular deformities. CombiHEPD instead of singleHEPD seems to be safer to prevent detrimental frontal knee joint line shift.Level of Evidence: Retrospective comparative therapeutic study, Level III.
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Affiliation(s)
- Jan Schagemann
- University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, Lübeck, Germany
- Christophorus Kliniken, Südring 41, Coesfeld, Germany
| | - Nils Kudernatsch
- Schön Kliniken Neustadt i.H., Am Kiebitzberg 10, Neustadt, Germany
| | - Martin Russlies
- University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Hagen Mittelstädt
- University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Melanie Götze
- University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | | | - Andreas Paech
- University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Barbara Behnke
- University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, Lübeck, Germany
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14
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Demirel M, Sağlam Y, Yıldırım AM, Bilgili F, Şeker A, Şen C. Temporary Epiphysiodesis Using the Eight-Plate in the Management of Children with Leg Length Discrepancy: A Retrospective Case Series. Indian J Orthop 2022; 56:874-882. [PMID: 35547335 PMCID: PMC9043087 DOI: 10.1007/s43465-021-00599-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/28/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although eight-plates have been shown to be effective in correcting angular deformities of the knee, the literature is scarce regarding the efficiency of this method in treatment of children with LLD. OBJECTIVES The aim of this study was to determine the efficiency, rates of correction and complications of epiphysiodesis using eight-plate in the management of children with leg length discrepancy (LLD). METHODS Eleven consecutive patients with LLD (7 boys, median age = 9, age range 6-11 years) who were treated by temporary epiphysiodesis using eight-plates were retrospectively reviewed and included in the study. The main indication for temporary epiphysiodesis was an LLD between 2 and 5 cm in all patients. LLD and lower limb alignment were examined on lower extremity weight-bearing radiography preoperatively and at skeletal maturity. Longitudinal correction rate was calculated. The final LLD was categorized as ''good result'' (final LLD < 1.5 cm), ''fair result'' (1.5-2 cm), and ''poor result'' (> 2 cm). RESULTS The mean treatment period with the eight-plate was 44 (min to max = 32-72) months, and the mean follow-up from the index surgery to the final follow-up was 62 (min to max = 39-106) months. The mean LLD was significantly reduced from 39 (range 25-50) mm preoperatively to 22.40 (range 6-55) mm postoperatively (p = 0.006). The mean longitudinal correction rate was found to be 0.48 mm/mo. Radiographic evidence of lower limb deformity in frontal and sagittal planes was determined in neither preoperative nor postoperative deformity analysis. No major complications were recorded. CONCLUSION For the management of children with LLD of 2-5 cm, temporary hemiepiphysiodesis using the eight-plate seems to be an effective treatment with low complication rates.
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Affiliation(s)
- Mehmet Demirel
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, Çapa Fatih, 34050 Istanbul, Turkey
| | - Yavuz Sağlam
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, Çapa Fatih, 34050 Istanbul, Turkey
| | - Ahmet M. Yıldırım
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, Çapa Fatih, 34050 Istanbul, Turkey
| | - Fuat Bilgili
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, Çapa Fatih, 34050 Istanbul, Turkey
| | - Ali Şeker
- School of Medicine, Department of Orthopedics and Traumatology, Istanbul University-Cerrahpaşa, Cerrahpaşa Fatih, 34098 Istanbul, Turkey
| | - Cengiz Şen
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, Çapa Fatih, 34050 Istanbul, Turkey
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Ozdemir E, Cetik RM, Ayvaz M, Yilmaz G. The efficacy of two-hole tension band plates in the treatment of lower extremity limb length discrepancy. J Pediatr Orthop B 2022; 31:e31-e36. [PMID: 33720078 DOI: 10.1097/bpb.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The main purpose of our study was to investigate the efficacy of dual two-hole tension band plates in the treatment of lower extremity limb length discrepancy (LLD). We retrospectively reviewed patients who underwent epiphysiodesis utilizing dual two-hole tension band plates due to lower extremity LLD between January 2012 and June 2018. The efficacy of epiphysiodesis was defined as the inhibited percentage of the expected growth of the physis between two time intervals and was calculated between 0-6 months and 6-18 months as the primary outcome. The relationship of efficacy of epiphysiodesis with time intervals, bone segments, physeal coverage percentage by the screws, age and interscrew angle and physeal health was also assessed. A total of 11 patients' 17 bone segments (9 femurs and 8 tibias) with a mean age of 8.7 ± 2.3 were included. The mean efficacy of the epiphysiodesis in the first 6 months for femurs was 23 ± 20 % (range, 0-53%) and for tibias was 21 ± 19 % (range, 0-53%); between 6 and 18 months it was 27 ± 19 % (range, 0-56%) for femurs and 15 ± 19 % (range, 0-50%) for tibias. In the first 6 months, physeal coverage percentage by the screws (r = 0.503, P = 0.04) and age (r = -0.534, P = 0.027) had a strong correlation with the epiphysiodesis efficacy. Dual two-hole tension band plating has variable efficacy in the treatment of LLD. Age and physeal coverage percentage by the screws could be related to epiphysiodesis efficacy.
