Temporary Hemiepiphysiodesis Research Articles

Temporary hemiepiphysiodesis for correction of genu valgum due to cystinosis: a preliminary interventional study in children

Background: Few studies have assessed the efficacy of temporary hemiepiphysiodesis in the treatment of genu valgum in patients with cystinosis. In the present study, the authors aimed to assess the postsurgical outcome of temporary hemiepiphysiodesis for genu valgum in patients with cystinosis. Methods: In this case series study, the inclusion criterion was the occurrence of genu valgum due to definitive diagnosis of cystinosis that was treated with temporary hemiepiphysiodesis technique. The lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were measured before and 6 to 12 mo after the operation. Surgical complications also were assessed within the mean follow-up time of 40.21±19.86 mo. Results: Overall, 14 patients undergoing temporary hemiepiphysiodesis due to genu valgum after cystinosis were assessed. The mean age was 10.00±2.41 yr (male 35.7%, female 64.3%). Hemiepiphysiodesis led to significantly increased LDFA in both left side (from 79.64±3.89 to 88.28±1.26, P=0.001) and right side (from 79.42±2.59 to 89.57±1.69, P=0.001). The change in MPTA in left side (from 88.21±1.36 to 86.07±1.32, P=0.001) and right side (from 88.35±2.49 to 86.42±1.74, P=0.016) also was significant. Conclusions: Temporary hemiepiphysiodesis is a reproducible, efficient, and safe approach for correction of genu valgum in patients with cystinosis with low and amendable complications in a short stature patient. Level of Evidence: Level III.

Comparison of Eight-plate with Reconstruction-plate in Temporary Hemiepiphysiodesis ‎to Correct the Idiopathic Genu Valgum ‎in Pediatrics.

High cost of eight-plate makes it unavailable in many countries; therefore, ‎developing an ‎alternative device for temporary hemiepiphysiodesis of knee deformities in ‎pediatrics ‎is valuable. In this study, we compared the outcome of the eight-plate with the ‎reconstruction-plate in this setting. In this retrospective study, 109 skeletally immature patients (212 physes) who underwent temporary hemiepiphysiodesis to correct idiopathic genu valgum were included. The eight-plate and reconstruction-plate were used in 47 patients (90 physes) and 62 patients (122 physes), respectively. Outcome measures were the valgus angle, medial proximal tibial angle (MPTA), the lateral distal femoral angle (LDFA), the joint-line convergence angle (JLCA), and lower limb mechanical axis (LLMA). The baseline characteristics of the patients were comparable between the two plate groups. The mean follow-up of the patients was 32.9 ± 15.1 months. The mean MPTA change was 2.7 ± 3.7º in the eight-plate group and 2.1 ± 3.4º in the reconstruction-plate group (P=0.2). The mean LDFA improvement was 8 ± 3.7º in the eight-plate group and 7.9 ± 3.5º in the reconstruction-plate group (P=0.61). The mean valgus correction was 10.7 ± 4.4º in the eight-plate group and 10.4 ± 4.6º in the reconstruction-plate group (P=0.74). Moreover, the mean change of JLCA was 0.7 ± 1.3º in the eight-plate group and 0.8 ± 1.3º in the reconstruction-plate group (P=0.58). The postoperative LLMA was comparable between the two study groups as well. In total, five postoperative complications were recorded in this series, which included one case of ‎screw loosening in each group, two cases of overcorrection, and one screw breakage in the ‎reconstruction-plate group. The radiologic results and complications of the reconstruction-plate are comparable with the eight-plate. Therefore, it can be safely and efficiently used in hemiepiphysiodesis to correct idiopathic genu valgum.

Efficacy and Safety of "Sleeper Plate" in Temporary Hemiepiphysiodesis and the Observation of "Tethering".

