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Shim JS, Ko KR, Lim KS, Na S. Factors Affecting Postoperative Courses After Removal of Transphyseal Screws Inserted for Correction of Genu Valgum. J Pediatr Orthop 2024; 44:e411-e418. [PMID: 38477319 DOI: 10.1097/bpo.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND The aim of this study was to investigate factors determining the final outcomes of hemipercutaneous epiphysiodesis using transphyseal screw (PETS) for the genu valgum, especially focusing on postoperative courses after screw removal. METHODS Fifty-five patients with idiopathic genu valgum treated with hemi-PETS were included. The mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA) were measured to calculate the degree of correction and rebound. Regarding factors related to surgical techniques, the number of screw threads beyond the physis, the moment arm of the screw, and screw insertion angles were measured. RESULTS In 54 femoral segments (randomly selected in bilateral cases), hemi-PETS was performed with a growth remaining of 2.0±0.6 years. The screw was removed after 6.5±2.1 months, and the degree of correction was 5.0±1.5 degrees. The mean rebound angle was -0.4±2.4 (the negative value means further correction after screw removal). A late time of surgery and an extreme peripheral position of a screw were associated with the growth inhibition. In 50 tibial segments (also randomly selected in bilateral cases), a screw was inserted with a growth remaining of 2.0±0.6 years and removed after 6.3±1.9 months. The degree of correction was 2.9±1.7 degrees during the interval, and the rebound angle was 0.8±1.7 degrees. An earlier time of surgery and a greater correction angle before screw removal were associated with the rebound phenomenon. CONCLUSIONS Growth inhibition of >1.6 degrees was observed in about one-fourth of femoral segments. An extreme peripheral position of a screw should be avoided when performing hemi-PETS at the distal femur. We also recommend not performing hemi-PETS at distal femur with too short a period of growth remaining. LEVEL OF EVIDENCE Level III-retrospective comparative series.
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Affiliation(s)
- Jong Sup Shim
- Department of Orthopedic Surgery, Samsung Medical Center, Gangnam-gu, Seoul
- Department of Orthopedic Surgery, Knot Hospital, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Kyung Rae Ko
- Department of Orthopedic Surgery, Samsung Medical Center, Gangnam-gu, Seoul
| | - Kyung Sup Lim
- Department of Orthopedic Surgery, Knot Hospital, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Sangwoon Na
- Department of Orthopedic Surgery, Samsung Medical Center, Gangnam-gu, Seoul
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Park H, Kim HW, Park KB, Kim JH, Chang WJ, Park BK. Effect of Solitary Osteochondroma on Alignment and Length in the Lower Extremities. J Pediatr Orthop 2024; 44:e351-e356. [PMID: 38180022 DOI: 10.1097/bpo.0000000000002612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND There is a lack of information about the effects of untreated solitary osteochondroma (SO) on longitudinal growth of the lower extremities in children and adolescents. This study aimed to assess the coronal alignment and length of the lower extremity in patients with SO around the knee and to identify the factors related to the development of deformities. METHODS We retrospectively reviewed 111 patients diagnosed with SO around the knee. The patients were classified into 2 groups depending on the location of the SO: 51 in the distal femur and 60 in the proximal tibia. Characteristics of the lesions, such as type, location, size, and distance from the joint line, were determined. Radiographic analysis of the lower limbs included mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, whole-leg length, femoral length, and tibial length. RESULTS The mean age at the time of diagnosis was 12.3±3.4 years. No statistically significant differences were found between the affected and contralateral sides for mechanical lateral distal femoral angle and mechanical medial proximal tibial angle in either the distal femur or the proximal tibia groups. In patients with femoral lesions, the femoral and whole-leg lengths were significantly shorter on the affected side than on the unaffected side ( P <0.001 and 0.002, respectively), and the mean differences were 2.1±3.6 and 2.1±4.4 mm, respectively. Univariate logistic regression analysis did not reveal any factors associated with limb length discrepancy (LLD). In patients with tibial lesions, no statistically significant differences were found in LLD. CONCLUSIONS SOs around the knee did not cause clinically significant deformity of the lower extremity. However, in contrast to proximal tibia lesions, SO in the distal femur was associated with the shortening of the affected limb. Consideration should be given to the development of LLD in skeletally immature children with SO in the distal femur. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Affiliation(s)
- Hoon Park
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Hyun Woo Kim
- Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul
| | - Kun-Bo Park
- Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul
| | - Jae Hong Kim
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Won June Chang
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Byoung Kyu Park
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
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Zeng JF, Xie YY, Liu C, Song ZQ, Xu Z, Tang ZW, Wen J, Xiao S. Effective time, correction speed and termination time of hemi-epiphysiodesis in children. World J Orthop 2024; 15:1-10. [PMID: 38293262 PMCID: PMC10824067 DOI: 10.5312/wjo.v15.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 01/16/2024] Open
Abstract
In children with asymmetric growth on the medial and lateral side of limbs, if there still remains growth potential, the guided growth technique of hemi-epiphysiodesis on one side of the epiphysis is recognized as a safe and effective method. However, when the hemi-epiphysiodesis start to correct the deformities, how many degrees could hemi-epiphysiodesis bring every month and when to remove the hemi-epiphysiodesis implant without rebound phenomenon are still on debate. This article reviews the current studies focus on the effective time, correction speed and termination time of hemi-epiphysiodesis.
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Affiliation(s)
- Jian-Fa Zeng
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Yu-Yin Xie
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Can Liu
- Department of Anatomy, Hunan Normal University school of Medicine, Changsha 410003, Hunan Province, China
| | - Zhen-Qi Song
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zheng Xu
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhong-Wen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
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Di Gennaro GL, Trisolino G, Stallone S, Ramella M, Rocca G, Gallone G. Guided Growth Technique for Epiphysiodesis and Hemiepiphysiodesis: Safety and Performance Evaluation. CHILDREN (BASEL, SWITZERLAND) 2023; 11:49. [PMID: 38255362 PMCID: PMC10814807 DOI: 10.3390/children11010049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Guided-growth modulation is a first-line treatment widely adopted to correct lower-limb angular deformities and limb-length discrepancies (LLD) in the paediatric population. METHODS We conducted a retrospective study to evaluate the safety and performance of a new construct (8-Plate Plus or Guided-Growth Plate System Plus, Orthofix S.r.l) used to correct angular deformities and LLD in non-skeletally mature children. The primary endpoint was safety (from plate implantation to removal). The secondary endpoint was performance; patients treated for LLD achieved complete correction if a pre- and post-surgery difference of <0 was observed; angular deformities performance was measured in terms of IMD, ICD, mMPTA, and mLDFA. RESULTS We performed 69 procedures in 41 patients. A total of 10 patients had an LLD, and 31 had an angular deformity. We observed nine minor complications in the hemiepiphysiodesis group. One patient experienced rebound. All 10 LLD patient treatments were successful. A total of 30/31 patients with an angular deformity had a successful treatment; the remaining patient had a partial correction. CONCLUSIONS Guided-growth by temporary epiphysiodesis or hemiepiphysiodesis was safe and effective for angular deformities and limb-length discrepancies. Further prospective and/or randomized controlled trial studies assessing more significant cohorts of patients and a comparison group could add evidence to our findings.
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Affiliation(s)
- Giovanni Luigi Di Gennaro
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.L.D.G.); (G.T.); (M.R.); (G.R.)
| | - Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.L.D.G.); (G.T.); (M.R.); (G.R.)
| | - Stefano Stallone
- Unit of Orthopedics and Traumatology, Ospedale Maggiore “Pizzardi”, 40133 Bologna, Italy;
| | - Marco Ramella
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.L.D.G.); (G.T.); (M.R.); (G.R.)
| | - Gino Rocca
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.L.D.G.); (G.T.); (M.R.); (G.R.)
| | - Giovanni Gallone
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.L.D.G.); (G.T.); (M.R.); (G.R.)