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Affiliation(s)
- Erdi Ozdemir
- Department of Orthopaedics and Traumatology, Hacettepe University, Ankara, Turkey
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16
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Kim NT, Kwon SS, Choi KJ, Park MS, Chung JY, Han HS, Sung KH. Effect of Screw Configuration on the Rate of Correction for Guided Growth Using the Tension-band Plate. J Pediatr Orthop 2021; 41:e899-e903. [PMID: 34534159 DOI: 10.1097/bpo.0000000000001970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study investigated the effect of screw configuration on the rate of correction of coronal angular deformity of the knee joint in children who underwent guided growth using the tension-band plate. METHODS Consecutive patients (76 patients with 154 physes; mean age: 11.8±2.2 y) who underwent guided growth using the tension-band plate for coronal angular deformity (genu varum or genu valgum) were included. The mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, and screw angle were measured from the teleroentgenograms of preoperative and postoperative periodic follow-up visits. RESULTS The mean initial screw angle and the mean rate of correction were 16.7±10.5 degrees and 6.5±5.3 degrees per year, respectively. The rate of correction was significantly affected by age at surgery, sex, physis treated, severity of deformity, and rate of change in screw angle (all P<0.001). However, the initial screw angle and type of deformity did not affect the rate of correction. The rate of correction per year was 3.6 degrees higher in boys than in girls and 2.8 degrees higher in the distal femur than in the proximal tibia. A 1 degree increase in the rate of change in screw angle was associated with a 0.5 degree increase in the correction rate. Screw angle significantly increased with follow-up duration (P<0.001) and the change in screw angle was significantly affected by age, sex, and physis treated (all P<0.001). CONCLUSIONS This study demonstrated that screw configuration did not affect the correction rate of coronal angular deformity for guided growth using the tension-band plate. Therefore, surgeons only need to insert the screws according to anatomic restriction, not considering the screw configuration when using the tension-band plate for guided growth in children. LEVEL OF EVIDENCE Prognostic level III.
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Affiliation(s)
- Nak Tscheol Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Sciences, Ajou University, Gyeonggi, Korea
| | - Kug Jin Choi
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Moon Seok Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Ju Young Chung
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Hee Soo Han
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Ki Hyuk Sung
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital
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17
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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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19
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Tamm AL, Vaher I, Linkberg R, Tilk T, Kritt J, Alviste A, Sild M, Vain A. Development of Garments with Elastic Straps and Pressure Applicator (GESPA) and "GVcorrect" App to Follow the Changes in Lower-Extremity Alignment ( Genu Valgum)-A Pilot Study. Pediatr Rep 2021; 13:495-503. [PMID: 34449703 PMCID: PMC8396288 DOI: 10.3390/pediatric13030057] [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: 04/19/2021] [Revised: 07/09/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There are non-invasive methods of correcting genu valgum (GV), but to date, there is no method to evaluate mechanotherapeutic intervention that does not restrict child's natural movements while the process is on-going so that timely decisions could be made on effectiveness of intervention. The aim of study was to develop and assess the comfortability of garments with elastic straps and pressure applicator (GESPA) and the reliability and user-friendliness of "GVcorrect" app, which aims to catch the elastic straps' pressure level (mN). METHODS 6 children (5-7 y) with intermalleolar distance ≥5 cm wore GESPA daily for 3 months. Anthropometrical and goniometrical measurements were done according to standard technique; tone and biomechanical parameters of skeletal muscles determined with MyotonPRO; feedback about GESPA and "GVcorrect" collected via questionnaire. RESULTS Based on feedback from children and parents, new, more comfortable and user-friendly GESPA were designed; several updates were made to "GVcorrect" app; new goals were set for the next phase of the study. CONCLUSIONS GESPA and the "GVcorrect" app serve their purpose, but there are still a number of important limitations that need to be removed before the product can be marketed. The study continues with product development until a medical device certificate is obtained.
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Affiliation(s)
- Anna-Liisa Tamm
- Physiotherapy and Environmental Health Department, Tartu Health Care College, Nooruse 5, 50411 Tartu, Estonia; (I.V.); (R.L.); (A.A.); (M.S.)
- Correspondence: ; Tel.: +372-5285181
| | - Ivi Vaher
- Physiotherapy and Environmental Health Department, Tartu Health Care College, Nooruse 5, 50411 Tartu, Estonia; (I.V.); (R.L.); (A.A.); (M.S.)
| | - Reet Linkberg
- Physiotherapy and Environmental Health Department, Tartu Health Care College, Nooruse 5, 50411 Tartu, Estonia; (I.V.); (R.L.); (A.A.); (M.S.)
| | - Teet Tilk
- Institute of Technology, University of Tartu, Nooruse 1, 50411 Tartu, Estonia;
| | - Jana Kritt
- Tallinn Children’s Hospital Foundation, Tervise 28, 13419 Tallinn, Estonia;
| | - Age Alviste
- Physiotherapy and Environmental Health Department, Tartu Health Care College, Nooruse 5, 50411 Tartu, Estonia; (I.V.); (R.L.); (A.A.); (M.S.)
| | - Maarit Sild
- Physiotherapy and Environmental Health Department, Tartu Health Care College, Nooruse 5, 50411 Tartu, Estonia; (I.V.); (R.L.); (A.A.); (M.S.)
| | - Arved Vain
- Institute of Physics, University of Tartu, W. Ostwaldi 1, 50411 Tartu, Estonia;
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Jing L, Wang X, Qu X, Liu K, Wang X, Jiang L, Wu D, Zhang Z, Li Z, Yu L, Wang S, Yang J. Closing-wedge distal femoral osteotomy combined with medial patellofemoral ligament reconstruction for recurrent patellar dislocation with genu valgum. BMC Musculoskelet Disord 2021; 22:668. [PMID: 34372805 PMCID: PMC8351451 DOI: 10.1186/s12891-021-04554-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients. However, despite being a promising procedure for RPD with genu valgum, there is a scarcity of reports on simultaneous MPFLR and closing-wedge distal femoral osteotomy (CWDFO). The purpose of the present study was to observe and analyse the clinical and imaging findings of CWDFO combined with MPFLR for RPD with genu valgum. METHODS From May 2015 to April 2018, 25 patients with RPD and genu valgum were surgically treated in our department. Anteroposterior long-leg, weight-bearing, lower-extremity radiographs, lateral radiographs and computed tomography (CT) scans of the patellofemoral joint were obtained, and the anatomical femorotibial angle (aFTA), mechanical lateral distal femoral angle (mLDFA), weight-bearing line rate (WBLR), patellar height, patellar lateral shift (PLS) and tibial tubercle-trochlear groove (TT-TG) distance were analysed. Validated knee scores, such as the Kujala, Lysholm, visual analogue scale (VAS) scores and Tegner socres, were evaluated preoperatively and 2 years postoperatively. RESULTS 25 patients, with an average age of 19.8 years (14-27), were evaluated. During the 2-year follow-up period, all patients were able to achieve a better sports level without any problems, with no recurrence of patellar instability. Compared with preoperation, the aFTA, mLDFA, WBLR and PLS showed statistically significant improvement following the procedure (p < 0.001). Meanwhile, no significant differences in the Insall index and TT-TG distance were found. The mean Kujala score, average Lysholm score, VAS score and Tegner socres showed significant postoperative improvement. CONCLUSIONS CWDFO combined with MPFLR is a suitable treatment for RPD with genu valgum, and can lead to significant improvement in the clinical and imaging findings of the knee in the short term.