Guided growth is commonly performed by placing an extraperiosteal 2-hole plate across the growth plate with one epiphyseal and one metaphyseal screw. Recent studies investigated the efficacy of the removal of the metaphyseal screw only (sleeper plate) after correction. They concluded the practice to be unnecessary as only 19% of patients showed recurrence of deformity. This study aims to examine the incidence of rebound and undesired bony in-growth of the plate (tethering) after metaphyseal screw removal only. In this retrospective case series, patient data on 144 plates inserted around the knee were obtained. Plates still in situ (n=69) at the time of study and full hardware removal (n=50) were excluded. The remaining 25 plates had only the metaphyseal screw removed after completed deformity correction. We analyzed the rate of tethering, rebound, and maintenance of correction in 2 age groups at latest follow (mean of 3.5 y). The Fisher exact test with Freeman-Halton extension was used to analyze categorical data and the Student t test for descriptive variables. Twenty-five plates were identified as "sleeper plates" in our series. Thirteen plates (52%) maintained the achieved correction after a mean of 21 months (range: 4 to 39 mo), 9 plates (36%) required screw reinsertion due to rebound after a mean of 22 months (range: 12 to 48 mo) from screw removal, and 4 plates (16%) showed tethering with undesired continuation of guided growth after a mean of 14 months (range: 7 to 22 mo) from screw removal. Younger patients (<8 y at time of plate insertion) had higher rates of rebound and tethering ( P =0.0112, Fisher exact test). All tethering occurred in titanium plates, none occurred in steel plates. The sleeper plate is an acceptable treatment strategy for coronal deformities around the knee, however, tethering and rebound may occur, especially in younger patients. Titanium plates may increase the risk of tethering, however, further long-term follow-up is needed as there were only 6 steel plates versus 19 titanium in this study. We stress the importance of close postoperative follow-up to identify signs of tethering and rebound early to prevent over-correction. Level IV-retrospective case study.

Efficacy Comparison of 3 Kinds of Distal Tibial Hemiepiphyseal Implants in the Treatment of Postoperative Ankle Valgus of Congenital Pseudarthrosis of the Tibia.

Congenital pseudarthrosis of the tibia (CPT) is a complex and serious disease in orthopaedics which often requires multiple operations for treatment. Postoperative ankle valgus deformity is easily seen after the operation of CPT. The aim of this study is to retrospectively evaluate the effectiveness of three different implants for treating postoperative ankle valgus after CPT. A total of 41 patients with postoperative ankle valgus after CPT from December 2010 to July 2019 were selected. Of these 41 patients, 23 patients were treated with "U"-shaped staple, 10 patients were treated with hollow screw and 8 patients were treated with cortical bone screw. The evaluation index was tibiotalar angle. The general data, preoperative, postoperative, and final follow-up imaging data were recorded, and the deformity correction rate and complications were compared. All the patients were performed with postoperative follow-up visit for at least 12 months (31 mo on average). In the "U"-shaped staple group, the preoperative tibiotalar angle was 74.8±4.8 degrees, the tibiotalar angle was 85.8±4.5 degrees when the internal fixation was removed; in the hollow screw group, the average preoperative tibiotalar angle was 72.2±6.1 degrees, the average tibiotalar angle was 88.4±5.1 degrees when the internal fixation was removed; in the cortical bone screw group, the average preoperative tibiotalar angle was 75.1±4.2 degrees, the average tibiotalar angle was 88.4±5.1 degrees when the internal fixation was removed. The correction rate of the "U"-shaped staple group was 0.71 degrees/month, with that of in the hollow screw group and cortical bone screw group being 0.64 degrees/month and 0.61 degrees/month, respectively. There was no significant difference in the correction rate between the 3 groups. One case of internal fixation complication was reported in the hollow screw group; 2 cases of missing correction effect were reported, 1 in cortical bone screw group and 1 in hollow screw group; and 2 cases showing symptom of wound pain were reported in the "U"-shaped staple group. Ankle valgus is a common postoperative complication of congenital tibial pseudarthrosis. Temporary hemiepiphysiodesis with "U"-shaped staple or screws is an effective treatment for postoperative ankle valgus deformity of CPT in children. Level IV-retrospective study.

Factors Affecting Rebound Phenomenon After Temporary Hemiepiphysiodesis and Implant Removal for Idiopathic Genu Valgum in Adolescent Patients.