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Fabricant PD, Chipman DE, Pascual-Leone N, Bram J, Salvato D, Green DW. Simultaneous anterior cruciate ligament reconstruction and implant-mediated guided growth to correct genu valgum in skeletally immature patients. J ISAKOS 2023; 8:184-188. [PMID: 36933662 PMCID: PMC12010450 DOI: 10.1016/j.jisako.2023.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/17/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES Adolescents with anterior cruciate ligament (ACL) tears can present with concomitant lower extremity coronal plane angular deformity (CPAD) that both predispose to injury as well as may increase the risk of graft rupture following ACL reconstruction (ACLR). The goal of this study was to examine the safety and efficacy of concomitant ACLR with implant-mediated guided growth (IMGG) compared to isolated IMGG procedures in paediatric and adolescent patients. METHODS Operative records of all paediatric and adolescent patients (age ≤ 18 years) that underwent simultaneous ACLR and IMGG by one of two paediatric orthopaedic surgeons between 2015 and 2021 were retrospectively reviewed. A comparison cohort of isolated IMGG patients was identified and matched based on bone age within one year, sex, laterality, and fixation type (i.e. transphyseal screw vs. tension band plate and screw construct). Pre- and post-operative mechanical axis deviation (MAD), angular axis deviation (AAD), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) were recorded. RESULTS A total of 9 participants who underwent concomitant ACLR and IMGG (ACLR + IMGG) were identified, with 7 of these participants meeting the final inclusion criteria. The participants had a median age of 12.7 (IQR = 12.1 - 14.2) years and median bone age of 13.0 (IQR = 12.0 - 14.0) years. Of the 7 participants that underwent ACLR and IMGG, 3 underwent a modified MacIntosh procedure with ITB autograft, 2 received quadriceps tendon autograft, and 1 underwent hamstring autograft reconstruction. There were no significant differences in the amount of correction obtained between ACLR + IMGG and matched IMGG subjects with respect to any measurement variable (MAD difference: p = 0.47, AAD difference: p = 0.58, LDFA difference: p = 0.27, MPTA difference: p = 0.20). There were also no significant differences in alignment variables per unit time between cohorts (MAD/month: p = 0.62, AAD/month = 0.80, LDFA/month = 0.27, MPTA/month = 0.20). CONCLUSION The results of the current study indicate that concomitant ACLR and lower extremity CPAD correction is a safe approach to treat CPAD concomitantly with ACLR in young patients who present with an acute ACL tear. Furthermore, one can expect reliable correction of CPAD after combined ACLR and IMGG, no different than the correction obtained in the setting of IMGG alone. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Peter D Fabricant
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Danielle E Chipman
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Nicolas Pascual-Leone
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Joshua Bram
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Damiano Salvato
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Daniel W Green
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
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Aksoy T, Bakircioglu S, Ozdemir E, Ramazanov R, Aksoy MC, Yilmaz G. The Fate of Overcorrection After Hemiepiphysiodesis in Valgus Deformities Around the Knee. J Pediatr Orthop 2023:01241398-990000000-00280. [PMID: 37168006 DOI: 10.1097/bpo.0000000000002429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Tension band plating is widely used in the surgical treatment of coronal plane deformities around the knee. The rebound phenomenon after implant removal is a common complication of this technique. Overcorrection of joint orientation angles is a method to minimize the effect of the rebound phenomenon. This study aims to investigate the natural course of overcorrected joint orientation angles after plate removal in patients with genu valgum deformity. METHODS Patients who underwent hemiepiphysiodesis with tension band plating due to genu valgum deformity between 2010 and 2019 were retrospectively analyzed. Mechanical lateral distal femoral angles (mLDFA) and mechanical medial proximal tibial angles were calculated before plate application, before implant removal, and at the last follow-up. At the implant removal, mLDFA>90 degrees and mechanical medial proximal tibial angles <85 degrees were accepted as overcorrected. RESULTS Seventy-two segments from 45 patients were included. For femoral valgus deformities (n=59), the mean mLDFAs at index surgery, implant removal, and the last follow-up were 79.8±3.9 degrees, 95.5±3.7 degrees, and 87.3±5.1 degrees, respectively. In the more and less than 10 degrees rebound groups, the median age of patients at index surgery were 66 and 101 months (P=0.04), the mLDFA during implant removal were 97.8 degrees and 94.4 degrees (P=0.005), and the mean amount of correction in mLDFA was 17 degrees and 13 degrees (P=0.001), respectively. At the last follow-up, joint orientation angles were found to be still overcorrected in 16 (22%), within normal limits in 36 (50%), and undercorrected in 20 (28%) segments. Ten (13%) segments required additional surgery due to residual deformity. CONCLUSIONS Overcorrection with tension band plating is an effective modality in the treatment of genu valgum deformity. Rebound after plate removal increases as the age at index surgery decreases and the amount of conscious overcorrection increases. Most segments return to normal joint orientation angle limits after overcorrection. We recommend a mean of 5 degrees routine overcorrection in patients with genu valgum deformity to overcome the rebound phenomenon and to make future interventions easier if ever needed. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Taha Aksoy
- Hacettepe University Department of Orthopedics and Traumatology
| | | | - Erdi Ozdemir
- Karabuk Training and Research Hospital, Department of Orthopedics and Traumatology, Karabuk, Turkey
| | - Rafik Ramazanov
- Private Cankaya Hospital, Orthopedics and Traumatology, Ankara
| | | | - Guney Yilmaz
- Hacettepe University Department of Orthopedics and Traumatology
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Kitoh H, Kamiya Y, Mishima K, Matsushita M, Kaneko H, Kitamura A, Sawamura K, Matsuyama S. Guided growth for coronal lower limb deformities in skeletal dysplasia. J Pediatr Orthop B 2023; 32:157-164. [PMID: 35191426 DOI: 10.1097/bpb.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Coronal angular deformities of the lower limbs are common in young children with skeletal dysplasia . The guided growth technique has been applied to correct deformities in children, but there are few comprehensive reports on the effectiveness of the procedure in skeletal dysplasia. We reviewed 44 limbs of 22 patients with various types of skeletal dysplasias who underwent guided growth surgery. Fifteen varus and 29 valgus limbs were treated with 102 epiphysiodesis. The average age at surgery, at implant removal, and at the latest examination was 10.4 ± 3.6 years, 11.8 ± 3.7 years and 14.1 ± 4.4 years, respectively. The mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (mMPTA), lateral distal tibial angle (mLDTA) and mechanical axis deviation (MAD) were measured from standing anteroposterior radiographs of both lower limbs. The mLDTA, mMPTA and MAD were successfully improved after surgery. Moderate or severe deformities were observed in 100% of the varus and 83% of the valgus limbs preoperatively, whereas only 14% of the varus and 20% of the valgus limbs had residual deformities at the latest examination. Correction of deformities was limited in some older children. Fifteen limbs (34%) required repeated implantations due to recurrence or inverted deformity. The guided growth surgery is effective in correcting coronal angular deformities in children with skeletal dysplasia with a limited risk of complications. The timing of surgery and implant removal is critical in obtaining satisfactory correction and preventing recurrence or inverted deformities.
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Affiliation(s)
- Hiroshi Kitoh
- Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu, Departments of
- Comprehensive Pediatric Medicine
| | - Yasunari Kamiya
- Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenichi Mishima
- Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaki Matsushita
- Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroshi Kaneko
- Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu, Departments of
| | - Akiko Kitamura
- Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu, Departments of
| | - Kenta Sawamura
- Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu, Departments of
| | - Saori Matsuyama
- Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu, Departments of
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Pang H, Guo R, Zhuang H, Ben Y, Lou Y, Zheng P. Risk factors for femoral overgrowth after femoral shortening osteotomy in children with developmental dysplasia of the hip. Front Pediatr 2023; 11:1104014. [PMID: 36969266 PMCID: PMC10033660 DOI: 10.3389/fped.2023.1104014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
Objective Developmental dysplasia of the hip (DDH) refers to a series of deformity of acetabulum and proximal femur and abnormal relationship between them, it represents the most common hip disease in children. Overgrowth and limb length discrepancy (LLD) was common complication in children undergoing femoral shortening osteotomy. Therefore, the purpose of this study was to explore the risk factors of overgrowth after femoral shortening osteotomy in children with DDH. Methods We included 52 children with unilateral DDH who underwent pelvic osteotomy combined with femoral shortening osteotomy between January 2016 and April 2018, including seven males (six left and one right hip) and 45 females (33 left and 12 right hips) with an average age of 5.00 ± 2.48 years, and an average follow-up time of 45.85 ± 6.22 months. The amount of overgrowth and limb length discrepancies (LLDs) were calculated. The risk factors of femoral overgrowth ≥1 cm and LLD ≥ 1 cm were analyzed. Results There were statistical differences in age (p < 0.001) and operation duration (p = 0.010) between the two groups with femoral overgrowth <1 cm and ≥1 cm. There was a statistical difference in operation duration (p < 0.001) between the two groups. Age (p < 0.001) was an independent influencing factor of femoral overgrowth in children with unilateral DDH after pelvic osteotomy and femoral shortening osteotomy, and a risk factor (p = 0.008) of LLD in these children. Conclusion The overgrowth and LLD of children with developmental dislocation of hip after pelvic osteotomy and femoral shortening osteotomy are significantly related to age. There was no significant difference between different pelvic osteotomies for femoral overgrowth in children. Therefore, surgeons should consider the possibility of LLD after femoral shortening osteotomy in children of a young age.
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SAĞLAM YAVUZ, DEMIREL MEHMET, YILDIRIM AHMETMUÇTEBA, BILGILI FUAT, ŞEN CENGIZ. CORONAL PLANE GROWTH MODULATION FOR GENU VALGUM IN SKELETAL DYSPLASIA. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e249113. [PMID: 36561480 PMCID: PMC9757729 DOI: 10.1590/1413-785220223006e249113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
Objective To investigate the efficiency and rates of correction by hemiepiphysiodesis using 8-plate to manage genu valgum deformity in children with skeletal dysplasia. Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- YAVUZ SAĞLAM
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - MEHMET DEMIREL
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - AHMET MUÇTEBA YILDIRIM
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - FUAT BILGILI
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - CENGIZ ŞEN
- Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
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Ko KR, Shim JS, Shin TS, Jang MC. Factors Affecting Rebound Phenomenon After Temporary Hemiepiphysiodesis and Implant Removal for Idiopathic Genu Valgum in Adolescent Patients. J Pediatr Orthop 2022; 42:e336-e342. [PMID: 35142715 DOI: 10.1097/bpo.0000000000002090] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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 OF EVIDENCE Level III-retrospective comparative series.
