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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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Jain A, Agarwal A, Patel Y, Sharma L. Limb length deceleration or coronal plane deformity correction using tension band plates: does plate configurations determine the intraarticular deformity of proximal tibia? J Pediatr Orthop B 2024; 33:223-226. [PMID: 37548689 DOI: 10.1097/bpb.0000000000001114] [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: 08/08/2023]
Abstract
We studied whether the two-plate tension band configuration is more prone for intraarticular deformations than the single plate application used for coronal plane deformities (CPD). The study was based on radiological chart review (retrospective cross-sectional) of records of children [15 patients (30 plates) with limb length discrepancies (LLD) and 20 patients (36 plates) with CPD]. Interscrew angle, slope angle, and roof angle were compared in the initial postoperative and final radiographs to determine changes of tibial morphology. The mean patient age and follow up for the LLD and CPD groups respectively were 6.5 years, 39.8 months and 8.1 years, 15.5 months respectively. The interscrew angles widened between initial and final radiographs in the CPD group and for both sides in the LLD group. The initial and final slope angles were not significantly different in both LLD and CPD groups. Similar trend was observed for roof angle in either group. In the intergroup comparisons between LLD and CPD group, the slope angle of medial/lateral operated side in LLD group versus that of the operated side in CPD group matched statistically in the final radiographs. Similarly, the final roof angle in LLD and CPD groups was statistically similar. No significant intraarticular morphological change was demonstrated following tension band plating epiphysiodesis of the proximal tibia for our series involving young children. It was observed neither with the two-plate configuration used for limb length decelerations nor with the single plate application for coronal plane corrections.
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Affiliation(s)
- Ankit Jain
- Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Delhi, India
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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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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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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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Rustagi N, Hussain A. Wedge-less oblique supracondylar femoral osteotomy and casting for genu valgum in older children and young adults. J Clin Orthop Trauma 2021; 25:101730. [PMID: 34926157 PMCID: PMC8666556 DOI: 10.1016/j.jcot.2021.101730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Genu valgum is one of the commonest deformities seen by the orthopaedicians. The most common cause is idiopathic but genu valgum secondary to nutritional deficiency is also fairly common in developing and third world countries. Supracondylar osteotomy and internal fixation with plate and screws, is the treatment of choice in older children and young adults, which is costly, requires a wide exposure, a second surgery for implant removal and risk of infection is more. This study was undertaken to measure the outcome of simple oblique percutaneous wedge-less metaphyseal supracondylar osteotomy of the distal femur and casting in older children and adolescents with Genu Valgum in a small centre catering mostly to patients from middle and low income households. PATIENTS AND METHODS Patients aged between 12 and 22 years with genu valgum deformity with a tibiofemoral angle ≥15°, and an intermalleolar distance of more than 7 cm in unilateral and more than 10 cm in bilateral cases, who are not amenable to be treated with guided growth techniques, were included. Patients having knee instability, restriction of knee range of motion, genu recurvatum, tibial deformity component, open physis, were excluded from the study. The correction was undertaken by a simple supracondylar wedge-less metaphyseal short oblique osteotomy of the distal femur followed by immobilization with a long leg plaster of Paris cast. Functional outcome was assessed using Böstman et al. score. RESULTS 46 limbs in 29 patients with a mean age of 14.5 years were operated. The mean follow-up of patients was 6 months. The preoperative radiological tibiofemoral angle (TFA) had a mean value of 19.89° which improved to a mean of 5.31° postoperatively. Intermalleolar distance (IMD) improved from a mean of 13.81 cm to 3.15 cm post-correction. Mean Lateral distal femoral angle (LDFA) improved from 77.11° to 87.20°. Knee score was excellent in all patients at 3 months and 6 months post intervention. There were no serious complications except superficial plaster sores in 4 patients, which healed uneventfully and temporary restriction of knee range of motion in 5 patients. All patients achieved a full range of knee motion after physical therapy. CONCLUSION Supracondylar wedge-less short oblique metaphyseal distal femoral osteotomy and immobilization with plaster of Paris cast is a simple, cheap, safe & viable option for the correction of genu valgum deformity originating from distal femur, with minimal complications in older children and adolescents with limited growth potential, especially in low income countries and small centres.
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Affiliation(s)
- Navneet Rustagi
- Department of Orthopaedics, Bhagwan Mahavir Hospital, Govt of NCT of Delhi, New Delhi, India
| | - Altaf Hussain
- Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre, Moradabad, Uttar Pradesh, India,Corresponding author.