The aim of this study was to investigate factors determining postoperative courses, especially focusing on the rebound phenomenon, in adolescent patients with idiopathic genu valgum who underwent temporary hemiepiphysiodesis and implant removal. We identified and reviewed patients with idiopathic genu valgum treated with temporary hemiepiphysiodesis [using tension-band plates (plate group, PG) or transphyseal screws (screw group, SG)] and followed-up to skeletal maturity. In our cohort [68 patients and their 68 limbs (randomly selected in bilateral cases)], the mean hip-knee-ankle alignment was -5.4±1.8 degrees at the time of temporary hemiepiphysiodesis (negative means valgus), 2.6±2.1 degrees at the time of implant removal, and 0.7±2.6 degrees at the last follow-up, respectively. Regarding the implants, the correction speed was not significantly different (P=0.192-0.315) between the PG (total 1.29±0.37 degrees/mo, 0.71±0.23 degrees/mo at distal femur, 0.59±0.16 degrees/mo at proximal tibia, n=19) and the SG (total 1.22±0.49 degrees/mo, 0.65±0.25 degrees/mo at distal femur, 0.57±0.23 degrees/mo at proximal tibia, n=49). The magnitude of rebound phenomenon in the PG (4.1±1.9 degrees) was greater (P<0.001) than that in the SG (1.1±3.1 degrees). The use of plates and faster correction speed, rather than more severe preoperative deformity or greater correction angle, were positively associated with the rebound phenomenon in regression analyses. Among the 68 knees, 1 showed valgus alignment ≥5 degrees and 5 showed varus alignment ≥5 degrees at the last follow-up. All the 6 cases were observed in the SG. Surgical wound dehiscence was observed in 1 patient in the PG. The use of plates and faster correction speed were positively associated with the rebound phenomenon. Careful attention will be needed with the corresponding conditions for optimal results. Progressive genu varum after transphyseal screw removal, which was observed in this study, should be explored in future research. Level III-retrospective comparative series.

Rebound predictors of varus-valgus deformities around the knee corrected by guided growth.

Coronal plane deformities around the knee are rather common condition in children. Guided growth by temporary hemiepiphysiodesis is considered to be the preferred primary treatment in many cases. Despite the popularity of hemiepiphysiodesis, the incidence of recurrence of deformity and predictors for rebound are not well defined. The objectives of this study were to determine the incidence of the recurrence of varus-valgus deformities around the knee treated by temporary hemiepiphysiodesis and possible predictors for the rebound. We retrospectively reviewed medical records and x-ray images of 130 patients with varus-valgus deformities around the knee treated by tension-band (eight-plate) hemiepiphysiodesis, between the years 2006 and 2016 in our institution. The incidence of rebound of varus-valgus deformities around the knee and possible predictors were analyzed. Rebound of the deformity was observed in 10% of patients. Risk factors found to be in correlation with recurrence include young age, deformity of proximal tibia, proximal tibial medial growth plate beaking, and comorbidities (like metabolic disorders, multiple hereditary exostoses and genetic syndromes). The results of this study show that there is a noteworthy incidence of rebound in patients treated by temporary hemiepiphysiodesis for coronal deformities around the knee. The risk factors are also outlined. These patients, especially the ones with risk factors, require close surveillance until maturity. Level III-Case control study.

Prediction of loss of correction after hemiepiphysiodesis for the alignment of lower limb angular deformities.

Guided growth by temporary hemiepiphysiodesis (HEPD) is established for the alignment of lower limb angular deformities. This retrospective cohort study was designed to assess the effect of HEPD in idiopathic coronal plane deformities around the knee and on the frontal knee joint line orientation, and to test the frontal knee joint line as predictive means for recurrence.Fourty-four patients (78 deformities: valgus n = 64, varus n = 14) were enrolled in the retrospective observational study. Mechanical axis deviation, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle were assessed prior to surgery and during follow-up. The facultative frontal knee joint line angle (FKJLA) was used as predictive tool. Cases of remaining growth potential (n = 45/78) after implant removal were followed to assess rebound deformity.Pre-operative angles of the mechanical axis were corrected average 9.0 months after HEPD. Pre-operative assessment of the frontal knee joint line revealed a mean of 3.9° in valgus, and –1.0° in varus deformities. At time of complete deformity correction, mean FKJLA was –0.2° in valgus, and –0.8° in varus deformities. Mean shift of FKJLA was significantly higher after singleHEPD compared to combiHEPD (P < .001). Patients having an unphysiological FKJLA (>/<0°–3°) after correction of mechanical axis had a significantly higher risk of rebound deformity (P = .01). Regression analysis showed a 60.5% higher risk of rebound deformity per each degree deviating from the FKJLA physiological range. Age, gender, or body mass index had no impact.Temporary HEPD offers great potential for the correction of the mechanical axis and the frontal knee joint line. An unphysiological change of the frontal knee joint line is associated with a high risk of recurrent angular deformities. CombiHEPD instead of singleHEPD seems to be safer to prevent detrimental frontal knee joint line shift.Level of Evidence: Retrospective comparative therapeutic study, Level III.