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Affiliation(s)
- Lizhong Jing
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, 250011, China
| | - Xiaole Wang
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, 250011, China
| | - Xiaoliang Qu
- Department of Orthopedics, Dongying Hospital of Traditional Chinese Medicine, Dongying, 257000, China
| | - Kun Liu
- Department of Orthopedics, Penglai Traditional Chinese Medicine Hospital, Yantai, 265600, China
| | - Xiaotan Wang
- Shandong University of Traditional Chinese Medicine, Jinan, 250000, China
| | - Lu Jiang
- Shandong University of Traditional Chinese Medicine, Jinan, 250000, China
| | - Di Wu
- Shandong University of Traditional Chinese Medicine, Jinan, 250000, China
| | - Zhiwei Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, 250000, China
| | - Zhuang Li
- Shandong University of Traditional Chinese Medicine, Jinan, 250000, China
| | - Le Yu
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, 250011, China
| | - Shaoshan Wang
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, 250011, China
| | - Jiushan Yang
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, 250011, China.
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21
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Stief F, Holder J, Böhm H, Meurer A. [Prevalence and predictors of rebound deformity in the frontal plane : A literature review]. DER ORTHOPADE 2021; 50:548-558. [PMID: 34156499 DOI: 10.1007/s00132-021-04118-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/24/2022]
Abstract
The present literature review presents the current state of the art on the prevalence and causes of the rebound phenomenon after successful correction of leg axis deformity using temporary epiphysiodesis in children and adolescents. A total of 20 studies was included by three independent reviewers. The validity of most studies regarding the rebound incidence is limited by a non-standardized follow-up after plate removal, heterogeneous patient groups with a small number of cases, and missing information on the definition of rebound. The rebound incidence in studies without fundamental limitations in study design is on an average about 50% and underlines the clinical relevance of the topic. Only four studies reported reasons or risk factors for the occurrence of a rebound. In particular, a young age at the beginning of treatment with high residual growth potential after implant removal represents an increased rebound risk, which can be minimized by appropriate overcorrection of the leg axis.
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Affiliation(s)
- Felix Stief
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstraße 2, 60528, Frankfurt am Main, Deutschland.
| | - Jana Holder
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstraße 2, 60528, Frankfurt am Main, Deutschland
| | - Harald Böhm
- Orthopädische Kinderklinik, Aschau im Chiemgau, Deutschland.,PFH Private Hochschule, Göttingen, Deutschland
| | - Andrea Meurer
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstraße 2, 60528, Frankfurt am Main, Deutschland
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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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Trisolino G, Boarini M, Mordenti M, Evangelista A, Gallone G, Stallone S, Zarantonello P, Antonioli D, Di Gennaro GL, Stilli S, Sangiorgi L. Outcomes of Temporary Hemiepiphyseal Stapling for Correcting Genu Valgum in Children with Multiple Osteochondromas: A Single Institution Study. CHILDREN-BASEL 2021; 8:children8040287. [PMID: 33917765 PMCID: PMC8068200 DOI: 10.3390/children8040287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Abstract
Background: Multiple osteochondromas is a rare skeletal disorder characterized by the presence of osteocartilaginous protrusions causing bony deformities, especially around the knee. Guided growth by temporary hemiepiphyseal stapling is the treatment of choice to correct the deformity by modulating the residual physeal growth of the lower limbs. Although this procedure is increasingly practiced, inconclusive evidence exists regarding its effectiveness in children with multiple osteochondromas. The study aims to compare the outcomes of temporary hemiepiphyseal stapling for correcting genu valgum in children with multiple osteochondromas vs. idiopathic cases. Methods: In this retrospective cohort study, we included patients admitted at a single institution from 2008 to 2018. A total of 97 children (77 idiopathic, 20 multiple osteochondromas) were enclosed, accounting for 184 limbs treated by temporary hemiepiphyseal stapling. We investigated if children with multiple osteochondromas had a similar successful rate of correction, rate of complications, and correction velocity compared to children with idiopathic genu valgum. Results: Overall, 151 limbs (82%) achieved complete correction or overcorrection, with idiopathic cases having a significantly higher rate of success compared to pathologic cases (88% vs. 55%; p < 0.001). In addition, multiple osteochondromas children sustained a higher rate of major complications (p = 0.021) and showed significantly lower correction velocity (p = 0.029). Conclusion: Temporary hemiepiphyseal stapling is effective in both idiopathic and multiple osteochondromas children, although the latter often achieved incomplete correction, had a higher risk of complications, and required a longer time of stapling. We suggest to anticipate the timing of intervention; otherwise, children with multiple osteochondromas and severe valgus deformity, approaching skeletal maturity, could undergo combined femoral and tibial stapling.
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Affiliation(s)
- Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Manila Boarini
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.B.); (A.E.); (L.S.)
| | - Marina Mordenti
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.B.); (A.E.); (L.S.)
- Correspondence: ; Tel.: +39-051-6366062
| | - Andrea Evangelista
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.B.); (A.E.); (L.S.)
| | - Giovanni Gallone
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Stefano Stallone
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Paola Zarantonello
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Diego Antonioli
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Giovanni Luigi Di Gennaro
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Stefano Stilli
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Luca Sangiorgi
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.B.); (A.E.); (L.S.)
