Detorsional guided growth — modern concepts and perspectives of clinical application: a review

Abstract

Background. Torsional deformities of the long bones in children are usually treated using correcting detorsional osteotomies with different types of osteosynthesis. However, this method is highly traumatic and can cause severe complications. Guided growth is the gold standard for frontal and sagittal planes deformities treatment in growing children. The technique is effective, minimally invasive, enables early weight-bearing and has lower complication rate. Recently, application of guided growth technique has been actively studied for horizontal plane deformities correction as well. The aim of the review — based on a scientific literature analysis, to present possibilities of using guided growth technique for correcting torsional deformities of the long bones, as well as to define the ways of its improvement for further clinical application. Methods. The search was performed in PubMed/MEDLINE, Google Scholar and eLIBRARY databases. For review, we included 8 articles (five animal experimental studies and three clinical studies), which were published from 2013 to 2023. Results. Analyzed studies demonstrated the possibility of applying detorsional guided growth for horizontal plane deformities correction in growing children. Three main surgical techniques were suggested. Correction efficiency mainly depends on the interplate angle, proper plate positioning and longitudinal growth potential. Limitations of these studies were: a small group number; absence of preoperative CT scans in animal studies; torsional profile measurement using computed tomography was performed only in one of three clinical studies. There was also no preoperative planning of deformity correction/creation amount, so it was not possible to evaluate the accuracy of the suggested methods. The main complications were secondary deformities and limb length discrepancy. Conclusions. Further clinical application of detorsional guided growth in children may be possible after solving the problem of secondary deformities and shortening and providing preoperative planning of the deformity correction amount.