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Tirta M, Hjorth MH, Jepsen JF, Kold S, Rahbek O. Staples, tension-band plates, and percutaneous epiphysiodesis screws used for leg-length discrepancy treatment: a systematic review and proportional meta-analysis. Acta Orthop 2024; 95:415-424. [PMID: 39023429 PMCID: PMC11257069 DOI: 10.2340/17453674.2024.41104] [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] [Received: 04/22/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND AND PURPOSE The primary aim of this systematic review and meta-analysis was to evaluate the success rate of 3 different epiphysiodesis techniques with implant usage for the treatment of leg-length discrepancy (LLD) in the pediatric population. The secondary aim was to address effectiveness (final LLD) and the reported complications of staples, tension-band plates (TBP), and percutaneous epiphysiodesis screws (PETS). METHODS In this systematic review we searched MEDLINE (PubMed), Embase, Cochrane Library, Web of Science and Scopus for studies on skeletally immature patients with LLD treated with epiphysiodesis with an implant. The extracted outcome categories were effectiveness of epiphysiodesis (LLD measurements pre-/postoperatively, successful/unsuccessful) and complications that were graded on severity. RESULTS 44 studies (2,184 patients) were included. 455 underwent epiphysiodesis with PETS, 578 patients with TBP, and 1,048 with staples. Successful epiphysiodesis was reported in 76% (95% confidence interval [CI] 61-89) with PETS (9 studies), 67% (CI 54-79) with TBP (10 studies), and 51% (CI 28-65) with Blount staples (8 studies). From pooled analysis, the severe complications rate was 7% for PETS, 17% for TBP, and 16% for Blount staples. Angular deformity was reported in 4% after PETS, 10% after TBP, and 17% after Blount staples. CONCLUSION Our results showed that epiphysiodesis with PETS implants was the most successful technique. PETS had a higher success rate, fewer severe complications, and a lower proportion with angular deformity.
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Affiliation(s)
- Maria Tirta
- Interdisciplinary Orthopedics, Aalborg University Hospital.
| | | | | | - Søren Kold
- Interdisciplinary Orthopedics, Aalborg University Hospital
| | - Ole Rahbek
- Interdisciplinary Orthopedics, Aalborg University Hospital
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Althobaiti MS, Aloraini LI, Alamri S, Binsaddik OK, Alobaysi YMY, Alabdulrahman FK, Al Shahrani OAS, Al-Awn RMM, Shafiy GA. Updates in the Management of Leg Length Discrepancy: A Systematic Review. Cureus 2024; 16:e62599. [PMID: 39027766 PMCID: PMC11257626 DOI: 10.7759/cureus.62599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
The aim of this study is to comprehensively investigate the recent literature on the management of leg length discrepancy (LLD). A thorough search of pertinent databases was done in order to find studies that satisfied the requirements for inclusion. A thorough search of PubMed, Web of Science, Scopus, and Science Direct was conducted to find pertinent literature. Rayyan Qatar Computing Research Institute (QRCI, Ar Rayyan, Qatar) was utilized during the whole operation. Eight studies, including a total of 345 patients, were included in our data, and 206 (59.7%) of them were males. Percutaneous epiphysiodesis was the surgical intervention of choice in four studies. LLD can be effectively corrected by temporary and permanent epiphysiodesis. One study reported the incidence of angular deformities following temporary epiphysiodesis. Circumferential periosteal and dual tension-band plating significantly reduced LLD, but reported the incidence of an "over-shoot" in some patients. Bilateral motion control shoes and orthotic insole both were found to improve the patient's gait and trunk symmetry, evidenced by longer and faster steps, reduced ground impact at heel strike, and lower peak plantar pressure in both limbs. Our findings confirm that no inferences about the superiority of a particular management approach for the treatment of LLD can be made. The poor quality of the studies shows that more randomized control trials and prospective studies on the subject are required.