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Lin KM, Thacher RR, Apostolakos JM, Heath MR, Mackie AT, Fabricant PD. Implant-Mediated Guided Growth for Coronal Plane Angular Deformity in the Pediatric Patient with Patellofemoral Instability. Arthrosc Tech 2021; 10:e913-e924. [PMID: 33738233 PMCID: PMC7953424 DOI: 10.1016/j.eats.2020.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/06/2020] [Indexed: 02/03/2023] Open
Abstract
Pediatric patellofemoral instability is a complex problem, for which there are several anatomic risk factors. Coronal plane malalignment (i.e., genu valgum) is one cause of patellofemoral instability, and treatment of genu valgum has been associated with improved patellofemoral stability. Coronal plane angular deformity correction, typically achieved by distal femoral osteotomy in the adult population, can be achieved with less invasive surgical techniques in pediatric patients using implant-mediated guided growth. By temporarily tethering one side of an open physis to generate differential growth in the coronal plane, valgus malalignment can be corrected. We present our technique for medial distal femoral implant-mediated guided growth using tension band plating for treatment of pediatric patellofemoral instability associated with genu valgum. This technique is minimally invasive, has a low complication rate, and in conjunction with conventional treatment can reduce the risk of recurrent instability.
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Affiliation(s)
- Kenneth M. Lin
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Ryan R. Thacher
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - John M. Apostolakos
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Madison R. Heath
- Pediatric Orthopedic Surgery Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Alexandra T. Mackie
- Pediatric Orthopedic Surgery Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Peter D. Fabricant
- Pediatric Orthopedic Surgery Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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Dai ZZ, Liang ZP, Li H, Ding J, Wu ZK, Zhang ZM, Li H. Temporary hemiepiphysiodesis using an eight-plate implant for coronal angular deformity around the knee in children aged less than 10 years: efficacy, complications, occurrence of rebound and risk factors. BMC Musculoskelet Disord 2021; 22:53. [PMID: 33422021 PMCID: PMC7797153 DOI: 10.1186/s12891-020-03915-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Temporary hemiepiphysiodesis (TH) using an eight-Plate implant is one of the most common surgeries used for the correction of coronal angular deformities around the knee in adolescents. However, few studies have focused on children aged less than 10 years treated with TH using an eight-Plate implant. The purpose of this study was to investigate the efficacy, correction velocity, and complications of TH with an eight-Plate implant as well as the occurrence of rebound and risk factors in this population. METHODS This retrospective study included a total of 135 physes (101 knees) from 66 children (mean age of 4.69 years old, range from 1 to 10 years old) who underwent TH with an eight-Plate implant to correct coronal genu angular deformities in our hospital. Related clinical factors were recorded and analysed by multivariable linear and logistic regression models. RESULTS The mean deformity correction period was 13.26 months, and the mean follow-up after eight-Plate removal was 12.71 months. In all, 94.06% (95/101 knees) of the genu angular deformities were completely corrected. Non-idiopathic genu angular deformity was found to be an independent risk factor for deformity correction failure (odds ratio (OR) = 2.47). The femoral correction velocity was significantly higher than the tibial correction velocity (1.28° vs. 0.83° per month, p < 0.001). After adjustment for other factors, younger children had higher correction velocities in the distal femur; however, genu valgum and idiopathic deformities were associated with higher correction velocities in the proximal tibia. In addition, we found three (3/101, 2.97%) knees with genu valgum that experienced rebound after removal of the eight-Plate, while five (5/101, 4.95%) knees with non-idiopathic genu angular deformity experienced screw loosening. No other complications were found, and non-idiopathic deformity was the only risk factor for complications (OR = 3.96). No risk factor was found for rebound in our study. CONCLUSIONS TH using an eight-Plate implant is an effective procedure for coronal genu angular deformities with a low incidence of complications and rebound in patients younger than 10 years old. For this population, TH using an eight-Plate should be considered as soon as the deformity stops responding to conservative treatments. The parents of children younger than 10 years of age with non-idiopathic deformities should be informed preoperatively that the deformity may be prone to correction failure or screw loosening after eight-Plate implantation.
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Affiliation(s)
- Zhen-Zhen Dai
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China
| | - Zhen-Peng Liang
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China
| | - Hao Li
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China
| | - Jing Ding
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China
| | - Zhen-Kai Wu
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China
| | - Zi-Ming Zhang
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China
| | - Hai Li
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China.
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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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Rebound phenomenon after hemiepiphysiodesis: Determination of risk factors after tension band plate removal in coronal plane deformities of lower extremities. J Pediatr Orthop B 2021; 30:52-58. [PMID: 32732797 DOI: 10.1097/bpb.0000000000000786] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Risk factors for rebound phenomenon (ReP) have not been investigated in detail. Aim of this study is to investigate risk factors of ReP in lower extremity deformities after two-hole plate removal. Patients who underwent hemiepiphysiodes were retrospectively reviewed. Joint orientation angles of tibia and femur, deformity type, age of patient at initial surgery and plate removal, deformity correction rate, bone growth rate were noted. An increase of 5° or more in joint orientation angles in the direction of the initial deformity was considered ReP. A relationship between the patient parameters and ReP was evaluated. Ninety-four segments (55 femurs and 39 tibias) of 43 patients (15 males and 28 females) were included. ReP was observed in 56.2% of all valgus deformities (n = 73), and in 23.8% of varus deformities (n = 21). The ReP rate was 60% (n = 27) and 20% (n = 2) in femoral segments with preoperative valgus and varus deformities, respectively (P = 0.03). When gender, etiology, sides and age of implant application and removal were compared, there was no difference between ReP(+) and ReP(-) groups in femur and tibia. The correction rate of mechanical lateral distal femoral angle in ReP(-) and ReP(+) femurs was 0.7 ± 0.4°/month and 1.1 ± 0.3°/month, respectively (P = 0.01). Age at implant application and removal in the femoral valgus group was significantly lower in the ReP(+) group (P = 0.008 and P = 0.005, respectively). The ReP rate was higher in femoral segments with overcorrection (P = 0.008). The ReP rate was higher in femoral valgus deformities. Younger age at plate application and removal, higher correction rate in deformity and intentional overcorrection increased risk for ReP.
