Treatment of the moderate leg length discrepancy in children using temporary bilateral blocking of the growth plate with plates and screws: first experience

Abstract

The results of applying of temporary bilateral blocking (TBB) of the growth plate (GP) for moderate leg length discrepancy (LLD) treatment showed sufficient efficacy and safety. It is known some studies are skeptical to use this method.Objective: to evaluate the results of moderate LLD treatment in children using TBB of the GP with plates and screws.Methods: 33 patients (14 boys and 19 girls) with moderate LLD were treated using TBB of the GP with non-blocking plates with screws: in 24 patients TBB of the distal femoral GP, in 2 patients — TBB of the proximal tibial GP and in 7 patients — combined TBB of both GP was performed. The mean age of patients was 10.7 ± 2.6 years. LLD before treatment ranged from 2 to 5.5 cm (mean — 2.9 ± 0.68). Evaluation of LLD after TBB of the GP was performed in dynamics every 6–12 months using clinical and radiological methods. For assessment of the secondary deformities formation during treatment, we measured mLDFA and MPTA angles and the mechanical axis zone (MAZ).Results: during the observation period, 25 patients have completed the treatment, 8 continued the treatment. Correction of the LLD of different values was noted in all patients (p < 0.05). At the time of TBB completion and removing of fixators, the mean LLD was 0.75 ± 0.82 cm. A good treatment results were obtained in 14 children (77.8 %), of which 7 children achieved a complete correction (50 %), fair — in 3 children (16.7 %), poor — in 1 child (5.5 %). The difference between the mean values of mLDFA and MPTA before and after the treatment was considered statistically insignificant (p > 0.05). Among the complications it should be noted moderate pain syndrome for 2 weeks — 2 cases (6 %), hemarthrosis — 1 case (3 %), contracture of the knee joint — 1 case (3 %), plate migration — 1 case (3 %), secondary angular deformation — 1 case (3 %).Conclusions: the TBB of the GP with plates and screws using for moderate LLD treatment is effective and safe method. The amount of complications that required surgical intervention was 6 %.