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Affiliation(s)
- Kyung Rae Ko
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Matsushita M, Mishima K, Kamiya Y, Haga N, Fujiwara S, Ozono K, Kubota T, Kitaoka T, Imagama S, Kitoh H. Health-related Quality of Life in Adult Patients with Multiple Epiphyseal Dysplasia and Spondyloepiphyseal Dysplasia. Prog Rehabil Med 2021; 6:20210048. [PMID: 34909512 PMCID: PMC8640375 DOI: 10.2490/prm.20210048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives: Multiple epiphyseal dysplasia (MED) and spondyloepiphyseal dysplasia (SED) are skeletal
dysplasias associated with premature osteoarthritis and short stature. Patients with SED
often have spinal and ocular problems. Few reports have focused on the health-related
quality of life (HRQoL) of patients with skeletal dysplasias associated with premature
osteoarthritis. The purpose of this study was to evaluate the HRQoL of adult patients
with MED and SED. Methods: Questionnaires covering demographics, medical history (cataract, retinal detachment,
and osteoarthritis), surgical history (osteotomy and arthroplasty), and the Short
Form-36 (SF-36) health survey were sent to all patients with MED and SED with medical
records at the investigators’ institutions. Among the 27 patients who completed the
questionnaire, patients aged 20 years or older were included in this cohort. Results: The subjects were 18 affected individuals. The physical component summary score (PCS)
was significantly lower in the MED and SED groups than in the normal population and
tended to deteriorate with age. Conversely, there was a positive correlation between the
mental component summary score and age. The role/social component summary score was not
correlated with age. MED patients with osteoarthritis had a low PCS. PCS was
particularly low in two SED patients with a medical history of cataract, whereas there
was no association with a history of retinal detachment or osteoarthritis. Conclusions: The physical domain of HRQoL in MED and SED patients significantly deteriorated at a
young age. Appropriate medical management of these skeletal dysplasias is required not
only for orthopedic functions but also for ocular problems.
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Affiliation(s)
- Masaki Matsushita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasunari Kamiya
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sayaka Fujiwara
- Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taichi Kitaoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kitoh
- Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu, Japan.,Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Karami M, Ebrahimpour A, Keihani S, Jafari Kafiabadi M, Etemadi R. Outcomes of Temporary Hemi-Epiphysiodesis Using a New Device for The Treatment of Pediatric Valgus Knee Deformity: a Preliminary Report. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:536-542. [PMID: 34692936 DOI: 10.22038/abjs.2020.49544.2460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/27/2020] [Indexed: 11/06/2022]
Abstract
Background This study aimed to evaluate the efficacy of hemi-epiphysiodesis using a new device (X-plate) for the correction of genu valgum. Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- Mohsen Karami
- Department of orthopedics, Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Adel Ebrahimpour
- Department of orthopedics, Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Keihani
- Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Stief F, Holder J, Böhm H, Meurer A. [Prevalence and predictors of rebound deformity in the frontal plane : A literature review]. DER ORTHOPADE 2021; 50:548-558. [PMID: 34156499 DOI: 10.1007/s00132-021-04118-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/24/2022]
Abstract
The present literature review presents the current state of the art on the prevalence and causes of the rebound phenomenon after successful correction of leg axis deformity using temporary epiphysiodesis in children and adolescents. A total of 20 studies was included by three independent reviewers. The validity of most studies regarding the rebound incidence is limited by a non-standardized follow-up after plate removal, heterogeneous patient groups with a small number of cases, and missing information on the definition of rebound. The rebound incidence in studies without fundamental limitations in study design is on an average about 50% and underlines the clinical relevance of the topic. Only four studies reported reasons or risk factors for the occurrence of a rebound. In particular, a young age at the beginning of treatment with high residual growth potential after implant removal represents an increased rebound risk, which can be minimized by appropriate overcorrection of the leg axis.
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Affiliation(s)
- Felix Stief
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstraße 2, 60528, Frankfurt am Main, Deutschland.
| | - Jana Holder
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstraße 2, 60528, Frankfurt am Main, Deutschland
| | - Harald Böhm
- Orthopädische Kinderklinik, Aschau im Chiemgau, Deutschland.,PFH Private Hochschule, Göttingen, Deutschland
| | - Andrea Meurer
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstraße 2, 60528, Frankfurt am Main, Deutschland
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Trisolino G, Boarini M, Mordenti M, Evangelista A, Gallone G, Stallone S, Zarantonello P, Antonioli D, Di Gennaro GL, Stilli S, Sangiorgi L. Outcomes of Temporary Hemiepiphyseal Stapling for Correcting Genu Valgum in Children with Multiple Osteochondromas: A Single Institution Study. CHILDREN-BASEL 2021; 8:children8040287. [PMID: 33917765 PMCID: PMC8068200 DOI: 10.3390/children8040287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Abstract
Background: Multiple osteochondromas is a rare skeletal disorder characterized by the presence of osteocartilaginous protrusions causing bony deformities, especially around the knee. Guided growth by temporary hemiepiphyseal stapling is the treatment of choice to correct the deformity by modulating the residual physeal growth of the lower limbs. Although this procedure is increasingly practiced, inconclusive evidence exists regarding its effectiveness in children with multiple osteochondromas. The study aims to compare the outcomes of temporary hemiepiphyseal stapling for correcting genu valgum in children with multiple osteochondromas vs. idiopathic cases. Methods: In this retrospective cohort study, we included patients admitted at a single institution from 2008 to 2018. A total of 97 children (77 idiopathic, 20 multiple osteochondromas) were enclosed, accounting for 184 limbs treated by temporary hemiepiphyseal stapling. We investigated if children with multiple osteochondromas had a similar successful rate of correction, rate of complications, and correction velocity compared to children with idiopathic genu valgum. Results: Overall, 151 limbs (82%) achieved complete correction or overcorrection, with idiopathic cases having a significantly higher rate of success compared to pathologic cases (88% vs. 55%; p < 0.001). In addition, multiple osteochondromas children sustained a higher rate of major complications (p = 0.021) and showed significantly lower correction velocity (p = 0.029). Conclusion: Temporary hemiepiphyseal stapling is effective in both idiopathic and multiple osteochondromas children, although the latter often achieved incomplete correction, had a higher risk of complications, and required a longer time of stapling. We suggest to anticipate the timing of intervention; otherwise, children with multiple osteochondromas and severe valgus deformity, approaching skeletal maturity, could undergo combined femoral and tibial stapling.
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Affiliation(s)
- Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Manila Boarini
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.B.); (A.E.); (L.S.)
| | - Marina Mordenti
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.B.); (A.E.); (L.S.)
- Correspondence: ; Tel.: +39-051-6366062
| | - Andrea Evangelista
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.B.); (A.E.); (L.S.)
| | - Giovanni Gallone
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Stefano Stallone
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Paola Zarantonello
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Diego Antonioli
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Giovanni Luigi Di Gennaro
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Stefano Stilli
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (G.G.); (S.S.); (P.Z.); (D.A.); (G.L.D.G.); (S.S.)
| | - Luca Sangiorgi
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.B.); (A.E.); (L.S.)
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Dai ZZ, Liang ZP, Li H, Ding J, Wu ZK, Zhang ZM, Li H. Temporary hemiepiphysiodesis using an eight-plate implant for coronal angular deformity around the knee in children aged less than 10 years: efficacy, complications, occurrence of rebound and risk factors. BMC Musculoskelet Disord 2021; 22:53. [PMID: 33422021 PMCID: PMC7797153 DOI: 10.1186/s12891-020-03915-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Temporary 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. METHODS This 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. RESULTS The 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. CONCLUSIONS TH 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.
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Affiliation(s)
- Zhen-Zhen Dai
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China
| | - Zhen-Peng Liang
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China
| | - Hao Li
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China
| | - Jing Ding
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China
| | - Zhen-Kai Wu
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China
| | - Zi-Ming Zhang
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China
| | - Hai Li
- Department of Pediatric Orthopedics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, 200092, Shanghai, China.
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Ding J, Dai ZZ, Li CY, Zhang ZQ, Wu ZK, Cai QX. A retrospective study of treatment of genu valgum/varum with guided growth: Risk factors for a lower rate of angular correction. Sci Prog 2021; 104:368504211002612. [PMID: 33749395 PMCID: PMC10455030 DOI: 10.1177/00368504211002612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The rate of angular correction (ROAC) is very unpredictable and may be affected by various factors in the treatment of genu valgum and varum by means of guided growth. The purpose of this study was to assess the ROAC in cases from our institution and to identify risk factors associated with the occurrence of lower ROAC.We retrospectively reviewed the chart records of 68 patients undergoing guided growth with figure-eight plate for the correction of genu valgum and varum. Based on the data from these patients, the annual increment of physeal growth was calculated and compared with data from the Anderson chart. The associations between patient characteristics and ROAC were evaluated with the use of univariate logistic regression.The mean rate of femoral angular correction was 10.29 degrees/year, while the mean rate of tibial angular correction was 7.92 degrees/year. In a univariate logistic regression analysis, the variables associated with a higher risk of lower ROAC included non-idiopathic coronal deformity of the knee (odds ratio = 13.58, p < 0.001) and body weight at or above the 95th percentile for children (odds ratio = 2.69, p = 0.020).Obesity and non-idiopathic coronal deformity of the knee are risk factors for lower ROAC. It is still uncertain whether severity of deformity, race, and operative procedure have a substantial effect on the rate of correction.Level III evidence.