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Affiliation(s)
| | | | - Saud Alamri
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Noonan SO, Miller KJ, Goldstein S, Leiferman E, White J, Brace C, Noonan KJ. Microwave Ablation of the Pig Growth Plate: Proof of Concept for Minimally Invasive Epiphysiodesis. Clin Orthop Relat Res 2024:00003086-990000000-01529. [PMID: 38471002 DOI: 10.1097/corr.0000000000003014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/30/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Different surgical methods for epiphysiodesis of limb length discrepancy (LLD) have been described. Although these methods are variably effective, they are associated with morbidity (pain and limp) and potential complications. Microwave ablation is a less-invasive opportunity to halt growth by selectively destroying the growth plate via thermal energy to treat LLD in children. QUESTIONS/PURPOSES In this proof-of-concept study using an in vivo pig model, we asked: (1) What is the durability of response 2 to 4 months after microwave ablation of the tibial growth plate as measured by length and angulation of the tibia via a CT scan? (2) Was articular cartilage maintained as measured by standard histologic staining for articular cartilage viability? METHODS To develop an in vivo protocol for microwave ablation, we placed microwave antennas adjacent to the proximal tibia growth plate in the cadaveric hindlimbs of 18 3-month-old pigs. To determine the suitable time, we varied ablation from 90 to 270 seconds at 65-W power settings. After sectioning the tibia, we visually assessed for discoloration (implying growth plate destruction) that included the central growth plate but did not encroach into the epiphysis in a manner that could disrupt the articular surface. Using this information, we then performed microwave ablation on three live female pigs (3.5 to 4 months old) to evaluate physiologic changes and durability of response. A postprocedure MRI was performed to ensure the intervention led to spatial growth plate alterations similar to that seen in cadavers. This was followed by serial CT, which was used to assess the potential effect on local bone and growth until the animals were euthanized 2 to 4 months after the procedure. We analyzed LLD, angular deformity, and bony deformity using CT scans of both tibias. The visibility of articular cartilage was compared with that of the contralateral tibia via standard histologic staining, and growth rates of the proximal tibial growth plate were compared via fluorochrome labeling. RESULTS Eighteen cadaveric specimens showed ablation zones across the growth plate without visual damage to the articular surface. The three live pigs did not exhibit changes in gait or require notable pain medication after the procedure. Each animal demonstrated growth plate destruction, expected limb shortening (0.8, 1.2, and 1.5 cm), and bony cavitation around the growth plate. Slight valgus bone angulation (4º, 5º, and 12º) compared with the control tibia was noted. No qualitatively observable articular cartilage damage was encountered from the histologic comparison with the contralateral tibia for articular cartilage thickness and cellular morphology. CONCLUSION A microwave antenna placed into a pig's proximal tibia growth plate can slow the growth of the tibia without apparent pain and alteration of gait and function. CLINICAL RELEVANCE Further investigation and refinement of our animal model is ongoing and includes shorter ablation times and comparison of dynamic ablation (moving the antennae during the ablation) as well as static ablation of the tibia from a medial and lateral portal. These refinements and planned comparison with standard mechanical growth arrest in our pig model may lead to a similar approach to ablate growth plates in children with LLD.