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Barrett MC, Manoukian D, Tzatzairis T, Segaren N, Firth GB, Ramachandran M. Hemiepiphysiodesis: when should it be considered a day-case procedure? J Pediatr Orthop B 2021; 30:48-51. [PMID: 32694429 DOI: 10.1097/bpb.0000000000000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hemiepiphysiodesis is usually planned as a day-case but patients may stay overnight for pain control. In this study, we assessed the required level of analgesia (LOA) and length of stay (LOS) in patients undergoing hemiepiphysiodesis about the knee joint. We conducted a retrospective cohort study of patients that underwent temporary hemiepiphysiodesis of the distal femur or proximal tibia using hemiepiphysiodesis plates (eight-plates) for coronal plane deformities between January 2012 and October 2019. Demographics, type of procedure, anatomical site, anaesthetic time, preoperative, intraoperative and postoperative analgesia, and time of surgery were collected. Anterior hemiepiphysiodesis and permanent drill epiphysiodesis procedures were excluded. In this series of 79 patients, those with increased American Society of Anesthesiologists Score >1 and patients that were operated on >2 sites required increased LOA, (P < 0.05) and prolonged LOS (P < 0.05). The timing of surgery (morning vs. afternoon list) did not influence LOS or LOA. Patient-controlled analgesia (PCA) was required in 8 of 14 (57%) patients with four growth plates operated on. All (n = 12) patients that received PCA remained in hospital for at least one night. The use of local infiltration intraoperatively played a significant role in early discharge of the patients and t lower the LOA postoperatively (P < 0.05). Parameters including the number of growth plates operated on, use of tourniquet and intraoperative local infiltration can independently influence LOS and LOA postoperatively and at discharge. These parameters should be taken into consideration when consulting with the patient and family and when planning the postoperative course.
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Affiliation(s)
- Matthew C Barrett
- Department of Orthopaedics, Royal London Hospital, Barts Health NHS Trust, London, UK
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Ballhause TM, Stiel N, Breyer S, Stücker R, Spiro AS. Does eight-plate epiphysiodesis of the proximal tibia in treating angular deformity create intra-articular deformity? Bone Joint J 2020; 102-B:1412-1418. [DOI: 10.1302/0301-620x.102b10.bjj-2020-0473.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Eight-plates are used to correct varus-valgus deformity (VVD) or limb-length discrepancy (LLD) in children and adolescents. It was reported that these implants might create a bony deformity within the knee joint by change of the roof angle (RA) after epiphysiodesis of the proximal tibia following a radiological assessment limited to anteroposterior (AP) radiographs. The aim of this study was to analyze the RA, complemented with lateral knee radiographs, with focus on the tibial slope (TS) and the degree of deformity correction. Methods A retrospective, single-centre study was conducted. The treatment group (n = 64 knees in 44 patients) was subclassified according to the implant location in two groups: 1) medial hemiepiphysiodesis; and 2) lateral hemiepiphysiodesis. A third control group consisted of 25 untreated knees. The limb axes and RA were measured on long standing AP leg radiographs. Lateral radiographs of 40 knees were available for TS analysis. The mean age of the patients was 10.6 years (4 to 15) in the treatment group and 8.4 years (4 to 14) in the control group. Implants were removed after a mean 1.2 years (0.5 to 3). Results No significant differences in RA (p = 0.174) and TS (p = 0.787) were observed. The limb axes were significantly corrected in patients with VVD (p < 0.001). The change in tibial slope (∆TS) did not correlate ( r = -0.026; p = 0.885) to the plate’s position on the physis when assessed by lateral radiographs. Conclusion We were not able to confirm the reported change in the bony morphology of the proximal tibia on AP radiographs in our patient population. In addition, no significant change in TS was detected on the lateral radiographs. A significant correction of the VVD in the lower limb axes was evident. Position of the implant did not correlate with TS change. Therefore, eight-plate epiphysiodesis is a safe and effective procedure for correcting VVD in children without disturbing the knee joint morphology. Cite this article: Bone Joint J 2020;102-B(10):1412–1418.