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Affiliation(s)
- Jing Ding
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen-Zhen Dai
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-You Li
- Orthopedics Department, Taizhou Hospital of Traditional Chinese Medicine, Taizhou, Jiangsu, China
| | - Zhi-Qiang Zhang
- Department of Orthopedics, National Children’s Medical Center and Children’s Hospital of Fudan University, Shanghai, China
| | - Zhen-Kai Wu
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi-Xun Cai
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lee SW, Lee KJ, Cho CH, Ye HU, Yon CJ, Choi HU, Kim YH, Song KS. Affecting Factors and Correction Ratio in Genu Valgum or Varum Treated with Percutaneous Epiphysiodesis Using Transphyseal Screws. J Clin Med 2020; 9:jcm9124093. [PMID: 33353069 PMCID: PMC7766970 DOI: 10.3390/jcm9124093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the correction rates of idiopathic genu valgum or varum after percutaneous epiphysiodesis using transphyseal screws (PETS) and analyzed the affecting factors. A total of 35 children without underlying diseases were enrolled containing 64 physes (44 distal femoral (DT), 20 proximal tibial (PT)). Anatomic tibiofemoral angle (aTFA) and the mechanical axis deviation (MAD) were taken from teleroentgenograms before PETS surgery and screw removal. The correction rates of the valgus and varus deformities for patients treated with PETS were 1.146°/month and 0.639°/month using aTFA while using MAD showed rates of 4.884%/month and 3.094%/month. After aTFA (p < 0.001) and MAD (p < 0.001) analyses, the correction rate of DF was significantly faster than that of PT. Under multivariable analysis, the aTFA correction rate was significantly faster in younger patients (p < 0.001), in males (p < 0.001), in patients with lower weights (p < 0.001), and in the group that was screwed at DF (p < 0.001). Meanwhile, the MAD correction rate was significantly faster in patients with lower heights (p = 0.003). PETS is an effective treatment method for valgus and varus deformities in growing children and clinical characters should be considered to estimate the correction rate.
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Abstract
BACKGROUND Patients with congenital fibular deficiency often develop genu valgum secondary to lateral femoral condylar hypoplasia. Guided growth strategies are often performed to correct limb alignment when adequate skeletal growth remains. METHODS A retrospective review of patients with postaxial hypoplasia of the lower extremity managed with an amputation strategy and who had a guided growth procedure for coronal plane limb malalignment during their course of treatment was performed. Clinical and radiographic data, including measures of coronal plane deformity and alignment, type of amputation, subsequent operative procedures, and complications were recorded. RESULTS Seventeen patients (20 extremities) met study inclusion criteria (mean follow-up 8.8 y). Foot ablation and hemiepiphysiodesis for valgus deformity of the knee was performed in all extremities. The average age at the time of initial hemiepiphysiodesis was 11.2 years at an average of 8.8 years from the initial amputation procedure. The mean preoperative mechanical axis deviation was 26.5 mm, which was corrected to a mean mechanical axis deviation of 7.0 mm. Fifteen (75%) of the extremities had correction of the deformity to neutral alignment after the initial procedure. Lack of correction occurred in 3 extremities, and overcorrection occurred in 2 extremities. Additional procedures were required in 5 extremities for rebound valgus deformity after hardware removal. CONCLUSIONS In patients with postaxial hypoplasia, regular monitoring of the residual limb for growth-related changes must occur to ensure optimal function and prosthetic fit. Timing of the guided growth procedure is critical, as younger patients may be more likely to experience rebound deformity. Families and patients should be made aware that growth might be unpredictable in this population with risks of both overcorrection and undercorrection. LEVEL OF EVIDENCE Level IV-case series.
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Temporary hemiepiphysiodesis for correcting idiopathic and pathologic deformities of the knee: A retrospective analysis of 355 cases. Knee 2020; 27:723-730. [PMID: 32563429 DOI: 10.1016/j.knee.2020.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/06/2019] [Accepted: 04/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hemiepiphysiodesis is a well-established treatment option in cases of pathologic deformities and leg discrepancies during evolution. The aim of this study was to evaluate the postoperative angular measurement, correction correlated with age at operation time, and postoperative complication rate. MATERIAL AND METHODS A total of 355 patients were treated with 887 8-plates between April 2007 and January 2013. Their mean age was 12.18 years (range four to 16 years), and the mean time to axis correction was 17.32 months (range two to 62 months). We analysed the entire population and also performed subgroup analyses for idiopathic, pathologic, varus, valgus and leg length discrepancy. RESULTS The mean durations (time from (hemi-) epiphysiodesis to implant removal) in the idiopathic and pathologic groups were 13.24 and 21.3 months, respectively. The time to implant removal was 18.39 months for idiopathic varus deformities and 11.07 months for idiopathic valgus deformities. For the pathologic deformity group it was 24.9 and 20 months in the varus and valgus subgroups, respectively. CONCLUSIONS Hemiepiphysiodesis is a well-established treatment option to correct angular deformities. The rate of correction was slower and less successful in pathologic deformities and for leg length discrepancies. This suggests that earlier intervention is appropriate for these patients. A higher body mass index (BMI) was observed for valgus deformity, but no correlation was present between BMI and durability.
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20
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Concomitant Anterior Cruciate Ligament Reconstruction and Temporary Hemiepiphysiodesis in the Skeletally Immature: A Combined Technique. J Pediatr Orthop 2019; 39:e500-e505. [PMID: 30628975 DOI: 10.1097/bpo.0000000000001330] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Young athletes with an anterior cruciate ligament (ACL) disruption and limb malalignment pose a treatment dilemma. Little has been published regarding limb malalignment in this population. Our aim is to review the results of combined treatment of an ACL deficient knee and genu valgum in skeletally immature patients. METHODS A retrospective review of skeletally immature patients who underwent transphyseal ACL reconstruction and concomitant hemiepiphysiodesis between 2004 and 2015 by 1 surgeon at a single institution was performed. Included patients had at least a year of growth remaining and were followed to skeletal maturity. Patients with a diagnosis of a connective tissue disorder were excluded. Knee stability, rate of retear, the rate of mechanical axis correction, and time to full correction were determined. RESULTS Ninety skeletally immature patients underwent transphyseal ACL reconstruction, 8 of which met inclusion criteria. Mean time to correction of the valgus deformity was 13 months (0.4 degree/mo). No patient required additional surgeries for malalignment. All patients had improvement in knee stability. One patient had a retear of their ACL reconstruction, for a failure rate of 13%. Preoperative mechanical lateral distal femoral angle and mechanical axis deviation corrected to near-neutral alignment for all treated limbs and were significantly different (P=0.001) than those measured preoperatively. CONCLUSIONS Promising results were seen for simultaneous correction of genu valgum and transphyseal ACL reconstruction. Treatment of both pathologies in a concomitant surgery can be considered in the appropriate population, with expected results comparable to each procedure in isolation. LEVEL OF EVIDENCE Level IV-case series.
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21
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Bayomy AF, Bompadre V, Schmale GA. The Impact of Transphyseal Anterior Cruciate Ligament Reconstruction on Lower Extremity Growth and Alignment. Arthroscopy 2019; 35:940-949. [PMID: 30733028 DOI: 10.1016/j.arthro.2018.10.132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/27/2018] [Accepted: 10/28/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of transphyseal anterior cruciate ligament (ACL) reconstruction on lower extremity radiographic growth and alignment. METHODS We retrospectively reviewed patients who underwent transphyseal ACL reconstruction and were followed to skeletal maturity or at least 2 years, with the nonoperative limb used as an internal control. Changes in coronal plane alignments and tibial slope of the operative limb were compared with a Wilcoxon test. Associations among sex, tunnel, and graft characteristics and failure; changes in coronal plane measures and tunnel size; and tunnel angles and the development of deformity were examined by χ-square and correlation coefficients. RESULTS Fifty-nine patients (41 boys and 18 girls) underwent surgery at a mean age of 12.5 years (range, 6.8-16.0 years). There were differences in changes in the mechanical lateral distal femoral angle comparing operative and nonoperative limbs (decreased 1.1° in girls and 1.9° in boys ≤13 years of age, P = .0008 and .025, respectively) and in changes in tibial slope of the operative limb (decreased 2.1° in male patients >13 years, P = .012). No patient developed a new limb length difference >1 cm. Two boys were treated for deformities. Eight additional patients developed >5° difference in alignment for a rate of radiologic deformity of 10 of 59 or 17%. Neither graft failure nor the presence of deformity was associated with sex, tunnel size, mode of femoral tunnel positioning, inclination of tunnels, or the use of allograft. CONCLUSIONS Radiographically evident limb deformities following transphyseal ACL reconstruction occurred at a rate of 17%, although these deformities were clinically evident in only 5% of patients. Tunnels intersecting physes near cortical margins may increase the risk of developing deformity. Regular follow-up should include alignment radiographs to detect deformities despite the clinical appearance of neutral limb alignment. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Ahmad F Bayomy
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington, U.S.A.; Department of Orthopaedics & Sports Medicine, University of Washington School of Medicine, Seattle, Washington, U.S.A.; Department of Orthopedic Surgery, Columbia University Children's Hospital of New York-Presbyterian, New York, New York, U.S.A
| | - Viviana Bompadre
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Gregory A Schmale
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington, U.S.A..