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Affiliation(s)
| | | | | | - Ellen Leiferman
- Department of Orthopaedics, University of Wisconsin, Madison, WI, USA
| | - James White
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Chris Brace
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Kenneth J Noonan
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Starobrat G, Danielewicz A, Szponder T, Wójciak M, Sowa I, Różańska-Boczula M, Latalski M. The Influence of Temporary Epiphysiodesis of the Proximal End of the Tibia on the Shape of the Knee Joint in Children Treated for Leg Length Discrepancy. J Clin Med 2024; 13:1458. [PMID: 38592267 PMCID: PMC10934898 DOI: 10.3390/jcm13051458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Leg length discrepancy (LLD) is a common problem in the daily clinical practice of pediatric orthopedists. Surgical treatment using LLD temporary epiphysiodesis with eight-plate implants is a minimally invasive, safe, and well-tolerated procedure that provides good treatment effects with a relatively low percentage of complications. The main aim of this retrospective study was to determine the effect of epiphysiodesis on the shape of the proximal tibia. Methods: The retrospective study was based on medical records from 2010 to 2019. Radiographs taken before the epiphysiodesis and at 6-month intervals until the end of the treatment were investigated. A total of 60 patients treated for LLD were included in the study (24 girls, 36 boys). They were divided into three groups depending on the duration of the LLD treatment: group I (18 months), group II (30 months), and group III (42 months of treatment). Radiological parameters were assessed, including the roof angle (D), the slope angles (α and β), and the specific parameters of the tibial epiphysis, namely LTH (lateral tubercle height), MTH (medial tubercle height), and TW (tibial width). Results: The roof angle decreased in all the groups, which was accompanied by an increase in the β or α angle. LTH, MTH and TW also increased, and the differences before and after the treatment for the treated legs were statistically significant in all the studied groups. The greatest change in the shape of the articular surface of the proximal tibia occurred after 42 months of treatment. Conclusions: The study showed that epiphysiodesis affects the proximal tibial articular surface over prolonged treatment. Thus, there is a need for future long-term follow-up studies to elucidate the potential effects of LLD egalization.
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Affiliation(s)
- Grzegorz Starobrat
- Department of Paediatric Orthopaedics, Medical University of Lublin, 20-093 Lublin, Poland; (G.S.); (M.L.)
| | - Anna Danielewicz
- Department of Paediatric Orthopaedics, Medical University of Lublin, 20-093 Lublin, Poland; (G.S.); (M.L.)
| | - Tomasz Szponder
- Department and Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, 20-612 Lublin, Poland;
| | - Magdalena Wójciak
- Department of Analytical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland; (M.W.); (I.S.)
| | - Ireneusz Sowa
- Department of Analytical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland; (M.W.); (I.S.)
| | - Monika Różańska-Boczula
- Department of Applied Mathematics and Computer Science, University of Life Sciences in Lublin, 20-033 Lublin, Poland;
| | - Michał Latalski
- Department of Paediatric Orthopaedics, Medical University of Lublin, 20-093 Lublin, Poland; (G.S.); (M.L.)
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Tirta M, Hjorth MH, Jepsen JF, Rahbek O, Kold S. Are percutaneous epiphysiodesis and Phemister technique effective in the treatment of leg-length discrepancy? A systematic review. J Pediatr Orthop B 2024:01202412-990000000-00177. [PMID: 38324644 DOI: 10.1097/bpb.0000000000001160] [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: 02/09/2024]
Abstract
Epiphysiodesis is considered the preferred treatment for children predicted to have leg length discrepancies (LLDs) 2-5 cm at maturity. The aim of this study was to systematically review the existing literature on the effectiveness of permanent epiphysiodesis for LLD treatment, and secondarily to address the reported complications of permanent epiphysiodesis techniques. This systematic review was performed according to PRISMA guidelines. We searched MEDLINE (PubMed), Embase, Cochrane Library, Web of Science and Scopus for studies on skeletally immature patients with LLD treated with permanent epiphysiodesis. The extracted outcome categories were effectiveness of epiphysiodesis (LLD measurements pre/post-operatively, successful/unsuccessful), physeal fusion/arrest, and complications that were graded on severity. Forty-nine studies (3051 patients) were included, 1550 underwent Phemister/modified Phemister epiphysiodesis and 1501 percutaneous epiphysiodesis (PE). Total successful permanent epiphysiodesis surgeries (16 studies) were 73.7% (516/700). Only 13 out of 23 studies had a mean final LLD of less than 1.5 cm. In total, 17.5% (513/2936) of complications were reported. 57 angular deformities were reported (1.9%). Phemister technique had higher percentage of complications (39%) than PE (19.1%) in total, but when failure to achieve adequate reduction in LLD was not included, complication rates for both were close to 14%. However, severe complications were 10.2% for Phemister group and 5.1% for PE. The high complication rates and the relative low success rate call for optimization of the timing and the applied techniques when treating LLD with permanent epiphysiodesis. Phemister technique was found to have higher percentage of severe complications than PE. Registration: PROSPERO (CRD42023435177).