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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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Struwe C, Walter SG, Druschel C, Bornemann R, Ploeger M, Koob S, Placzek R. Biomechanical evaluation of temporary epiphysiodesis at the femoral epiphysis using established devices from clinical practice. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:41. [PMID: 33792782 PMCID: PMC8016773 DOI: 10.1007/s10856-021-06515-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
The aim of this study is to compare biomechanical features of different devices used in clinical routine for temporary epiphysiodesis (eight-Plate® and FlexTackTM). The tested implants were divided into four different groups (eight-Plate® vs. FlexTackTM for lateral and anterior implantation) á 10 samples for testing implanted eight-Plate® vs. FlexTackTM in fresh frozen pig femora for maximum load forces (Fmax) and axial physis distance until implant failure (lmax). A servo hydraulic testing machine (858 Mini Bionix 2) was used to exert and measure reproducible forces. Statistical analyses tested for normal distribution and significant (p < 0.05) differences in primary outcome parameters. There were no significant differences between the eight-Plate® lateral group and the FlexTackTM lateral group for neither Fmax (p = 0.46) nor lmax (p = 0.65). There was a significant higher Fmax (p < 0.001) and lmax (p = 0.001) measured in the eight-Plate® group compared to the FlexTackTM group when implanted anteriorly. In anterior temporary ephiphysiodesis, eight-Plate® demonstrated superior biomechanical stability. At this stage of research, there is no clear advantage of either implant and the choice remains within the individual preference of the surgeon.
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Affiliation(s)
- Charlotte Struwe
- Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Sebastian G Walter
- Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany.
| | - Claudia Druschel
- Department for Orthopedic Surgery and Traumatology, Carl-Gustav-Carus-Universität, Dresden, Germany
| | - Rahel Bornemann
- Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Milena Ploeger
- Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Sebastian Koob
- Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Richard Placzek
- Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany
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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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12
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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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Baghdadi S, Mortazavi SMJ, Dastoureh K, Moharrami A, Baghdadi T. Middle to long-term results of distal femoral tension band hemiepiphysiodesis in the treatment of idiopathic genu valgum. J Pediatr Orthop B 2021; 30:43-47. [PMID: 32044859 DOI: 10.1097/bpb.0000000000000718] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Idiopathic genu valgum is a common deformity in children. Guided growth is the treatment of choice in severe or symptomatic cases, although long-term results are mostly unknown. The purpose of this study was to determine the middle- to long-term results and complications of tension band plating in the treatment of idiopathic genu valgum, and the association between obesity and idiopathic genu valgum. A retrospective review of patients with idiopathic genu valgum treated by tension band plating between January 2007 and September 2017 was performed. Data from 99 patients (198 limbs) were reviewed. All underwent bilateral medial distal femoral tension band plating and subsequent plate removal and were followed by a mean of 56.1 months (12-120 months) after surgery. Full correction was achieved in all patients, with a mean correction rate of 0.52° per month. No cases of infection or premature physeal closure were recorded. Screw breakage at the time of removal occurred in five limbs (2.5%). Fifteen limbs (7.5%) developed a minor overcorrection. 44.4% of our patients were either overweight or obese, which is higher than the national average. A third of our patients complained of an unsightly scar at the latest follow-up. Tension band plating is an effective, well tolerated, and reproducible technique in the treatment of idiopathic genu valgum. The risk of premature physeal closure is minimal. We recommend achieving a minor overcorrection before plate removal in patients with more than a year of expected growth. Also, predicting correction based on the mean correction rate is discouraged.