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Schmale GA, Bayomy AF, O’Brien AO, Bompadre V. The reliability of full-length lower limb radiographic alignment measurements in skeletally immature youth. J Child Orthop 2019; 13:67-72. [PMID: 30838078 PMCID: PMC6376436 DOI: 10.1302/1863-2548.13.180087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Reliable radiographic measurement techniques are important for investigating limb alignments prior to and following paediatric anterior cruciate ligament (ACL) reconstruction. We investigated the inter- and intraobserver reliability of alignment measurements from lower extremity anteroposterior and lateral radiographs of adolescents having undergone transphyseal ACL reconstruction. METHODS A total of 15 of 90 patients who had undergone transphyseal ACL reconstruction were randomly selected for alignment measurements of radiographs of operative and nonoperative limbs. Radiographs were de-identified, randomized to three varying sequences and made available in electronic format to three blinded investigators: a junior orthopaedic resident, a senior orthopaedic resident and a paediatric orthopaedic attending. Coronal measurements comprised the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and mechanical axis deviation (MAD), measured from standing teleoroentgenograms of the lower extremities. Tibial slope was measured on lateral knee radiographs of operative limbs. The intra-class correlation coefficient (ICC) was calculated for each of the three coronal measures and for tibial slope. RESULTS Intraobserver reliability was excellent across all measures (ICC > 0.75) except for tibial slope in one investigator's measurements (good or ICC = 0.68 for the operative limbs) and mLDFA in another investigator's measurements (fair or ICC = 0.49 for the operative limbs, and poor ICC = 0.27 for the nonoperative limbs). Interobserver reliability was excellent across all investigators for all measurements for operative and nonoperative limbs. CONCLUSIONS Radiographic measurements of lower extremity alignment may be reliably measured on teleoroentgenograms in a subset of youth who underwent transphyseal ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- G. A. Schmale
- Department of Orthopedics & Sports Medicine, Seattle Children’s Hospital, Seattle, Washington, USA,Department of Orthopaedics & Sports Medicine, University of Washington School of Medicine, Seattle, Washington, USA,Correspondence should be sent to Gregory A. Schmale, MD, Department of Orthopedics and Sports Medicine, Seattle Children’s Hospital, 4800 Sand Point Way NE, MS-OA.931, Seattle, Washington 98105, USA. E-mail:
| | - A. F. Bayomy
- Department of Orthopedics & Sports Medicine, Seattle Children’s Hospital, Seattle, Washington, USA,Department of Orthopaedics & Sports Medicine, University of Washington School of Medicine, Seattle, Washington, USA,Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - A. O. O’Brien
- Department of Orthopedics & Sports Medicine, Seattle Children’s Hospital, Seattle, Washington, USA,Department of Orthopaedics & Sports Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - V. Bompadre
- Department of Orthopedics & Sports Medicine, Seattle Children’s Hospital, Seattle, Washington, USA
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Herzenberg J, Kadhim M, Hammouda A. The “Sleeper” plate: A technical note. JOURNAL OF LIMB LENGTHENING & RECONSTRUCTION 2019. [DOI: 10.4103/jllr.jllr_2_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Ding J, He J, Zhang ZQ, Wu ZK, Jin FC. Effect of Hemiepiphysiodesis on the Growth Plate: The Histopathological Changes and Mechanism Exploration of Recurrence in Mini Pig Model. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6348171. [PMID: 30687754 PMCID: PMC6330884 DOI: 10.1155/2018/6348171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 12/10/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE Hemiepiphysiodesis has been widely used to correct angular deformity of long bone in immature patients. However, there is a limited knowledge about the biomechanical effect of this technique on the histopathological changes of the growth plate and the mechanism of recurrence of malformation after implant removal. We aimed to evaluate the biomechanical effect of hemiepiphysiodesis on the histopathological changes of the growth plate and the mechanism of recurrence of malformation after implant removal in Bama miniature pigs, and to explore the role of asymmetric stress during this procedure. METHODS Eight 3-month-old male Bama miniature pigs sustained surgeries on the bilateral medial hind leg proximal tibia as the intervention group (n=16), and four pigs sustained bilateral sham surgeries as the control (n=8). In the 18th week after surgeries, hardware was removed in the unilateral leg of each animal in the intervention group. In the 24th week of the study, all animals were euthanized. A total of 24 samples were obtained and stained with H&E, TUNEL, and immunohistochemistry. Sixteen samples in the intervention group were divided into two subgroups. The tibias without an implant were included in the implant removal group (IR group), while the tibias with an implant were included in the implant persist group (IP group). The proximal tibia specimens were divided into 3 equidistant parts from medial to lateral, named as area A, area B, and area C, respectively. The change of thickness of growth plates, chondral apoptosis index, and the expression of Caspase-3, Caspase-9, CHOP, and P65 were compared. RESULTS H&E staining showed the thickness of growth plate to be varied in different areas. In the IP group, the thickness of growth plate in areas A and B was statistically significantly thinner than that in area C (p<0.05). In the IR group, the thickness of growth plate in areas A and B was statistically significantly thicker than that in area C (p<0.05). TUNEL staining showed that the apoptosis rate increased significantly after hemiepiphysiodesis and declined after implant removal (p<0.05). Immunohistochemical staining suggested that the expression of Caspase-3, Caspase-9, P65, and CHOP protein was upregulated in the experimental group and downregulated after implant removal. CONCLUSION The thickness parameter of the growth plate changes with asymmetric pressure. When the pressure is relieved, the recurrence of malformation is related to the thickening of the growth plate.
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Affiliation(s)
- Jing Ding
- Department of Pediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1665, Kongjiang Road, Shanghai 200092, China
| | - Jin He
- Department of Pediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1665, Kongjiang Road, Shanghai 200092, China
| | - Zhi-Qiang Zhang
- Department of Pediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1665, Kongjiang Road, Shanghai 200092, China
| | - Zhen-Kai Wu
- Department of Pediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1665, Kongjiang Road, Shanghai 200092, China
- Division of Orthopaedic Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Fang-Chun Jin
- Department of Pediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1665, Kongjiang Road, Shanghai 200092, China
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Hemiepiphysiodesis for Idiopathic Genu Valgum: Percutaneous Transphyseal Screw Versus Tension-band Plate. J Pediatr Orthop 2018; 38:325-330. [PMID: 27658181 DOI: 10.1097/bpo.0000000000000821] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to compare the outcomes of angular deformity correction by percutaneous hemiepiphysiodesis using transphyseal screw (PETS) or tension-band plating (TBP) in growing children with idiopathic genu valgum with emphasis on the rate of deformity correction. METHODS We retrospectively reviewed cases of hemiepiphysiodesis for angular deformity in lower extremities between 2009 and 2014. A total of 90 limbs in 33 patients received PETS and 60 limbs in 24 patients received TBP. Angular measurements were compared preoperatively and at the time of hardware removal. The amount and rate of angular deformity correction were compared between the 2 groups. Potential factors affecting correction velocity were investigated using multivariate analysis. RESULTS Angular correction was achieved in all patients. The mean rate of correction was more rapid with PETS than with TBP at both the distal femur (0.92 vs. 0.64 deg./mo, respectively; P<0.001) and proximal tibia (0.72 vs. 0.55 deg./mo, respectively; P=0.019). Multivariate analysis showed that the used implant significantly affected the rate of correction: PETS demonstrated faster correction velocity than TBP (-0.26, 95% confidence interval, -0.35 to -0.17, P<0.001). CONCLUSIONS Both PETS and TBP techniques result in satisfactory correction of coronal angular deformity in patients with idiopathic genu valgum. However, the observed rate of correction was faster with PETS than TBP. Correction with PETS, rather than TBP, may better serve patients near skeletal maturity. LEVEL OF EVIDENCE Level III-retrospective comparative series.
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Park KH, Oh CW, Kim JW, Park IH, Kim HJ, Choi YS. Angular deformity correction by guided growth in growing children: Eight-plate versus 3.5-mm reconstruction plate. J Orthop Sci 2017; 22:919-923. [PMID: 28688811 DOI: 10.1016/j.jos.2017.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/17/2017] [Accepted: 06/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Guided growth using the eight-plate (8-plate) is the most commonly used method to correct angular deformities in children; however, implant failure has been reported. Recently, the 3.5-mm reconstruction plate (R-plate) has been used as an alternative option for guided growth; however, hardware prominence has been problematic. This study aimed to compare the coronal angular deformity correction results of guided growth between relatively thin 8-plates with cannulated screws and thick R-plates with solid screws. METHODS Thirty-nine physes (24 distal femoral, 15 proximal tibial) in 20 patients underwent hemiepiphysiodesis using 8-plates, and 61 physes (40 distal femoral, 21 proximal tibial) in 35 patients underwent hemiepiphysiodesis using R-plates. Coronal angular corrections were measured and compared preoperatively, and after the completion of corrections. Amounts and rates of correction and complications were compared between the groups. RESULTS Mean body mass index was 18.7 kg/m2 in the 8-plate group, and 22.7 kg/m2 in the R-plate group. Angular correction was achieved in all deformities at a mean of 13.7 months and 19.7 months in the 8-plate and the R-plate group, respectively. The mean corrected mechanical lateral distal femoral angle was 9.0° in the 8-plate group, and 9.9° in the R-plate group (P = 0.55). The mean corrected medial proximal tibial angle was 7.1° in the 8-plate group, and 9.0° in the R-plate group (P = 0.07). The mean rates of angular correction were also not significantly different in the distal femur (1.03°/month vs. 0.77°/month, P = 0.2) and the proximal tibia (0.66°/month vs. 0.63°/month, P = 0.77). There was one superficial infection in each group, and one case of implant failure in the R-plate group. Two rebound deformities were observed and needed repeat hemiepiphysiodesis. Permanent physeal arrest was not observed in this series.