Temporary Epiphysiodesis Using the Eight-Plate in the Management of Children with Leg Length Discrepancy: A Retrospective Case Series.

Although eight-plates have been shown to be effective in correcting angular deformities of the knee, the literature is scarce regarding the efficiency of this method in treatment of children with LLD. The aim of this study was to determine the efficiency, rates of correction and complications of epiphysiodesis using eight-plate in the management of children with leg length discrepancy (LLD). Eleven consecutive patients with LLD (7 boys, median age = 9, age range 6-11years) who were treated by temporary epiphysiodesis using eight-plates were retrospectively reviewed and included in the study. The main indication for temporary epiphysiodesis was an LLD between 2 and 5cm in all patients. LLD and lower limb alignment were examined on lower extremity weight-bearing radiography preoperatively and at skeletal maturity. Longitudinal correction rate was calculated. The final LLD was categorized as ''good result'' (final LLD < 1.5cm), ''fair result'' (1.5-2cm), and ''poor result'' (> 2cm). The mean treatment period with the eight-plate was 44 (min to max = 32-72) months, and the mean follow-up from the index surgery to the final follow-up was 62 (min to max = 39-106) months. The mean LLD was significantly reduced from 39 (range 25-50) mm preoperatively to 22.40 (range 6-55) mm postoperatively (p = 0.006). The mean longitudinal correction rate was found to be 0.48mm/mo. Radiographic evidence of lower limb deformity in frontal and sagittal planes was determined in neither preoperative nor postoperative deformity analysis. No major complications were recorded. For the management of children with LLD of 2-5cm, temporary hemiepiphysiodesis using the eight-plate seems to be an effective treatment with low complication rates.

CORONAL PLANE GROWTH MODULATION FOR GENU VALGUM IN SKELETAL DYSPLASIA.

To investigate the efficiency and rates of correction by hemiepiphysiodesis using 8-plate to manage genu valgum deformity in children with skeletal dysplasia. 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. 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. 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.

Management of ankle valgus in a skeletally immature patient by tension band plate hemiepiphysiodesis: A case report

Temporary hemiepiphysiodesis is the procedure of choice to correct ankle valgus deformity in a skeletally immature patient. However, the literature is inconclusive regarding the ideal choice of implant and the timing of the surgery. In the current case report, a 9-year-old girl with multiple hereditary exostoses and unilateral ankle valgus deformity underwent tension band plate (TBP) hemiepiphysiodesis, and gained a modest correction at a rate of 0.61°/month. After 18 months of follow-up, there were no implant-related complications, and the functional outcome was also good. This case report shows a promising result of medial malleolar temporary hemiepiphysiodesis using a TBP for ankle valgus deformity in the pediatric population.

Functional outcome of temporary hemiepiphysiodesis by using 8 plate in patients with genu valgum deformity

Background: Idiopathic genu valgum is one of the common deformity encountered in OPD of orthopaedics. After a fair conservative trail to treat the deformity fails, temporary epiphysiodesis become the standard treatment. This deformity can also be treated with several types of osteotomies with additional risk of extensive soft tissue handling, infection, delayed union, non-union, malunion etc. various method of temporary epiphysiodesis are present but most of them are on the principle of compression such as stapling, transphyseal screws fixation etc. On the other hand 8 plate, works on the principle of tension band. Hereby the aim of this study is to see the functional outcome and complications related to 8 plate generated growth modulation.Method: Study design was prospective and interventional, between June 2018 to May 2020.Eight plate was implanted on 16 patients aged between 6 years to 15 years suffering from genu valgum deformity. Plate was implanted over distal femur medially. Patients were evaluated pre-operatively and post-operatively by determining various joint angles both clinically and radiologically. Following are the various joint angles evaluated:1.Tibio femoral angle2.Medial proximal tibial angle3.Lateral distal femoral angle4.Mechanical axis zoneAll these paraments were recorded in each follow up and data collected was analyzed statistically.Result: 16 patients were included in the study with a median follow up of 16 months. Out of 16 patients operated 6 were females. A mean pre-operative and post-operative tibio femoral axis were recorded. We observed a p-value of 0.001 which is statistically significant.Conclusion: Growth modulation using 8 plate method proves to be an effective method for correcting genu valgum deformity in skeletally immature patients. It is a reversible procedure and surgeon friendly and at the same time 8 plate adjust dynamically to the ever changing physeal anatomy.

