Abstract
The need for concomitant proximal fibular epiphysiodesis (PFE) when correcting leg length discrepancy (LLD) with temporary proximal tibial epiphysiodesis (PTE) in children is controversially discussed. This single center, retrospective cohort study analyzes proximal fibular growth in patients treated by PTE with and without concomitant PFE. Radiographic measurements were conducted before implantation and at implant removal. The position of the fibular head in relation to the tibia was assessed with recently established radiographic reference values. All patients (n = 58, 19 females) received PTE to treat LLD at a mean age of 12.2 years (range 7 to 15). In 27/58 (47%) concomitant PFE was performed. Mean follow-up was 36.2 months (range 14.2 to 78.0). The position of the proximal fibula at implant removal was within physiological range in 21/26 patients (81%) with PFE and in 21/30 patients (70%) without PFE. Proximal fibular overgrowth newly developed in 2/26 patients (8%) treated with PFE and in 5/30 patients (17%) treated without PFE (p = 0.431). Peroneal nerve injury or discomfort due to proximal fibular overlength was not reported. The position of the proximal fibula should be critically assessed preoperatively under consideration of reference values before PTE. In consequence of this study, the authors do not routinely perform PFE concomitantly with PTE for correction of moderate LLD in children if the proximal fibula is localized within physiological radiographic margins determined by the established reference values.
Highlights
Growth arrest by epiphysiodesis is a common surgical procedure to correct moderate leg length discrepancy (LLD) in children [1,2,3]
To date there is no clear consensus if proximal fibular epiphysiodesis (PFE) should be performed concomitantly with proximal tibial epiphysiodesis (PTE)
On the one hand these findings show that treatment without PFE can lead to radiographically measured proximal fibular overgrowth in up to one of six procedures
Summary
Growth arrest by epiphysiodesis is a common surgical procedure to correct moderate leg length discrepancy (LLD) in children [1,2,3]. Med. 2021, 10, 1245 if proximal fibular epiphysiodesis (PFE) should be performed concomitantly with proximal tibial epiphysiodesis (PTE). The tibial growth plate was fluoroscopically localized and the implants were inserted medially and laterally through minimal invasive approaches preserving the periosteum. Surgical treatment of LLD ≥ 5 cm consisted of lengthening by distraction osteogenesis either using external fixators or intramedullary lengthening nails. The tibial growth plate was fluoroscopically localized and the implants were inserted medially and laterally through minimal invasive approaches preserving the perFiFioiggsutuerreue3m3...OOFppoeerrrcaaottiinvveceotteemcchhitnnaiinqqtuuPeeFooEff pparroocaxxinimmnaaulllfafiibtbeuudllaasrrceerppeiwipphhwyysasiiosodidmeesspiissl.a.(na(a)t)eInIdntritnaraoaoppeKer-arwatitviirveeelagltauetreidarlaelrdardatedioci-oh-gngrriaaqppuhheooffrfoppmrrooxxtihimmeaapllrffioibbxuuimllaarraelepplaiipptehhryyassliiotooddweessaiissrdwwsiittthhhaeacdcaiansnntnaululamlateteedddfiuafulllaylystphterhecraetdaodefdetdhscesrcferiwbewuimlaimphlpaelnaatdnetd(eFdinigianurae K3Kep-)-w.wipiirhreyegsgiuouididdeeesddistteiencchhann1iqi2qu-uyeeecacoron-noclcodommbiotiatyan.nt(ltbyly)wIwnittirhthadodpisiestartaal ltfiefvememoloartarealrlaaanlndrdapdpriorooxgxirmiampahal ltoitbifbisaiaalmltetememppapotoriearnraytryaefpteiprhysiiomdpeslaisnitnataio1n2.-y(ce)aIrn-otrladobpoeyr.a(tbiv)eInatnrtaeorpoeproasttievreiolartreardaliorgadraiopghroapf hsaomf esapmateiepnattiaefntetraifmtepr liamnptalatinotna.tion. After equalization of LLD or closing of the growth plates implants were removed (mean time of treatment: 26.5 months; range 8.4 to 77.9). After implantation and removal surgery immediate full weight bearing was permitted
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