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Affiliation(s)
- Tobias M. Ballhause
- Department of Paediatric Orthopaedics, Altonaer Children’s Hospital, Hamburg, Germany
- Department of Traumatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Norbert Stiel
- Department of Paediatric Orthopaedics, Altonaer Children’s Hospital, Hamburg, Germany
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Breyer
- Department of Paediatric Orthopaedics, Altonaer Children’s Hospital, Hamburg, Germany
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Stücker
- Department of Paediatric Orthopaedics, Altonaer Children’s Hospital, Hamburg, Germany
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander S. Spiro
- Department of Paediatric Orthopaedics, Altonaer Children’s Hospital, Hamburg, Germany
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Correction of Recurrent Equinus Deformity in Surgically Treated Clubfeet by Anterior Distal Tibial Hemiepiphysiodesis. J Pediatr Orthop 2020; 40:520-525. [PMID: 32555046 DOI: 10.1097/bpo.0000000000001609] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Residual or recurrent equinus deformity is a common problem in surgically treated clubfeet. This deformity may occur due to soft tissue-related reasons or due to bony deformity. An increased anterior distal tibial angle (ADTA) was previously found in 48% of the operated clubfeet. This study aimed to determine the efficacy and safety of anterior distal tibial hemiepiphysiodesis (ADTE) in the treatment of recurrent equinus deformity in patients with an increased ADTA. METHODS Eighteen children (23 feet) treated by ADTE to correct recurrent equinus deformity in surgically treated clubfeet were included in this retrospective, single-center study. ADTE using 8 plates was performed in children with an increased ADTA (>82 degrees) and inability to dorsiflex the ankle (≤0 degree of dorsiflexion). The mean patient age was 11.3 years (range: 10.2 to 12.9 y). All patients had completed treatment with implant removal after an average of 20.3 months (range: 9 to 37 mo). RESULTS The mean preoperative ankle dorsiflexion significantly improved from -3.3 degrees (range: -20 to -0 degrees) to 6.1 degrees (range: -15 to 10 degrees) at the time of 8-plate removal (correction rate: 9.4 degrees; P<0.0001). The ADTA was a mean of 87.5 degrees (range: 83 to 110 degrees) before surgery and significantly improved to 75.8 degrees (range: 63 to 106 degrees) at the time of implant removal (correction rate: 11.7 degrees; P<0.0001). Average follow-up was 43.9 months (range: 10 to 76 mo). Follow-up examinations were continued in 11 patients (13 feet) after implant removal. Changes of ankle dorsiflexion (mean: -2.5 degrees) and ADTA (mean: 3.6 degrees) occurred in this group. CONCLUSIONS ADTE was safe and effective in the treatment of recurrent equinus deformity in surgically treated clubfeet with increased ADTA. Deterioration of ankle dorsiflexion and ADTA occurred after implant removal in some cases. The results of this study have to be analyzed with caution due to the limited number of included patients and its retrospective nature. LEVEL OF EVIDENCE Level IV-retrospective case series.
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Mordenti M, Shih F, Boarini M, Pedrini E, Gnoli M, Antonioli D, Tremosini M, Sangiorgi L. The natural history of multiple osteochondromas in a large Italian cohort of pediatric patients. Bone 2020; 139:115499. [PMID: 32592948 DOI: 10.1016/j.bone.2020.115499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/04/2020] [Accepted: 06/14/2020] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Multiple osteochondromas is a rare hereditary skeletal disorder, characterized by bony protrusions arising from growth plates on long bones during skeletal development. The disorder frequently leads to diminished stature, deformities and functional limitations. Understanding of the natural history of multiple osteochondromas and its evolution in children and adolescents is limited. OBJECTIVE To provide valuable information on the natural history of multiple osteochondromas, to inform recommendations for treatment and prevent impairments caused by osteochondromas. DESIGN This retrospective cohort study in children with multiple osteochondromas includes longitudinal data collected from first to last follow-up visit for patient demographics, and over 36 months for disease evolution. SETTING Data were collected from the Registry of Multiple Osteochondromas, which includes data from circa 1200 patients with multiple osteochondromas treated from 2003 to 2017 at IRCCS Istituto Ortopedico Rizzoli in Bologna. PARTICIPANTS Patients ≤18 years with multiple osteochondromas, who provided written informed consent and had data for ≥1 12-month follow-up visit. MAIN OUTCOME(S) AND MEASUREMENT(S) Demographics, clinical features, incidence of surgeries, and disease evolution (progression or regression) were assessed. Results were summarized using descriptive statistics, annual rates of new clinical features and surgeries, and Kaplan-Meier estimates. Patient height was evaluated following Italian growth charts. RESULTS 158 patients were included in these analyses. Throughout follow-up, 80.4% of patients developed new osteochondromas, 57.6% developed new deformities, 23.4% developed new functional limitation(s). New osteochondroma(s) were developed by 28.5% patients by Month 12, 39.9% at Month 24, 50% at Month 36. Most new osteochondromas were detected in the younger population; patients aged 0-4 years underwent a significantly higher number of lesions within 12, 24 and 36 months of follow-up. The overall incidence of patients with ≥1 new deformity within 12 months was 17.7%, with incidences decreasing with increasing age (p = .023). In addition, the analyses on height highlight that 13 years is a cut off age for slow growth of the stature (p < .0005). At last follow-up visit, 46.2% of patients had disease progression, while regression (spontaneous and surgical) occurred in 7.6% (p = .007). CONCLUSIONS AND RELEVANCE This natural history study reports the main set of clinically relevant data for patients with multiple osteochondromas during skeletal development, providing insight for patient management and development of therapeutic interventions.
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Affiliation(s)
- Marina Mordenti
- Department of Medical Genetics and Rare Orthopedic Diseases and CLIBI Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | | | - Manila Boarini
- Department of Medical Genetics and Rare Orthopedic Diseases and CLIBI Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Elena Pedrini
- Department of Medical Genetics and Rare Orthopedic Diseases, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Maria Gnoli
- Department of Medical Genetics and Rare Orthopedic Diseases, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Diego Antonioli
- Ward of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Morena Tremosini
- Department of Medical Genetics and Rare Orthopedic Diseases, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Luca Sangiorgi
- Department of Medical Genetics and Rare Orthopedic Diseases and CLIBI Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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CORR Synthesis: Can Guided Growth for Angular Deformity Correction Be Applied to Management of Pediatric Patellofemoral Instability? Clin Orthop Relat Res 2020; 478:2231-2238. [PMID: 32433105 PMCID: PMC7491886 DOI: 10.1097/corr.0000000000001311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Naik P, Ganjwala D, Bhatt C, Vora KS. Usefulness of the Sauvegrain Method of Bone Age Assessment in Indian Children. Indian J Orthop 2020; 55:116-124. [PMID: 33569105 PMCID: PMC7851268 DOI: 10.1007/s43465-020-00189-1] [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: 05/13/2020] [Accepted: 06/25/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Bone age estimation is very useful in children undergoing epiphysiodesis or guided growth surgery especially during the years of accelerated growth. It may be noted that no data are available on bone age estimation for Indian children of this age group. Sauvegrain (French) method is a very useful and simple method for bone age assessment during the years of accelerated growth. We decided to check the usefulness and the accuracy of the Sauvegrain method in Indian children. MATERIALS AND METHODS A team of two pediatric orthopaedic surgeons and a radiologist scored elbow X-rays of 80 healthy children (40 boys and 40 girls), using the Sauvegrain method twice. Interobserver reliability and intraobserver reproducibility of the Sauvegrain scoring were assessed. RESULTS There was a very strong correlation between all observers in both rounds (r = > 0.8) and an excellent reproducibility by the same observer in both rounds (r = 0.955). Chronological and bone age are considered the same if the difference between them is less than 6 months. With this criterion bone and chronological ages matched in > 37% of boys and girls, similar to the study done in French children. In the nonmatching group, more children had delayed bone age compared to their chronological age. CONCLUSION The Sauvegrain method of bone age assessment described for French children was found to be useful in estimating bone age in Indian children. It is especially helpful in the clinical practice for detecting mismatch between the chronological and the radiological age before undertaking guided growth or epiphysiodesis.