Outcomes of Temporary Hemi-Epiphysiodesis Using a New Device for The Treatment of Pediatric Valgus Knee Deformity: a Preliminary Report.

This study aimed to evaluate the efficacy of hemi-epiphysiodesis using a new device (X-plate) for the correction of genu valgum. In total, 22 children with a total of 34 pathologic knee valgus deformities underwent the procedure and were followed up 25.3 months on average. The mean time to clinical correction of genu valgum was 10.9±2.2 months. Furthermore, the mean preoperative anatomic Lateral Distal Femoral Angle (aLDFA) and mechanical Tibia Femoral angle (mTFA) were obtained at 75.1±3.8 and 6±2.8 degrees, respectively. When clinical correction of the deformity was achieved, the mean of aLDFA and mTFA corrections were determined at 8.9±5.3 and 6.5±3.2 degrees, respectively. The mean speed of aLDFA and mTFA corrections were estimated at 0.8±0.45 and 0.6±0.3 degrees per month, respectively. The postoperative aLDFA and mTFA were measured at 84±4.2 and -0.8±2.9 on average. With a mean of 25.3±14.5 months at final follow-up, there were 6 (17.6%) mild valgus knees, 26 (75.5%) normal alignment knees, and only 2 (5.9%) mild varus knee within an acceptable clinical limit. Hemi-epiphysiodesis using X-plate at the distal physis of the femur is an effective and safe method for the treatment of valgus knee deformity in children.

X-linked hypophosphatemic rickets. What the orthopedic surgeon needs to know

Purpose: X-linked hypophosphatemic rickets (XLH) is a rare genetic disease characterized by an increase in fibroblast growth factor 23 (FGF23) expression. The skeleton is one of the systems most affected and deformities of the lower limbs are one of the first reasons for consulting an orthopedic surgeon. The aim of the present study was to offer practical advice for a comprehensive orthopedic approach to XLH. Materials: A literature search was conducted in PubMed, a freely available and cost-effective database. The articles included in the study were discussed by a research group with specific expertise in bone metabolism and pediatric deformities, in order to answer three fundamental questions and thus provide the orthopedic specialist with guidance on XLH: (1) How should the physician complete the diagnosis of XLH?; (2) When might a surgical procedure be recommended?; (3) What kind of surgical procedure should be performed? Results: Sixty-three articles were included and discussed by the research group. Conclusions: A correct and timely diagnosis of XLH is essential to appropriately manage affected patients. To complete this diagnosis a detailed medical history of the patient, a comprehensive clinical and radiographic evaluation, and specific biochemical tests are needed. Pharmacological treatment is based on supplementation of both phosphate and vitamin D, however, a monoclonal antibody that inactivates FGF23 (burosumab), has recently been introduced with promising results. Orthopedic surgery is needed in cases of moderate or severe deformities, to allow physiological growth and prevent early osteoarthritis and gait alterations. Surgical options are osteotomies and hemiepiphysiodesis, which is preferred whenever possible. Three different devices for temporary hemiepiphysiodesis are available (staples, transphyseal screws and tension band plates). Obviously, surgical procedures need an appropriate medical therapy to be effective. In conclusion, the diagnosis, treatment and follow-up of XLH require a multidisciplinary approach and a comprehensive evaluation of anamnestic, clinical and radiographic data.

