Abstract
Leg length discrepancy and angular deformities can, in contrast to adults; easily be corrected with epiphysiodesis during growth. Goal of this study was to evaluate our results of a modified Canale technique for definitive epiphysiodesis treating leg length discrepancy and also angular deformities. Between 2000 and 2007, 22 patients (11 boys and 11 girls) were subjected to definitive epiphysiodesis. In total 73 hemiepiphysiodesis were performed (26 proximal tibial, 47 distal femoral). All patients could be followed to the end of growth. Mean follow-up was 32.2 month (range 13-76 months). In 20 patients the epiphysiodesis was planed to correct axis and leg length discrepancy. In two patients' contralateral epiphysiodesis was performed to avoid further leg length discrepancy because of closed physis of the shorter affected side. A staged procedure was necessary in nine patients to achieve the best possible correction. No complications were seen such as wound healing, knee-joint contractures after epiphysiodesis of the distal femur and proximal tibia. In two patients three rehemiepiphysiodesis because of not fully closure of the physis had to be done. Definitive epiphysiodesis using this modified Canale technique is a safe, minimal invasive method to correct leg length discrepancy and angular deformities if preoperative planning is performed properly.
Highlights
Epiphysiodesis is an accepted method for correcting leg length discrepancy and is increasingly being used for angular deformities in children and adolescents
The site and timing of epiphysiodesis were dependent upon the calculations made to achieve full correction at the time adult height is reached
The goals of correction of angular deviations and leg length discrepancy have been achieved in all patients according to the calculated remaining growth potentials
Summary
Epiphysiodesis is an accepted method for correcting leg length discrepancy and is increasingly being used for angular deformities in children and adolescents. Phemister in 1933 [1] is credited with first description of the fusion of the growth plate. It included resection of a rectangular portion of bone containing metaphysis, epiphysis, and its reinsertion with ends reversed resulting in a bony bridge. Considerable pain, prolonged postoperative recovery, extensive scarring, secondary angular deformities and exostosis. Blount and Clarke in 1949 [2] introduced a method with application of staples to the growth plate to slow it down, keeping it potentially reversible. Since after staple removal only the preserved perichondral ring and epiphyseal vessels would allow adequate growth resumption
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