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Affiliation(s)
- Premal Naik
- Rainbow Superspeciality Hospital and Children’s Orthopaedic Centre, Next To Asia School, Behind HDFC Bank, Opposite Drive in Cinema Bodakdev, Ahmedabad, Gujarat 380054 India ,Smt S C L Hospital, Smt NHL Municipal Medical College, Ahmedabad, Gujarat India
| | - Dhren Ganjwala
- Ganjwala Orthopedic Hospital, 302, Anshi Avenue, Polytechnic, Ahmedabad, Gujarat 380015 India
| | - Chhaya Bhatt
- Smt NHL Municipal Medical College and Sardar Vallabhbhai Patel Institute of Medical Sciences & Research, Ahmedabad, Gujarat India
| | - Kranti Suresh Vora
- Indian Institute of Public Health Gandhinagar, Opp. Airforce quarters, Lekawada, Gandhinagar, Gujarat India ,University of Canberra, Bruce, Australia
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Li J, Ma J, Guo X, Yue C, Chen K, Wang J, Tang X. Closed reduction with crossed Kirschner wire fixation for displaced supracondylar femoral fractures in young children. Medicine (Baltimore) 2020; 99:e19666. [PMID: 32221095 PMCID: PMC7220454 DOI: 10.1097/md.0000000000019666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supracondylar femoral fractures are uncommon in children, but may result in various deformities. Though many approaches have been used to manage them, there is no literally approved standard yet.From 2015 to 2017, 12 young children at the average age of 2.5 years old (range 3.6-1.6) with displaced supracondylar fractures were admitted to our department and received closed reduction with crossed Kirschner wire (K-wire) fixation as treatment. After the surgeries, we performed follow-up to every patient at the average length of 26 months (range 24-30) and used the Knee Society Score scale to evaluate the outcome.Fracture healing was observed within 10 weeks for all patients and walking was resumed between 10 to 13 weeks. No patient reported a valgus deformity more than 10°, neurovascular injury or knee infection. The average limb length discrepancy was 0.4 cm at the end of our follow-up. Every patient had perfect score on the Knee Society Score scale.Our study suggests that closed reduction with percutaneous crossed Kirschner wire is a favorable method for displaced supracondylar femoral fractures in young children.
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Affiliation(s)
- Jin Li
- Department of Orthopaedic Surgery
| | - Jiewen Ma
- Department of Radiology, Union Hospital
| | - Xikai Guo
- Department of Radiology, Union Hospital
| | | | | | - Jing Wang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xin Tang
- Department of Orthopaedic Surgery
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Growth Modulation for Knee Coronal Plane Deformities in Children With Nutritional Rickets: A Prospective Series With Treatment Algorithm. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:JAAOSGlobal-D-19-00009. [PMID: 32159063 PMCID: PMC7028784 DOI: 10.5435/jaaosglobal-d-19-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 11/25/2019] [Indexed: 12/15/2022]
Abstract
To report prospectively the radioclinical outcome of guided growth surgery for coronal plane deformities around the knee in young children with nutritional rickets on the intermediate term, to assess the responsiveness of torsional deformities of the tibias to guided growth regarding function and objective clinical parameters, and to propose a treatment algorithm.
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Martínez G, Gündel A, Ruiz P, Cañete I, Hodgson F. Distal femoral hemiepiphysiodesis with screws and suture versus 8-plate for the treatment of genu valgum in children. Orthop Traumatol Surg Res 2019; 105:751-755. [PMID: 31000342 DOI: 10.1016/j.otsr.2019.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/14/2019] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There are different techniques for gradual correction of angular deformities in lower limbs. The use of screws and non-absorbable filament have been described as an effective alternative for transitory hemiepiphysiodesis in pediatric population. HYPOTHESIS In pediatric population with genu valgum there are no differences in outcome between hemiepiphysiodesis, using screws and non-absorbable filament (SNAF) versus 8-plate. METHODS Retrospective evaluation, 44 knees in 22 patients younger than 15 years, with idiopathic genu valgum, were operated on. One group (20 knees) was operated on with 8-plate technique and another group (24 knees) was operated on with SNAF technique. Initial and final intermalleolar distance (IMD) and mechanical lateral distal femoral angle (mLDFA) were compared, registering complications for each group. Mann-Whitney test was used for statistics, with significance value <0.05. RESULTS All patients achieved the expected mechanical axis correction. IMD and mLDFA significatively improved. There were no significant differences in magnitude and speed of correction when comparing the two techniques. Only one SNAF patient had a minor perioperative complication. DISCUSSION This report compares postoperative results between SNAF and 8-plate technique for correction of angular deformities in lower limbs. In this series of patients, significant clinical and radiological changes were observed between the initial and final values using both techniques, with no significant differences between them. Our group proposes the SNAF technique as an efficient, simple and cost-effective alternative to the traditional 8-plate technique, for the treatment of idiopathic genu valgum in children. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Gino Martínez
- Department of Traumatology and Orthopedics, Clinical Hospital of Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Alejandro Gündel
- Department of Traumatology and Orthopedics, Clinical Hospital of Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Ruiz
- Department of Traumatology and Orthopedics, Clinical Hospital of Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ismael Cañete
- Department of Traumatology and Orthopedics, Clinical Hospital of Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Hodgson
- Department of Traumatology and Orthopedics, Clinical Hospital of Pontificia Universidad Católica de Chile, Santiago, Chile
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Ding J, Jin F, Zhao X, Zhao L, Wu Z, Li J. Hemiepiphysiodesis stapling induces ER stress apoptosis and autophagy in rat growth plates. Am J Transl Res 2019; 11:1486-1497. [PMID: 30972176 PMCID: PMC6456511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/13/2019] [Indexed: 06/09/2023]