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Affiliation(s)
- Kyeong-Hyeon Park
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
| | - Joon-Woo Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Il-Hyung Park
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hee-June Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Young-Seo Choi
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
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Shoulder arthroplasty in patients with osteo-chondrodysplasias. INTERNATIONAL ORTHOPAEDICS 2017; 41:2129-2134. [PMID: 28782076 DOI: 10.1007/s00264-017-3588-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Osteo-chondrodysplasias are a rare cause of limb malalignment, deformity and degenerative joint disease. Earlier in life, deformities may be managed with bony realignment and soft tissue releases; however, as degenerative changes progress, arthroplasty may be considered. There are limited reports examining shoulder arthroplasty in this population. This study aims to assess pain relief, function, and re-operation rate of shoulder arthroplasty in patients with osteo-chondrodysplasias. METHODS Between January 1984 and December 2012, 13 shoulders with end-stage arthritis secondary to osteo-chondrodysplasia underwent shoulder arthroplasty. Three were treated with hemiarthroplasty (HA), nine with anatomic total shoulder arthroplasty (TSA), and one with a reverse total shoulder arthroplasty (RSA). All shoulders were followed for two years or until reoperation (mean 7.9 years, range 2-25). RESULTS Shoulder arthroplasty significantly improved pain, elevation, external rotation, and internal rotation. All but one patient considered their shoulder to be better than pre-operatively; however, only two shoulders received an excellent Neer rating. Seven shoulders had satisfactory Neer ratings and four unsatisfactory. One TSA was converted to a RSA for aseptic glenoid loosening at 9.5 years (re-operation rate 8%). DISCUSSION Pain relief and improved function can be expected in patients with osteo-chondrodysplasias despite challenging anatomy. Unlike the only previous case series reporting a 31% revision rate at mean follow-up of seven years, our series shows the incidence of failure to be much lower. CONCLUSIONS With the advent of smaller humeral components, the need for custom implants may not be necessary, and surgeons may intervene earlier and more confidently in this population. LEVEL OF EVIDENCE IV case series.
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Wu Z, Ding J, Zhao D, Zhao L, Li H, Liu J. Multiplier method may be unreliable to predict the timing of temporary hemiepiphysiodesis for coronal angular deformity. J Orthop Surg Res 2017; 12:104. [PMID: 28693513 PMCID: PMC5504749 DOI: 10.1186/s13018-017-0604-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/18/2017] [Indexed: 11/23/2022] Open
Abstract
Background and purposes The multiplier method was introduced by Paley to calculate the timing for temporary hemiepiphysiodesis. However, this method has not been verified in terms of clinical outcome measure. We aimed to (1) predict the rate of angular correction per year (ACPY) at the various corresponding ages by means of multiplier method and verify the reliability based on the data from the published studies and (2) screen out risk factors for deviation of prediction. Methods A comprehensive search was performed in the following electronic databases: Cochrane, PubMed, and EMBASE™. A total of 22 studies met the inclusion criteria. If the actual value of ACPY from the collected date was located out of the range of the predicted value based on the multiplier method, it was considered as the deviation of prediction (DOP). The associations of patient characteristics with DOP were assessed with the use of univariate logistic regression. Results Only one article was evaluated as moderate evidence; the remaining articles were evaluated as poor quality. The rate of DOP was 31.82%. In the detailed individual data of included studies, the rate of DOP was 55.44%. Conclusion The multiplier method is not reliable in predicting the timing for temporary hemiepiphysiodesis, even though it is prone to be more reliable for the younger patients with idiopathic genu coronal deformity.
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Affiliation(s)
- Zhenkai Wu
- Department of Pediatric Orthopaedics, Xin-Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Jing Ding
- Department of Pediatric Orthopaedics, Xin-Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Dahang Zhao
- Department of Pediatric Orthopaedics, Xin-Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Li Zhao
- Department of Pediatric Orthopaedics, Xin-Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China. .,Department of Pediatric Orthopaedics, Ying-Hua Medical Group of Bone and Joint Healthcare in Children, No. 358, Haibo Road, Shanghai, 200000, China.
| | - Hai Li
- Department of Pediatric Orthopaedics, Xin-Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Jianlin Liu
- Department of Pediatric Orthopaedics, Xin-Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
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Park SS, Kang S, Kim JY. Prediction of rebound phenomenon after removal of hemiepiphyseal staples in patients with idiopathic genu valgum deformity. Bone Joint J 2017; 98-B:1270-5. [PMID: 27587531 DOI: 10.1302/0301-620x.98b9.37260] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 04/18/2016] [Indexed: 11/05/2022]
Abstract
AIMS Our aim was to investigate the predictive factors for the development of a rebound phenomenon after temporary hemiepiphysiodesis in children with genu valgum. PATIENTS AND METHODS We studied 37 limbs with idiopathic genu valgum who were treated with hemiepiphyseal stapling, and with more than six months remaining growth at removal of the staples. All children were followed until skeletal maturity or for more than two years after removal of the staples. RESULTS On multivariate logistic regression analysis, the rate of correction, body mass index (BMI), age, and initial valgus angle were significantly associated with a rebound phenomenon. With those characteristics, a predictive model for rebound was generated using recursive partitioning analysis. Children with a rapid rate of correction had the most frequent and severe rebound phenomenon (incidence 79%, mean 4°), whereas those with a slow rate of correction had less rebound when they had low BMI (43%, 2°) and none when the BMI was ≥ 21 kg/m(2). CONCLUSION This is the first study to evaluate a predictive model for a rebound phenomenon after temporary hemiepiphysiodesis in children with idiopathic genu valgum. Cite this article: Bone Joint J 2016;98-B:1270-5.
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Affiliation(s)
- S-S Park
- Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - S Kang
- Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - J Y Kim
- Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South Korea
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Koch JE, Mann G, Hetsroni I. Extensive Arthroscopic Chondroplasty for Cartilage Hyperplasia of the Femoral Condyle Causing Recurrent Knee Locking in a Patient With Multiple Epiphyseal Dysplasia. Arthrosc Tech 2016; 5:e229-34. [PMID: 27354941 PMCID: PMC4913047 DOI: 10.1016/j.eats.2015.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/18/2015] [Indexed: 02/03/2023] Open
Abstract
Multiple epiphyseal dysplasia is a genetically heterogeneous group of diseases causing altered enchondral ossification. It may affect the knee, among other joints, with variable clinical manifestations. In this report, we present a case of a young adult patient with multiple epiphyseal dysplasia, presenting recurrent catching and locking of the knee due to hyperplastic irregular cartilage. Although radiographs and magnetic resonance imaging of his knee were inconclusive with regard to the source of symptoms, arthroscopic examination revealed a flap of irregular and extensive hypertrophic cartilage of the medial femoral condyle that was causing catching during knee motions. This was treated by extensive arthroscopic resection of the hypertrophic cartilage with the knee held in a deep flexion position and symptoms resolved uneventfully. The case emphasizes the importance of a thorough arthroscopic examination when radiographs and magnetic resonance imaging may overlook the specific source for symptoms, and shows the potential for symptom resolution by arthroscopic intervention in these unusual circumstances.
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Affiliation(s)
- Jonathan E.J. Koch
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Address correspondence to Jonathan E.J. Koch, M.D., Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel.Department of Orthopedic SurgeryMeir Medical CenterKfar SabaIsrael
| | - Gideon Mann
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iftach Hetsroni
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tissue-engineered cartilage implantation for the chondral lesion in a patient with multiple epiphyseal dysplasia. J Orthop Sci 2016; 21:91-6. [PMID: 26740422 DOI: 10.1016/j.jos.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 09/22/2014] [Accepted: 09/25/2014] [Indexed: 11/23/2022]
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Kulkarni RM, Ilyas Rushnaiwala FM, Kulkarni GS, Negandhi R, Kulkarni MG, Kulkarni SG. Correction of coronal plane deformities around the knee using a tension band plate in children younger than 10 years. Indian J Orthop 2015; 49:208-18. [PMID: 26015611 PMCID: PMC4436488 DOI: 10.4103/0019-5413.152484] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Guided growth through temporary hemiepiphysiodesis has gained acceptance as the preferred primary treatment in treating pediatric lower limb deformities as it is minimally invasive with a lesser morbidity than the traditional osteotomy. The tension band plate is the most recent development in implants used for temporary hemiepiphysiodesis. Our aim was to determine its safety and efficacy in correcting coronal plane deformities around the knee in children younger than 10 years. MATERIALS AND METHODS A total of 24 children under the age of 10 were operated for coronal plane deformities around the knee with a single extra periosteal tension band plate and two nonlocking screws. All the children had a pathological deformity for which a detailed preoperative work-up was carried out to ascertain the cause of the deformity and rule out physiological ones. The average age at hemiepiphysiodesis was 5 years 3 months (range: 2 years to 9 years 1 month). RESULTS The plates were inserted for an average of 15.625 months (range: 7 months to 29 months). All the patients showed improvement in the mechanical axis. Two patients showed partial correction. Two cases of screw loosening were observed. In the genu valgum group, the tibiofemoral angle improved from a preoperative mean of 19.89° valgus (range: 10° valgus to 40° valgus) to 5.72° valgus (range: 2° varus to 10° valgus). In patients with genu varum the tibiofemoral angle improved from a mean of 28.27° varus (range: 13° varus to 41° varus) to 1.59° valgus (range: 0-8° valgus). CONCLUSION Temporary hemiepiphysiodesis through the application of the tension band plate is an effective method to correct coronal plane deformities around the knee with minimal complications. Its ease and accuracy of insertion has extended the indication of temporary hemiepiphysiodesis to patients younger than 10 years and across a wide variety of diagnosis including pathological physis, which were traditionally out of the purview of guided growth.