Growth modulation through hemiepiphysiodesis : Novel surgical techniques: risks and progress

The correction of angular deformities of the lower limb is a key task in paediatric orthopaedic surgery. The growth potential of the physis can be employed for the correction of these malalignments in childhood and adolescence. Hemiepiphysiodesis (HED) is asurgical technique used for growth modulation by permanent or temporary asymmetrical arrest of the growth plate. In permanent HED, exact timing of the procedure is mandatory to achieve optimal correction. Temporary HED through tension band devices such as two-hole-plates or flexible staples has been established as the treatment of choice for growth guidance with excellent results. Implant-associated complications have been significantly reduced through implant modifications. Several experimental procedures have the potential to achieve growth modulation even without the requirement of surgical intervention.

Growth modulation of angular deformities with a novel constant force implant concept-preclinical results.

PurposeVarus-valgus deformities in children and adolescents are often corrected by temporary hemi-epiphysiodesis, in which the physis is bridged by an implant to inhibit growth. With standard implant solutions, the acting forces cannot be regulated, rendering the correction difficult to control. Furthermore, the implant load steadily increases with ongoing growth potentially leading to implant-related failures. A novel implant concept was developed applying a controlled constant force to the physis, which carries the potential to avoid these complications. The study aim was to proof the concept in vivo by analyzing the effect of three distinct force levels on the creation of varus deformities.MethodsThe proposed implant is made of a conventional cerclage wire and features a twisted coil that unwinds with growth resulting in an implant-specific constant force level. The proximal medial tibial physes of 18 lambs were treated with the implant and assigned to three groups distinct by the force level of the implant (200 N, 120 N, 60 N).ResultsThe treatment appeared safe without implant-related failures. Deformity creation was statistically different between the groups and yielded on average 10.6° (200 N), 4.8° (120 N) and 0.4° (60 N) over the treatment period. Modulation rates were 0.51°/mm (200 N), 0.23°/mm (120 N) and 0.05°/mm (60 N) and were constant throughout the treatment.ConclusionBy means of the constant force concept, controlled growth modulation appeared feasible in this preclinical experiment. However, clinical trials are necessary to confirm whether the results are translatable to the human pathological situation.

Prospective Study on Tension Band Plating: Most Patients are Not Returning to Normal Activities 1 Month Following Surgery.

Tension band plating for temporary hemiepiphysiodesis has been reported by several authors as simple and effective for treating angular deformities of the lower limb. Anecdotally, patients have reported higher pain levels than expected given the small size of incision and relatively minimal amount of dissection, and we sought to investigate this further. Patients 16 years old or less with lower extremity angular deformities or limb length inequality were prospectively enrolled before tension band plating from 2 pediatric institutions from July 2016 to December 2018. Participants completed postoperative questionnaires regarding their pain and activity level. Pain was assessed using the FACES Pain Scale. Patients were included if they completed the 1 month survey. Of the 48 patients that met inclusion criteria (mean age at surgery: 13.1 y; range: 7 to 16 y), 39 patients completed the survey at 3 months postoperatively. There was a significant change in pain level between 1 week and 1 month postoperatively (P<0.001). Eighty-three percent (34/41) of patients were still taking pain medication at 1 week, which decreased to 38% (18/48) at 1 month. At 3 months, 21% (8/39) patients reported they were still using pain medication. At 1 month, 65% of patients (31/48) had not returned to their prior activity level. Of the 39 patients who played sports, 59% (23/39) still had not fully returned to sports at 1 month. At 1 month following tension band plating, 65% of patients had not returned to their preoperative activity level, and 38% were taking pain medications. Although the tension band plate and surgical incision is small in size, patients and parents should be counseled that there are significant activity limitations and pain levels for a month or longer in many patients. Level II.

Correction of Genu Valgum Deformity by Temporary Hemiepiphysiodesis using 8-Plate.

ABSTRACTBackground:The rationale behind temporary hemiepiphysiodesis is to tether growth on the convex side of the deformity to allow the concave side of the physis to continue growth leading to deformity correction. Tension band plating in the form of 8-plate had been introduced by Stevens in 2007 to allow for guided growth correction. It is an easy, minimal invasive procedure that allows for early weight bearing Patients and Methods:This study included 38 patients. Deformity was bilateral in 24 patients (a total of 62 knees). 25 females (65.8%) and 13 males (34.2%). The cause of deformity was idiopathic in 29 patients (76.3%), post-traumatic in 5 patients (13%) and chronic renal failure in 4 patients (10.7%). Mechanical axis deviation MAD, lateral distal femoral angle LDFA and medial proximal tibial angle MPTA were recorded for all patients at presentation and on follow up for monitoring of deformity correction.Results: Mechanical axis deviation MAD corrected from (Mean ± SD) 34.3 ± 14.3mm to 7.9 ± 5.3 mm. Lateral distal femoral angle LDFA corrected from (Mean ± SD) 77.9 ± 3.18 °to 90.5 ± 2.55 degrees. This was found to be statistically significant. P value