Abstract
Angular deformities of adolescents can be treated with temporary hemiepiphysiodesis. It is confirmed that mechanical staples leading to apoptosis of chondrocyte in the growth plate. In addition, clinical evidences revealed that release from growth-inhibition condition resulted in catch-up growth, which caused damage to the patients. Thus, the current study aimed to investigate the mechanisms underlying the cell growth inhibition and the rebound growth during the temporary hemiepiphysiodesis on the growth plate. Rats with knee stapling were housed for indicated weeks, then were separated into control group, hemiepiphysiodesis groups and removal of staple groups. The tissue samples were analyzed by histopathological staining or western blotting. The results indicated there was significant growth arrest and cell apoptosis in rats treated with mechanical stress loaded (hemiepiphysiodesis group). Additionally, immunohistochemistry staining and western blotting revealed the ER-stress induced cell apoptosis was involved in growth inhibition. In removal of staple group, growth-inhibition, apoptotic cells, ER stress and autophagy-related markers were all decreased when the staples were removed from mice. Moreover, IκB/NF-κB pathway were activated in the growth plate of rats when the loads were released. In conclusion, mechanical load leaded to growth inhibition in the growth plate. ER-stress induced apoptosis and autophagy might be responsible for this process. In contrast, the possible reason for the rebound growth of growth plate may be due to the elevated IκB/NF-κB activity.
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Affiliation(s)
- Jing Ding
- Department of Pediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200092, China
| | - Fangchun Jin
- Department of Pediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200092, China
| | - Xiang Zhao
- Department of Pediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200092, China
| | - Li Zhao
- Department of Pediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200092, China
- Department of Pediatric Orthopaedics, Ying-Hua Medical Group of Children’s Bone and Joint HealthcareShanghai 200000, China
| | - Zhenkai Wu
- Department of Pediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200092, China
| | - Jiyu Li
- Department of General Surgery, Shanghai Tenth People’s Hospital of Tong Ji UniversityShanghai 200072, China
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Merker A, Neumeyer L, Hertel NT, Grigelioniene G, Mohnike K, Hagenäs L. Development of body proportions in achondroplasia: Sitting height, leg length, arm span, and foot length. Am J Med Genet A 2018; 176:1819-1829. [DOI: 10.1002/ajmg.a.40356] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/07/2018] [Accepted: 05/17/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Andrea Merker
- Department of Women's and Children's HealthKarolinska Institutet Stockholm, Sweden
| | - Luitgard Neumeyer
- Pediatric Endocrinology Unit, Karolinska University Hospital Stockholm Sweden
| | - Niels Thomas Hertel
- Department of Quality, Research, Innovation & Education, Odense University Hospital Odense Denmark
| | - Giedre Grigelioniene
- Department of Molecular Medicine and SurgeryKarolinska Institutet Stockholm Sweden
- Center for Molecular Medicine, Karolinska Institutet Stockholm Sweden
- Department of Clinical GeneticsKarolinska University Hospital Stockholm Sweden
| | - Klaus Mohnike
- Otto‐von‐Guericke Universität, Universitätskinderklinik Magdeburg Germany
| | - Lars Hagenäs
- Department of Women's and Children's HealthKarolinska Institutet Stockholm, Sweden
- Pediatric Endocrinology Unit, Karolinska University Hospital Stockholm Sweden
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Merker A, Neumeyer L, Hertel NT, Grigelioniene G, Mäkitie O, Mohnike K, Hagenäs L. Growth in achondroplasia: Development of height, weight, head circumference, and body mass index in a European cohort. Am J Med Genet A 2018; 176:1723-1734. [PMID: 30070757 DOI: 10.1002/ajmg.a.38853] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/12/2018] [Accepted: 05/01/2018] [Indexed: 11/12/2022]
Abstract
As growth references for achondroplasia are limited to reports from United States, Japan, Argentina, and Australia, the aim of this study was to construct growth references for height, weight, head circumference, and body mass index (BMI) from a European cohort of children with achondroplasia and to discuss the development of these anthropometric variables. A mix of cross-sectional and longitudinal, retrospective, and prospective data from 466 children with achondroplasia and 4,375 measuring occasions were modeled with generalized additive model for location, scale and shape (GAMLSS) to sex-specific references for ages 0 to 20 years. Loss in height position, that is, reduction in height standard deviation scores, occurred mainly during first 2 years of life while pubertal growth seemed normal if related to adult height. Adult height was 132 cm in boys and 124 cm in girls with a variability comparable to that of the general population and seems to be remarkably similar in most studies of children with achondroplasia. BMI had a syndrome-specific development that was not comparable to BMI development in the general population. Weight and BMI might be misleading when evaluating, for example, metabolic health in achondroplasia. Head circumference reached adult head size earlier than in the general population. Increased tempo of head circumference growth necessitates thus close clinical follow-up during first postnatal years.
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Affiliation(s)
- Andrea Merker
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Luitgard Neumeyer
- Pediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Niels Thomas Hertel
- Department of Quality, Research, Innovation & Education, Odense University Hospital, Odense, Denmark
| | - Giedre Grigelioniene
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Outi Mäkitie
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Klaus Mohnike
- Universitätskinderklinik, Otto-von-Guericke Universität, Magdeburg, Germany
| | - Lars Hagenäs
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Pediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden
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