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Affiliation(s)
- Ruta M Kulkarni
- Department of Orthopaedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India
| | - Faizaan M Ilyas Rushnaiwala
- Department of Orthopaedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India
| | - GS Kulkarni
- Department of Orthopaedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India
| | - Rajiv Negandhi
- Department of Orthopaedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India
| | - Milind G Kulkarni
- Department of Orthopaedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India
| | - Sunil G Kulkarni
- Department of Orthopaedic Surgery, Post Graduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India
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Abstract
Multiple epiphyseal dysplasia is a genotypically and phenotypically heterogeneous disorder affecting the epiphysis of long bones. Inheritance may be autosomal dominant or autosomal recessive. Autosomal dominant variants include mutations of the collagen oligomeric matrix protein, collagen type IX α-1, collagen type IX α-2, collagen type IX α-3, and matrilin-3 genes. The autosomal recessive variant is caused by a mutation of the sulfate transporter gene SLC26A2. These mutations cause disorganized endochondral ossification of the epiphysis, ultimately leading to destruction of the articular cartilage. Patients typically present in childhood, but some may not present until early adulthood. A presumptive diagnosis can be made with clinical history, physical examination, detailed family history, and radiographic findings. Definitive diagnosis requires genetic testing. Treatment is based on the age of the patient, the amount of limb deformity, the level of joint destruction, and the needs of the patient. Children can greatly benefit from limb realignment procedures, and adults can have excellent outcomes with joint arthroplasty.
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Determining the best treatment for coronal angular deformity of the knee joint in growing children: a decision analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:603432. [PMID: 25276801 PMCID: PMC4167958 DOI: 10.1155/2014/603432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/11/2014] [Indexed: 01/28/2023]
Abstract
This study aimed to determine the best treatment modality for coronal angular deformity of the knee joint in growing children using decision analysis. A decision tree was created to evaluate 3 treatment modalities for coronal angular deformity in growing children: temporary hemiepiphysiodesis using staples, percutaneous screws, or a tension band plate. A decision analysis model was constructed containing the final outcome score, probability of metal failure, and incomplete correction of deformity. The final outcome was defined as health-related quality of life and was used as a utility in the decision tree. The probabilities associated with each case were obtained by literature review, and health-related quality of life was evaluated by a questionnaire completed by 25 pediatric orthopedic experts. Our decision analysis model favored temporary hemiepiphysiodesis using a tension band plate over temporary hemiepiphysiodesis using percutaneous screws or stapling, with utilities of 0.969, 0.957, and 0.962, respectively. One-way sensitivity analysis showed that hemiepiphysiodesis using a tension band plate was better than temporary hemiepiphysiodesis using percutaneous screws, when the overall complication rate of hemiepiphysiodesis using a tension band plate was lower than 15.7%. Two-way sensitivity analysis showed that hemiepiphysiodesis using a tension band plate was more beneficial than temporary hemiepiphysiodesis using percutaneous screws.
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Seo SG, Song HR, Kim HW, Yoo WJ, Shim JS, Chung CY, Park MS, Oh CW, Jeong C, Song KS, Kim OH, Park SS, Choi IH, Cho TJ. Comparison of orthopaedic manifestations of multiple epiphyseal dysplasia caused by MATN3 versus COMP mutations: a case control study. BMC Musculoskelet Disord 2014; 15:84. [PMID: 24629099 PMCID: PMC3984757 DOI: 10.1186/1471-2474-15-84] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/05/2014] [Indexed: 01/15/2023] Open
Abstract
Background Multiple epiphyseal dysplasia (MED) is a relatively common skeletal dysplasia mainly involving the epiphyses of the long bones. However, it is a genetically heterogeneous group of diseases sharing certain aspects of the radiologic phenotype. In surveys conducted in East Asia, MATN3 was the most common causative gene, followed by COMP. In this study, the authors compared clinical manifestation of MED patients caused by MATN3 and COMP gene mutations, as well as subsequent orthopaedic interventions. Methods Fifty nine molecularly-confirmed MED patients were subjects of this study. The MATN3 gene mutation group comprised of 37 patients (9 female, 28 male). The COMP gene mutation consisted of 22 cases (15 females, 7 males). Medical records and radiographs were reviewed, and questionnaire surveys or telephone interviews were conducted. Results At the first presentation, the mean age was 8.8 ± 2.8 years (mean ± standard deviation) in the MATN3 group, and 8.5 ± 3.5 years in the COMP group (p = 0.670). The height in the COMP group was significantly shorter than those in the MATN3 group (p < 0.001). Gait abnormality at the first visit (p = 0.041) and the lastest follow-up (p = 0.037) were statistically significant difference. Hip pain (p = 0.084), limitation of daily activity (p = 0.075) at the latest follow-up tended to be more frequent in the COMP group. Hip dysplasia was more common in the COMP group, having significantly larger acetabular angle (p = 0.037), smaller center-edge angle (p = 0.002), severe Stulberg classification (p < 0.001), and smaller femoral head coverage (p < 0.001). Conclusions Clinical manifestations of MED caused by MATN3 were milder than manifestations of the COMP mutation group. These differences in clinical manifestation and prognosis justify molecular differentiation between the two genotypes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Tae-Joon Cho
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 110-799, Korea.
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Distal tibial physeal bridge: a complication from a tension band plate and screw construct. Report of a case. J Pediatr Orthop B 2013; 22:259-63. [PMID: 22158054 DOI: 10.1097/bpb.0b013e32834f0477] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report on a case of a tension band plate and screw construct (Eight Plate) used over the anterior distal tibia in an 9-year-old girl in an attempt to induce recurvatum of the ankle joint to correct a recalcitrant equinus deformity. With growth of the distal tibial physis, the epiphyseal screw was drawn through the physis into the distal tibial metaphysis, resulting in the creation of a transphyseal bony bar. Caution should be exercised when attempting temporary hemiepiphyseodesis using a plate and screw construct in small epiphyses or in an osteopenic bone.
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Rate of correction after asymmetrical physeal suppression in valgus deformity: analysis using a linear mixed model application. J Pediatr Orthop 2012; 32:805-14. [PMID: 23147624 DOI: 10.1097/bpo.0b013e318273e411] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study was performed to estimate the rate of angular correction after asymmetrical physeal suppression and analyze the factors that influence the rate of correction by using a linear mixed model application. METHODS A total of 175 physes (72 distal femoral, 70 proximal tibial, and 33 distal tibial) from 78 consecutive patients with valgus angular deformity of the lower limb who underwent asymmetrical physeal suppression were included. The anatomic lateral distal femoral angle, the anatomic lateral proximal tibial angle, and the anatomic lateral distal tibial angle were measured from the teleroentgenograms of the patients' preoperative visit and periodic follow-ups. The rate of angular correction was adjusted by multiple factors by using a linear mixed model with age, sex, and surgical method as the fixed effects and each subject as the random effect. The final model included the age-specific and surgical method-specific rate and sex-specific and surgical method-specific intercept. Multivariate analysis was performed for this model. RESULTS In younger children (boys 14 y or younger and girls 12 y or younger), the rate of correction of valgus deformity at the distal femur, proximal tibia, and distal tibia was 0.71 degrees/month (8.5 degrees/y), 0.40 degrees/month (4.8 degrees/y), and 0.48 degrees/month (5.8 degrees/y), respectively. In older children, the rate of correction of valgus deformity at the distal femur, proximal tibia, and distal tibia was 0.39 degrees/month (4.7 degrees/y), 0.29 degrees/month (3.5 degrees/y), and 0.48 degrees/month (5.8 degrees/y), respectively. The rate of correction at the distal femur was significantly lower in older children (P = 0.025). The rate of angular correction at the proximal tibia was significantly faster in the screw group than in the staple group (P = 0.046). CONCLUSIONS Asymmetrical physeal suppression with staples, percutaneous transphyseal screws, and permanent method all are effective methods for treating valgus deformity in growing children. When we treat valgus deformity in growing children, we should take into consideration the fact that the rate of correction at the distal femur is lower in older children, and that at the proximal tibia is faster in the screw group. LEVEL OF EVIDENCE Therapeutic level III.