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Affiliation(s)
- Soroush Baghdadi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - S M Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamel Dastoureh
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Moharrami
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Taghi Baghdadi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Narayana Kurup JK, Shah HH. Hemiepiphysiodesis using 2-holed reconstruction plate for correction of angular deformity of the knee in children. J Orthop 2020; 20:54-59. [PMID: 32042230 DOI: 10.1016/j.jor.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/06/2020] [Indexed: 12/21/2022] Open
Abstract
Background This study assesses the outcome of hemi epiphysiodesis with a 2-holed reconstruction plate using the tension band principle in angular deformities of the knee and variables influencing the outcome. Methods Prospective study from 2012 to 2016 included 23 children with coronal deformities of the knee joint. IMD, ICD, BMI, mLDFA, mMPTA, mTFA, Mechanical axis deviation, Perpendicular mechanical axis ratio, and screw angle measured. Correction and rate of correction compared with BMI, age, etiology, PMAR and MAD, deformity, a segment of bone and the screw angle. Results Total 65 segments operated in 23 children with 40 knees. Out of the total 65, 36 plates were kept in distal femur physis and 29 in the proximal tibial physis. Thirteen knees had genu varum and 27 had genu valgum. The mean age at the time of surgery was 11.25 months. The mean follow-up of 36 months and the average time for correction was 18.64 months. 77.5% correction achieved with ROC maximum in the initial 6 months. ROC in TFA per year were 7.80(femur), 50(tibia), and 120(femur with tibia). Complications included broken implant, screw back out, screw irritation and rebound phenomenon. Conclusions 2-holed reconstruction plate gives similar correction to that of the 8-plate within a comparable period without additional complications. It has the advantage of being cost effective and readily available. Age, BMI, type of deformity, amount of initial deformity, do not play a significant role in the outcome of correction. Screw placement may have a role in the final correction of the deformity. Level of evidence Level 3.
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Affiliation(s)
| | - Hitesh H Shah
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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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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Knapik DM, Buschbach J, Sabharwal S, Liu RW. Hemiepiphysiodesis for Idiopathic Genu Valgum Using Physeal Staples Versus Tension-Band Plating: A Systematic Review. Orthopedics 2019; 42:e485-e491. [PMID: 31355901 DOI: 10.3928/01477447-20190723-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/02/2018] [Indexed: 02/03/2023]
Abstract
This review assesses the outcomes of hemiepiphysiodesis in patients with idiopathic genu valgum (IGV) treated with physeal staples vs tension-band plating (TBP). A systematic review of the literature was conducted to identify articles examining the use of physeal staples vs TBP for the treatment of IGV in skeletally immature patients. No significant difference in overall mean deformity correction (P=.92) or correction per month (P=.61) was observed between groups. Repeat hemiepiphysiodesis was more common in patients who underwent TBP vs physeal staples (P=.05). Tension-band plating did not yield significantly improved results compared with physeal staples in skeletally immature patients with IGV. [Orthopedics. 2019; 42(6):e485-e491.].
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Growth modulation for coronal deformity correction by using Eight Plates-Systematic review. J Orthop 2018; 15:168-172. [PMID: 29657461 DOI: 10.1016/j.jor.2018.01.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/14/2018] [Indexed: 12/24/2022] Open
Abstract
Introduction Coronal deformities are commonly encountered in paediatric orthopaedics and surgical treatment is indicated for severe deformities causing pain, function and cosmetic problems. In a growing bone, major surgical intervention like osteotomy with internal or external fixation can be avoided by growth modulation (hemiepiphysiodesis) using 8-plates. Our aim is to review the published literature on the use of 8-plates for deformity correction. Methods We conducted a systematic review on 8-plate growth modulation for coronal deformity correction. We carried out detailed literature search on PubMed, Google Scholar, EMBASE, and Cochrane databases. We analysed selected studies for patient demographics, rate of deformity correction, clinical outcome and complications. Results We identified seven studies using 8-plate for deformity correction involving 215 patients (350 Limbs). The mean age was 9.5 years (2-16 years M/F Ratio 1.1:1); underlying aetiology was Idiopathic in 33% and Pathological 67% cases. The deformities were successfully corrected in 196/215 patients (91.2%) and partial/no correction in 19/215 patients (8.8%). The mean time to correction was 15.3 Months (10.3-25) and follows up of 18.9 months (12.4-24). The deformity corrected at 1.28 °/month (0.93-1.53), lateral distal femoral angle changed at 0.87°/month (0.65-1.0) and medial proximal tibial angle changed at 0.72 (0.5-1). Complications were reported in 12/215 patients (5.6%) including hardware failure in 5, overcorrection/leg length difference in 5, infection 1 and stiffness 1. The rebound was reported in 8 patients (3.7%). Conclusion Growth modulation with 8-plates has high efficacy and low complications for deformity correction; and has been used widely across all paediatric age groups and aetiology. The literature is mostly retrospective and heterogeneous to develop age and aetiology specific recommendations.