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Affiliation(s)
- Maria Tirta
- Interdisciplinary Orthopaedics, Aalborg University Hospital
| | | | | | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital
| | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital
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Younis MH, Hanstein R, Javed K, Fornari ED, Gomez JA, Sharkey MS, Schulz JF. Does Combining Drilling and Curettage to Percutaneous Trans-epiphyseal Screws Improve Correction of Limb Length Discrepancy? A Comparative Study. Indian J Orthop 2024; 58:190-198. [PMID: 38312896 PMCID: PMC10831026 DOI: 10.1007/s43465-023-01070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 11/21/2023] [Indexed: 02/06/2024]
Abstract
Objectives Physeal drilling and curettage (PDC) and percutaneous epiphysiodesis using transphyseal screws (PETS) are among the most widely used techniques to treat leg-length discrepancy (LLD). This study compared the efficacy and outcomes between PETS alone and PETS combined with PDC (PETS + PDC). Methods Retrospective study of children who underwent epiphysiodesis of the proximal tibia or distal femur with either PETS or PETS + PDC between 2008 and 2018 at a single institution. Radiographic parameters and complications were reviewed at completion of treatment and most recent follow-up. Results A total of 23 epiphysiodeses in 15 patients, average age 13.1 years, with either PETS (13 femur/tibias) or PETS + PDC (10 femur/tibias) were included. PETS patients were treated for a longer time (median: 24 months vs 11 months, p = 0.004), however, follow-up time was similar between groups (p = 0.577), on average 2.7 years. In the PETS group, LLD decreased from 2.55 to 0.84 cm at most recent follow-up (p = 0.010), and in the PETS + PDC group from 3.01 to 1.2 cm (p = 0.005), achieving a correction of 1.71 cm for PETS and 1.83 cm for PETS + PDC (p = 0.871). A correction of LLD to ≤ 2 cm was achieved in 8 PETS (89%) and 4 PETS + PDC cases (67%) (p = 0.525). Two PETS patients (22%) and 1 PETS + PDC (17%) patient returned to the OR for further correction due to persistent LLD (p = 1.000). No differences existed in total number of complications, angular deformity or return to physical activity between groups (p ≥ 0.05 for each comparison). Conclusions This study showed equal efficiency in resolving LLD between the PETS and PETS + PDC procedures with minimal operative complications.Level of Evidence III.
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Affiliation(s)
| | - Regina Hanstein
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| | | | - Eric D. Fornari
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| | - Jaime A. Gomez
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| | - Melinda S. Sharkey
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| | - Jacob F. Schulz
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
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Di Gennaro GL, Trisolino G, Stallone S, Ramella M, Rocca G, Gallone G. Guided Growth Technique for Epiphysiodesis and Hemiepiphysiodesis: Safety and Performance Evaluation. CHILDREN (BASEL, SWITZERLAND) 2023; 11:49. [PMID: 38255362 PMCID: PMC10814807 DOI: 10.3390/children11010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Guided-growth modulation is a first-line treatment widely adopted to correct lower-limb angular deformities and limb-length discrepancies (LLD) in the paediatric population. METHODS We conducted a retrospective study to evaluate the safety and performance of a new construct (8-Plate Plus or Guided-Growth Plate System Plus, Orthofix S.r.l) used to correct angular deformities and LLD in non-skeletally mature children. The primary endpoint was safety (from plate implantation to removal). The secondary endpoint was performance; patients treated for LLD achieved complete correction if a pre- and post-surgery difference of <0 was observed; angular deformities performance was measured in terms of IMD, ICD, mMPTA, and mLDFA. RESULTS We performed 69 procedures in 41 patients. A total of 10 patients had an LLD, and 31 had an angular deformity. We observed nine minor complications in the hemiepiphysiodesis group. One patient experienced rebound. All 10 LLD patient treatments were successful. A total of 30/31 patients with an angular deformity had a successful treatment; the remaining patient had a partial correction. CONCLUSIONS Guided-growth by temporary epiphysiodesis or hemiepiphysiodesis was safe and effective for angular deformities and limb-length discrepancies. Further prospective and/or randomized controlled trial studies assessing more significant cohorts of patients and a comparison group could add evidence to our findings.