Comparison of histomorphometric and radiographic effects of growth guidance with tension-band devices (eight-Plate and FlexTack) in a pig model

Background and purpose — Temporary hemiepiphysiodesis for growth modulation in skeletally immature patients is a long-known technique. Recently the use of tension-band devices has become popular. This study compares 2 tension-band implants (eight-Plate and FlexTack) regarding their effects on the growth plate. Animals and methods — 12 pigs in 2 equally sized groups (A and B) were investigated. The right proximal medial tibia was treated with either eight-Plate or FlexTack. The left tibia of the same pig was treated with the opposite implant. After 9 weeks all implants were removed. Animals in group B were then hosted for another 5 weeks. Histomorphometric analysis of the growth plate was carried out after 9 and 14 weeks, respectively. Radiographs were taken at implantation, removal, and after 14 weeks. Results — Both tension-band devices achieved a statistically significant and clinically relevant growth inhibition, whereas the effect appeared to be more distinct after the use of FlexTack. Implant-related complications or physeal damage was not observed. After implant removal, rebound phenomenon was radiologically observed in all cases. The growth plates treated with eight-Plate showed a paradox reversal of the zonal distributions, with an increase of the proliferative zones at the previously arrested medial aspect of the physis and a decrease laterally. Interpretation — Both eight-Plate and FlexTack proved to be appropriate devices for growth-guiding treatment. The radiographic evaluation showed a change in angular axes after treatment with each implant, while the correction appeared to be faster with FlexTack. The paradox cartilaginous reaction observed after removal of the eight-Plate might be a histopathological correlate for rebound phenomenon.

Correction of coronal plane deformities around knee in children with two-hole tension band plates.

Objectives This study aims to present the 10-year results and complications of two-hole tension band plate hemiepiphysiodesis for coronal deformities around knee in a large population from a single center.Patients and methods Seventy-seven patients (46 boys, 31 girls; mean age 93±36 months; range, 22 to 181 months) who underwent temporary hemiepiphysiodesis around knee between January 2009 and January 2019 with two-hole tension band plates were retrospectively evaluated. Improvement of joint orientation angles and mechanical axis deviations, deformity correction rates, etiology groups, and complications were noted.Results A total of 166 bone segments (93 femurs, 73 tibias) were included in the study. Mean follow-up duration after the implantation was 36±17 (range, 12 to 88) months. Plates were removed at mean 18±8 (range, 7 to 47) months of implantation. Of the bone segments, 95.2% (n=158) responded successfully to the plates. Mean correction rate of mechanical lateral distal femoral angle in femoral valgum deformity was 0.94±0.43° (range, 0.17 to 2.22)/month and mean correction rate of mechanical medial proximal tibial angle in tibial valgum deformity was 0.62±0.36° (range, 0.11 to 1.55)/month. Mean correction rate of mechanical lateral distal femoral angle in femoral varum deformity was 1.3±0.8° (range, 0.48 to 2.92)/month and mean correction rate of mechanical medial proximal tibial angle in tibial varum deformity was 0.94±0.49° (range, 0.26 to 1.67)/month. The most common complication observed was rebound deformity seen in 41.2% (n=70) of the bone segments. Nine bone segments had persistent hemiepiphysiodesis despite plate removal. Four screw breakages (three metaphysial and one epiphysial) were observed.Conclusion Two-hole tension band plate hemiepiphysiodesis appears to be an effective and safe method for the correction of coronal deformities around knee.

Temporary hemiepiphysiodesis using an eight\u2010plate implant for coronal angular deformity around the knee in children aged less than 10 years: efficacy, complications, occurrence of rebound and risk factors

BackgroundTemporary 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.MethodsThis 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.ResultsThe 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.ConclusionsTH 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.