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Vaishya R, Shah M, Agarwal AK, Vijay V. Growth modulation by hemi epiphysiodesis using eight-plate in Genu valgum in Paediatric population. J Clin Orthop Trauma 2018; 9:327-333. [PMID: 30449980 PMCID: PMC6224631 DOI: 10.1016/j.jcot.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/02/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Genu valgum is an angular deformity of the knee, often treated surgically by osteotomy or by growth modulation (using tension band, staples, transphyseal screws and eight-plate which require removal after correction). With this study, we attempt to evaluate the efficacy, rate of correction and complications with the use of 8-plate in the correction of genu valgum deformity in children. MATERIAL AND METHOD In a retrospective study of 24 patients with 11 bilateral and 13 unilateral (35 knees) genu valgum deformity which required surgical corrections were included. There were 11 males, and 13 females and all of them were treated with Steven's technique (Stevens, 2006) using eight-plate and monitored closely. RESULT Twenty-four patients with an average age of 10 years and 8 months (range: 5 yrs, 7 months-14 yrs, 2 months), with the mean preoperative & post-implant removal (Post-IR) tibiofemoral angle of 22.02° ± 5.15° (range 14°-31°) & 6.14° ± 1.92° (range 2°-10°) respectively, required an average time period of 1yr & 5m ± 5 m (range 10 months-28 months) for correction after which implants were removed. Of the 35 limbs, we achieved excellent results in 91.6%. One case (4.16%) had a partial correction of the deformity, and one case (4.16%) had reported with a superficial infection which was taken care. There were 2 cases (8.33%) of over-correction, which was gradually self-corrected during follow-up. CONCLUSION Our results reflect the efficacy of flexible titanium eight plate which corrects angular deformity by acting as a tension band on one side of the growth plate and offers the advantage of reversible Hemi epiphyseal growth modulation. Guided growth modulation is a best available alternative for the treatment of an angular deformity in the patients with open physis.
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Prakash J, Boruah T, Mehtani A, Chand S, Lal H. Experience of supracondylar cheveron osteotomy for genu valgum in 115 adolescent knees. J Clin Orthop Trauma 2017; 8:285-292. [PMID: 28951649 PMCID: PMC5605728 DOI: 10.1016/j.jcot.2017.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/19/2017] [Accepted: 05/30/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Medial close wedge Coventry type osteotomy is commonly performed procedure for adoloscent Genu valgum. However this osteotomy has some inherent problems, a wedge resection causes shortening of affected site. An additional plate for stabilization causes increase in soft tissue dissection and surgical time. A cheveron osteotomy is an alternative procedure, not requiring any internal fixation due to its inherent stability. We started this study with aim to analyze the results of Cheveron osteotomy, to see if the osteotomy was stable enough without implants, time required for healing of osteotomy, post-operative range of motion, limb length discrepancy and to evaluate any other complication. METHODS This study was conducted to evaluate the efficacy of cheveron osteotomy in cases with genu valgum in our department from 2005 to 2012. 75 children with 115 knee deformities were included in the study. Patients were followed upto minimum 3 years post surgery. Clinical and radiological assessment was done on all subsequent visits. RESULTS Preoperative mean valgus angle was 21° (12-30°) and mean inter malleolar distance was 12.3 cm(11-21 cm). The mean post-operative angle was 6.5° and mean intermalleolar distance was 5.6 cm. The difference was statistically significant. The mean tourniquet time was 26 min and mean surgical time including plaster cast application was 38 min. Mean blood loss was 75 ml. The mean time to union was 10.3 weeks. CONCLUSION Supracondylar cheveron osteotomy is simple, stable, low cost osteotomy for surgical correction of genu valgum. The osteotomy provides excellent clinical, radiological and functional results in short surgical time and has an added advantage of omitting the need of second surgery.
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Affiliation(s)
- Jatin Prakash
- Central Institute of Orthopaedics, Safderjung Hospital and VMMC, Delhi-29, India
- Corresponding author at: H-19/82, Sec-7, Rohini, 110085, India.
| | - Tankeswar Boruah
- Central Institute of Orthopaedics, Safderjung Hospital and VMMC, Delhi-29, India
| | - Anil Mehtani
- Department of Orthopaedics, Lady Hardinge medical College, Shaheed Bhagat Singh Marg, New Delhi-110002, India
| | - Suresh Chand
- Department of Orthopaedics, Lady Hardinge medical College, Shaheed Bhagat Singh Marg, New Delhi-110002, India
| | - Hitesh Lal
- Central Institute of Orthopaedics, Safderjung Hospital and VMMC, Delhi-29, India
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