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Affiliation(s)
- Giovanni Luigi Di Gennaro
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.L.D.G.); (G.T.); (M.R.); (G.R.)
| | - Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.L.D.G.); (G.T.); (M.R.); (G.R.)
| | - Stefano Stallone
- Unit of Orthopedics and Traumatology, Ospedale Maggiore “Pizzardi”, 40133 Bologna, Italy;
| | - Marco Ramella
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.L.D.G.); (G.T.); (M.R.); (G.R.)
| | - Gino Rocca
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.L.D.G.); (G.T.); (M.R.); (G.R.)
| | - Giovanni Gallone
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.L.D.G.); (G.T.); (M.R.); (G.R.)
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Hvidberg E, Antfang C, Gosheger G, Vogt B, Abood A, Møller-San Pedro A, Frommer A, Weyer-Elberich V, Møller-Madsen MK, Roedl R, Møller-Madsen B, Rölfing JD. Morphology of the knee after guided growth using tension-band devices: a retrospective multicenter study of 222 limbs and 285 implants. Acta Orthop 2023; 94:609-615. [PMID: 38153250 PMCID: PMC10755675 DOI: 10.2340/17453674.2023.34902] [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] [Received: 08/16/2023] [Accepted: 11/08/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND AND PURPOSE Temporary hemiepiphysiodesis by tension-band devices is commonly applied to correct angular limb deformities in children. We aimed to evaluate knee joint morphology after guided growth using these devices. PATIENTS AND METHODS In a retrospective multicenter study we analyzed standardized anteroposterior long-leg radiographs of 222 limbs (285 implants) of patients treated by temporary hemiepiphysiodesis with either eight-Plates or FlexTacks for coronal angular deformities of the knee joint between 2013 and 2019. Femoral floor angle (FFA), femoral notch-intercondylar distance (FNID), and tibial roof angle (TRA) were measured pre- and postoperatively to assess the central knee joint morphology. Statistical exploratory analyses were performed using linear mixed models, t-tests, Wilcoxon signed-rank test, and Mann-Whitney U test. RESULTS 217 FlexTacks (femur 106, tibia 111) in 104 children and 68 eight-Plates (femur 61, tibia 7) in 35 children were identified. Median time period under growth guidance was 11 months (range 4-42). No statistically significant change in the FFA was detected (eight-Plate: P = 0.2; FlexTack: P = 0.3). A statistically significant difference of the FNID was found in the eight-Plate group (P = 0.02), but not in the FlexTack group (P = 0.3). While TRA increased in both groups, a statistical significance was observed only in the FlexTack group (P < 0.01). CONCLUSION We found minor but clinically irrelevant changes in knee morphology after the treatment.
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Affiliation(s)
- Emma Hvidberg
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Denmark; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark
| | - Carina Antfang
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | - Georg Gosheger
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | - Bjoern Vogt
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | - Ahmed Abood
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Denmark; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark
| | - Alexander Møller-San Pedro
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Denmark; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark
| | - Adrien Frommer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | | | | | - Robert Roedl
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | - Bjarne Møller-Madsen
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Denmark; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark
| | - Jan Duedal Rölfing
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Denmark; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany.