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Reliability of lower-limb alignment measurements in patients with multiple epiphyseal dysplasia. Clin Orthop Relat Res 2012; 470:3566-76. [PMID: 22948526 PMCID: PMC3492612 DOI: 10.1007/s11999-012-2548-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 08/07/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although radiographic measurements are used in multiple epiphyseal dysplasia (MED) during correction of lower-limb alignment, the reliabilities of the measurements are unclear. QUESTIONS/PURPOSES We determined interobserver and intraobserver reliabilities of the measurement methods used in evaluation of lower-limb alignment in MED. METHODS After consensus building, we included 10 radiographic measurement methods widely used to evaluate lower-limb alignment: mechanical tibiofemoral angle, anatomic tibiofemoral angle, mechanical axis deviation, joint line convergence angle, mechanical lateral distal femoral angle, anatomic lateral distal femoral angle, mechanical medial proximal tibial angle, anatomic medial proximal tibial angle, epimetaphyseal angle, and tibial metadiaphyseal angle. A study group consisting of 30 patients with MED was compared with a control group consisting of 30 sex- and age-matched patients with genu varum and genu valgum. Mean age in both groups was 11 years (study group: SD, 2 years; range, 6-16 years; control group: SD, 2 years; range, 6-15 years). Interobserver and intraobserver reliabilities of all radiographic measurement methods were obtained and expressed by intraclass correlation coefficients (ICCs). RESULTS Mechanical tibiofemoral angle, anatomic tibiofemoral angle, and mechanical axis deviation were associated with high interobserver reliability (ICCs, 0.987, 0.985 and 0.982, respectively). Epimetaphyseal angle had the lowest reliability (ICC, 0.280). Intraobserver reliability exhibited similar trends, with mechanical axis deviation and mechanical tibiofemoral angle having the highest ICCs and epimetaphyseal angle the lowest. CONCLUSIONS Mechanical tibiofemoral angle, anatomic tibiofemoral angle, and mechanical axis deviation are reasonably reliable measures of alignment in MED. The lateral distal femoral angle and medial proximal tibial angle (mechanical and anatomic) can be used as complementary measurement methods. LEVEL OF EVIDENCE Level II, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
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Abstract
BACKGROUND Young children with chondrodysplasia may develop multilevel varus deformities that compromise comfort and gait. The classic treatment of performing corrective, staged osteotomies, at each level of deformity, is a daunting prospect that is fraught with potential complications. To avoid this scenario, we have adopted single-event, multilevel surgery, using guided growth to simultaneously address bilateral varus deformities of the knee and hip, with good results. METHODS Three cousins with Schmid-type metaphyseal dysplasia, presented for treatment of progressive varus deformities. In lieu of osteotomies, we used simultaneous guided growth of the proximal and distal lateral femora and proximal lateral tibiae, while ignoring the distal tibial deformity. The pan-genu 8-plates served to neutralize the mechanical axis while preserving a horizontal knee. The rationale for applying the trochanteric 8-plate was to stabilize the proximal femoral chondroepiphysis, hoping to postpone or avert intertrochanteric osteotomy. The average age at surgery was 28 months, with a range of 19 to 33 months, and follow-up has ranged from 28 to 59 months (average 48 mo). The pan-genu 8-plates were removed after an average of 12 months, leaving the trochanteric implants in situ, pending further growth. RESULTS Neutralization of the mechanical axis resolved lateral knee thrust and intoeing. As the femur is effectively adducted by knee realignment, the greater trochanteric impingement on the ilium is alleviated. Lateral tethering of the trochanteric apophysis served to increase the femoral neck-shaft angle, improving the abductor lever arm. Each patient experienced complete resolution of the fatigue hip pain and Trendelenburg gait. As knee alignment was restored, the ankle varus resolved spontaneously, requiring no direct treatment. The clinical improvement was reflected in trending of the radiographic angles and axes toward normal. CONCLUSIONS These children have benefited from outpatient guided growth, rather than the anticipated osteotomies, to correct multilevel varus deformities. Our goal is to exclusively use guided growth, repeatedly as needed, to avoid osteotomies altogether. Annual follow-up until skeletal maturity is planned. LEVEL OF EVIDENCE Level IV-retrospective case series.
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Guided growth with a noncannulated screw-plate system for angular deformity of the knee: a preliminary report. J Pediatr Orthop B 2012; 21:339-47. [PMID: 22568964 DOI: 10.1097/bpb.0b013e3283547198] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We assessed the result of guided growth for an angular knee deformity using a 3.5-mm noncannulated screw-plate system. Twenty-seven patients with angular deformities (10 distal femora, 13 proximal tibiae, and four both areas) underwent this procedure with the reconstruction plate and two noncannulated screws. Average age at the time of the procedure was 7.8 years and the average follow-up was 25.7 months. Except for one patient (two knees), 25 of 27 deformities showed a resolved outcome with a neutral alignment. The mechanical lateral distal femoral angle changed an average of 8.3° for 13 months and the medial proximal tibial angle changed an average of 7.7° for 11.8 months in the neutral state. The mean angle between the two screws was -2° in immediate postoperative radiographs and 23° in radiographs taken at the latest follow-up. Two patients showed a rebound outcome and one showed a failure of no correction. There was a superficial infection, but no mechanical failure of the screw and the plate was observed. The noncannulated screw-plate system may play a similar role of guided growth, to correct angular knee deformity, although a large series study with a long follow-up is required for a definitive conclusion.
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Sun XT, Easwar TR, Manesh S, Ryu JH, Song SH, Kim SJ, Song HR. Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail. ACTA ACUST UNITED AC 2011; 93:782-7. [PMID: 21586777 DOI: 10.1302/0301-620x.93b6.25521] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We compared the complications and outcome of tibial lengthening using the Ilizarov method with and without the use of a supplementary intramedullary nail. In a retrospective case-matched series assembled from 176 patients with tibial lengthening, we matched 52 patients (26 pairs, group A with nail and group B without) according to the following criteria in order of importance: 1) difference in amount of lengthening (± 2 cm); 2) percentage difference in lengthening (± 5%); 3) difference in patient’s age (± seven years); 4) aetiology of the shortening, and 5) level of difficulty in obtaining the correction. The outcome was evaluated using the external fixator index, the healing index and an outcome score according to the criteria of Paley. It was found that some complications were specific to group A or B respectively, but others were common to both groups. The outcome was generally better in lengthenings with a nail, although there was a higher incidence of rectifiable equinus deformity in these patients.
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Affiliation(s)
- X.-T. Sun
- Department of Orthopaedic Surgery, Fuzhou General Hospital, No. 156 Second West Ring Road, Fuzhou, Fujian 350025, China
| | - T. R. Easwar
- Department of Orthopaedic Surgery, Institute for Rare Disease, Korea University Medical College, Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 152-703, Korea
| | - S. Manesh
- Department of Orthopaedic Surgery, Institute for Rare Disease, Korea University Medical College, Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 152-703, Korea
| | - J.-H. Ryu
- Department of Orthopaedic Surgery, Institute for Rare Disease, Korea University Medical College, Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 152-703, Korea
| | - S.-H. Song
- Department of Orthopaedic Surgery, Institute for Rare Disease, Korea University Medical College, Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 152-703, Korea
| | - S.-J. Kim
- Department of Orthopaedic Surgery, Institute for Rare Disease, Korea University Medical College, Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 152-703, Korea
| | - H.-R. Song
- Department of Orthopaedic Surgery, Institute for Rare Disease, Korea University Medical College, Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 152-703, Korea
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Sabharwal S, Green S, McCarthy J, Hamdy RC. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2011; 93:213-21. [PMID: 21248221 DOI: 10.2106/jbjs.j.01420] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopaedics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA.
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Angular deformity correction by asymmetrical physeal suppression in growing children: stapling versus percutaneous transphyseal screw. J Pediatr Orthop 2010; 30:588-93. [PMID: 20733425 DOI: 10.1097/bpo.0b013e3181e04b5d] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to compare the outcomes of angular deformity correction by hemiepiphyseal stapling versus percutaneous hemiepiphysiodesis using transphyseal screw in growing children. METHODS Forty-three physes in 19 patients underwent hemiepiphyseal stapling, and 37 physes in 23 patients underwent percutaneous transphyseal screw placement. All cases were followed up to skeletal maturity or for more than 1 year after hardware removal. Amounts and rates of angular deformity correction, physeal behaviors after hardware removal, and postoperative courses were compared between the 2 groups. RESULTS The goal of angular correction was achieved in all except 2 patients, who reached skeletal maturity precociously. The mean rates of angular correction were not significantly different between the 2 groups, in both distal femur and proximal tibia. Hardware was removed before skeletal maturity from 56 physes. Angular change remained within 3 degrees for 43 physes (76.8%) at more than 1 year postoperatively, and the rebound phenomenon was observed in 12 (21.4%). No significant difference was observed between the 2 groups in terms of physeal behavior after hardware removal. Patients in the screw group were administered less postoperative pain medication, had shorter hospital stays, and smaller operation scars. In the stapling group, 1 case was complicated due to an extruded staple, and another case experienced premature physeal arrest at 1.5 years postoperatively. One case in the screw group experienced correction failure, probably because of a technical error during screw placement. CONCLUSIONS Hemiepiphysiodesis using percutaneous transphyseal screw is as effective as hemiepiphyseal stapling in terms of angular deformity correction. Furthermore, hemiepiphysiodesis using transphyseal screw has the advantage of being a minimally invasive procedure, and in this series, did not cause permanent physeal arrest. LEVEL OF EVIDENCE Level III.
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Abstract
Guided growth is useful in correcting pediatric angular deformities. Although growth manipulation has been applied to various deformities, it is most commonly used to correct coronal plane deformity about the knee. Temporary hemiepiphysiodesis is performed using staples, percutaneous transphyseal screws, or a tension band plate. Permanent hemiepiphysiodesis can be done using either an open Phemister or a percutaneous approach. These techniques function by tethering one side of a growing physis, thereby allowing differential growth. Applied correctly, this can also result in angular deformity correction. Undercorrection and overcorrection are common problems with guided growth. However, careful preoperative planning and appropriate follow-up can minimize complications and allow for excellent deformity correction with minimal morbidity.
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Abstract
PURPOSE OF REVIEW Lower extremity angular deformities are among the most common nontraumatic conditions in children being referred to pediatric orthopedists. Understanding of this abnormality is essential for pediatricians and primary caregivers. There is a development in the surgical management of these problems that has improved the quality of care of affected children and adolescents. RECENT FINDINGS In recent years, we have improved our understanding of consequences of lower limb angular deformities on knees. New treatment options for angular deformity include the method of 'guided growth' using small, extraphyseal tension band plates. SUMMARY The development of this surgical technique for growth plate manipulation for the treatment of angular deformities of knees has expanded the indications for surgical management and has a potential to decrease the incidence and the severity of complications.
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