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9
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Erdal OA, Gorgun B, Razi O, Sarikaya IA, Inan M. Effects of tension band plating on coronal plane alignment of lower extremities in children treated for idiopathic limb length discrepancy. J Child Orthop 2022; 16:505-511. [PMID: 36483641 PMCID: PMC9723863 DOI: 10.1177/18632521221135192] [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: 05/15/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE One of the most common treatment methods for moderate limb length discrepancy in children is growth modulation using tension band plating. Coronal plane deformities after tension band plating for limb length discrepancy have been documented as an important complication in articles involving heterogeneous groups consisted of both idiopathic cases and patients with pathological physes. The aim of the study was to determine the rate of coronal plane deformities after treatment of a homogeneous group of idiopathic limb length discrepancy cases with tension band plating and to compare screw constructs of medial and lateral plates. METHODS Patient files were retrospectively reviewed for amount of limb length discrepancy, anatomical femorotibial angle, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, and inter-screw angles of each plate on both sides of the tibiae and femora. Measurements at each follow-up period were compared to each other. RESULTS A total of 26 patient files (37 bones) were included to the study. The mean age was 10.5 years. The mean limb length discrepancy was 27.5 mm. Implants were removed after mean 34.5 months. The mean follow-up period was 58.5 months. There was no significant difference in inter-screw angle on each side of the bones at the time of implantation and in lower limb alignments during follow-up. CONCLUSION Treatment of mild-to-moderate idiopathic limb length discrepancy with tension band plating in children was found to be safe against any coronal plane deformity during follow-up until skeletal maturity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ozan A Erdal
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey,Ozan A Erdal, Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Dikilitas Mah. Hakki Yeten Cad. No 10/D 34365 Besiktas, Istanbul, Turkey.
| | - Baris Gorgun
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
| | - Ozan Razi
- Ministry of Health, Burhan Nalbantoglu State Hospital, Lefkosa, Cyprus,Ozan A Erdal, Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Dikilitas Mah. Hakki Yeten Cad. No 10/D 34365 Besiktas, Istanbul, Turkey.
| | - Ilker A Sarikaya
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
| | - Muharrem Inan
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
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10
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Stevens P, Desperes M, McClure PK, Presson A, Herrick J. Growth Deceleration for Limb Length Discrepancy: Tension Band Plates Followed to Maturity. Strategies Trauma Limb Reconstr 2022; 17:26-31. [PMID: 35734037 PMCID: PMC9166257 DOI: 10.5005/jp-journals-10080-1548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Peter Stevens
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
- Peter Stevens, Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America, Phone: +8013303656, e-mail:
| | - Matias Desperes
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
| | - Philip K McClure
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
| | - Angela Presson
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
| | - Jennifer Herrick
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
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11
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Tolk JJ, Merchant R, Calder PR, Hashemi-Nejad A, Eastwood DM. Tension-band Plating for Leg-length Discrepancy Correction. Strategies Trauma Limb Reconstr 2022; 17:19-25. [PMID: 35734032 PMCID: PMC9166256 DOI: 10.5005/jp-journals-10080-1547] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jaap J Tolk
- Department of Orthopaedics and Sports Medicine, Erasmus MC–Sophia Children's Hospital, Rotterdam, South Holland, Netherlands; Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
- Jaap J Tolk, Department of Orthopaedics and Sports Medicine, Erasmus MC–Sophia Children's Hospital, Rotterdam, South Holland, Netherlands; Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom, e-mail:
| | - Rajiv Merchant
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom; Department of Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Peter R Calder
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Aresh Hashemi-Nejad
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Deborah M Eastwood
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom; Department of Orthopaedics, Great Ormond Street Hospital for Children, London, United Kingdom
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12
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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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13
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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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14
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Vogt B, Roedl R, Gosheger G, Frommer A, Laufer A, Kleine-Koenig MT, Theil C, Toporowski G. Growth arrest: leg length correction through temporary epiphysiodesis with a novel rigid staple (RigidTack). Bone Joint J 2021; 103-B:1428-1437. [PMID: 34334047 PMCID: PMC9948429 DOI: 10.1302/0301-620x.103b8.bjj-2020-1035.r4] [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] [Indexed: 11/05/2022]
Abstract
AIMS Temporary epiphysiodesis (ED) is commonly applied in children and adolescents to treat leg length discrepancies (LLDs) and tall stature. Traditional Blount staples or modern two-hole plates are used in clinical practice. However, they require accurate planning, precise surgical techniques, and attentive follow-up to achieve the desired outcome without complications. This study reports the results of ED using a novel rigid staple (RigidTack) incorporating safety, as well as technical and procedural success according to the idea, development, evaluation, assessment, long-term (IDEAL) study framework. METHODS A cohort of 56 patients, including 45 unilateral EDs for LLD and 11 bilateral EDs for tall stature, were prospectively analyzed. ED was performed with 222 rigid staples with a mean follow-up of 24.4 months (8 to 49). Patients with a predicted LLD of ≥ 2 cm at skeletal maturity were included. Mean age at surgery was 12.1 years (8 to 14). Correction and complication rates including implant-associated problems, and secondary deformities as well as perioperative parameters, were recorded (IDEAL stage 2a). These results were compared to historical cohorts treated for correction of LLD with two-hole plates or Blount staples. RESULTS The mean LLD was reduced from 25.2 mm (15 to 45) before surgery to 9.3 mm (6 to 25) at skeletal maturity. Implant-associated complications occurred in 4/56 treatments (7%), and secondary frontal plane deformities were detected in 5/45 legs (11%) of the LLD cohort. Including tall stature patients, the rate increased to 12/67 legs (18%). Sagittal plane deformities were observed during 1/45 LLD treatments (2%). Compared to two-hole plates and Blount staples, similar correction rates were observed in all devices. Lower rates of frontal and sagittal plane deformities were observed using rigid staples. CONCLUSION Treatment of LLD using novel rigid staples appears a feasible and promising strategy. Secondary frontal and sagittal plane deformities remain a potential complication, although the rate seems to be lower in patients treated with rigid staples. Further comparative studies are needed to investigate this issue. Cite this article: Bone Joint J 2021;103-B(8):1428-1437.
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Affiliation(s)
- Bjoern Vogt
- Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany,Correspondence should be sent to Bjoern Vogt. E-mail:
| | - Robert Roedl
- Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany
| | - Georg Gosheger
- General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany
| | - Adrien Frommer
- Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany
| | - Andrea Laufer
- Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany
| | - Marie-Theres Kleine-Koenig
- Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany
| | - Christoph Theil
- General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany
| | - Gregor Toporowski
- Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany
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15
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Tomasevich KM, Quinlan NJ, Mortensen AJ, Hobson TE, Aoki SK. Overgrowth After Pediatric Tibial Spine Repair with Symptomatic Leg Length Discrepancy: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00079. [PMID: 34010177 DOI: 10.2106/jbjs.cc.21.00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 12-year-old girl sustained a right-sided tibial spine fracture while jumping on a trampoline. Postoperative course was complicated initially by arthrofibrosis requiring manipulation under anesthesia and subsequent leg length discrepancy attributed to posttraumatic overgrowth necessitating femoral epiphysiodesis. Ten years after initial injury, she reported her knee to be 63% of normal and an International Knee Documentation Committee score of 63.2. Symptomatic overgrowth requiring epiphysiodesis after tibial spine repair has not been previously reported to our knowledge. CONCLUSION Tibial spine fixation, although previously associated with growth arrest because of physeal damage, may also result in symptomatic limb overgrowth.
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Affiliation(s)
| | - Noah J Quinlan
- University of Utah, Department of Orthopaedics, Salt Lake City, Utah
| | | | - Taylor E Hobson
- University of Utah, Department of Orthopaedics, Salt Lake City, Utah
| | - Stephen K Aoki
- University of Utah, Department of Orthopaedics, Salt Lake City, Utah
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16
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Applebaum A, Nessim A, Cho W. Overview and Spinal Implications of Leg Length Discrepancy: Narrative Review. Clin Orthop Surg 2021; 13:127-134. [PMID: 34094002 PMCID: PMC8173231 DOI: 10.4055/cios20224] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/20/2020] [Accepted: 12/23/2020] [Indexed: 11/25/2022] Open
Abstract
Leg length discrepancy (LLD) is an underrecognized and prevalent condition among the U.S. population, with effects varying depending on the cause and size of the discrepancy. LLD occurs when the paired lower extremities are unequal in length and can be etiologically classified as functional or structural. Length differences are typically less than 10 mm and asymptomatic or easily compensated for by the patient through self-lengthening or shortening of the lower extremities. Literature review of the etiology, diagnostic modalities, clinical complications, and treatment option for patients with LLD. LLD can be assessed directly through tape measurements or indirectly through palpation of bony landmarks. Imaging modalities, specifically radiography, are more precise and help identify coexistent deformity. Once LLD has been diagnosed, evaluation for potential adverse complications is necessary. Discrepancies greater than 20 mm can alter biomechanics and loading patterns with resultant functional limitations and musculoskeletal disorders, such as functional scoliosis. Functional scoliosis is nonprogressive and involves a structurally normal spine with an apparent lateral curvature, which regresses fully or partially when the LLD is corrected. Long-standing LLD and functional scoliosis often result in permanent degenerative changes in the facet joints and intervertebral discs of the spine. Further understanding of the contribution of LLD in the development of scoliosis and degenerative spine disease will allow for more effective preventative treatment strategies and hasten return to function.
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Affiliation(s)
- Ariella Applebaum
- Department of Orthopedic Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adam Nessim
- Department of Orthopedic Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Woojin Cho
- Department of Orthopedic Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
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18
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Willegger M, Schreiner M, Kolb A, Windhager R, Chiari C. Epiphysiodesis for the treatment of tall stature and leg length discrepancy. Wien Med Wochenschr 2021; 171:133-141. [PMID: 33738632 PMCID: PMC8016792 DOI: 10.1007/s10354-021-00828-8] [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] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/10/2021] [Indexed: 12/14/2022]
Abstract
Painful orthopedic conditions associated with extreme tall stature and leg length discrepancy (LLD) include back pain and adopting bad posture. After failure of conservative treatment options, blocking of the growth plates (epiphysiodesis) around the knee emerged as gold standard in patients with tall stature and LLD in the growing skeleton. Surgical planning includes growth prediction and evaluation of bone age. Since growth prediction is associated with a certain potential error, adequate planning and timing of epiphysiodesis are the key for success of the treatment. LLD corrections up to 5 cm can be achieved, and predicted extreme tall stature can be limited. Percutaneous epiphysiodesis techniques are minimally invasive, safe and efficient methods with low complication rates. In general, a multidisciplinary approach should be pursued when treating children and adolescents with tall stature.
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Affiliation(s)
- Madeleine Willegger
- Department of Orthopedics and Trauma Surgery-Division for Orthopedics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
| | - Markus Schreiner
- Department of Orthopedics and Trauma Surgery-Division for Orthopedics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
| | - Alexander Kolb
- Department of Orthopedics and Trauma Surgery-Division for Orthopedics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery-Division for Orthopedics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
| | - Catharina Chiari
- Department of Orthopedics and Trauma Surgery-Division for Orthopedics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Vienna Bone and Growth Center, Vienna, Austria.
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19
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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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20
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Morrison SG, Georgiadis AG, Dahl MT. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2020; 102:1391-1396. [PMID: 32544124 DOI: 10.2106/jbjs.20.00531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Stewart G Morrison
- The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Orthopaedic Surgery, Gillette Children's Specialty Healthcare, St. Paul, Minnesota
| | - Andrew G Georgiadis
- Department of Orthopaedic Surgery, Gillette Children's Specialty Healthcare, St. Paul, Minnesota.,Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Mark T Dahl
- Department of Orthopaedic Surgery, Gillette Children's Specialty Healthcare, St. Paul, Minnesota.,Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
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