Hemiepiphysiodesis Using Eight-Plate Versus Blount Staple to Correct Genu Valgum and Genu Varum

Rodrigues, Natasha Vogel Majewski; Guarniero, Roberto; Bôas, Paulo José Fortes Villas; Miranda, Bruno Rodrigues de; Montenegro, Nei Botter

doi:10.1590/1413-785220202804233440

Cited by 5 publications

(5 citation statements)

References 18 publications

(32 reference statements)

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“…It is yet questionable if intentional overcorrection is legitimate in order to retain imminent recurrence. [8,[19][20][21][22] Limitations of the present cohort study are the retrospective design and the heterogeneity of the deformities. Future studies ought to focus either on varus or valgus deformities to draw conclusions.…”

Section: Discussionmentioning

confidence: 97%

“…It is yet questionable if intentional overcorrection is legitimate in order to retain imminent recurrence. [ 8 , 19 – 22 ]…”

Section: Discussionmentioning

confidence: 99%

“…In addition to unfavorable knee strain and consecutive complaints eventually, we provide evidence of an increased risk for recurrent deterioration of the mechanical axis after implant removal with the growth plates being still open. It is yet questionable if intentional overcorrection is legitimate in order to retain imminent recurrence [8,19–22] …”

Section: Discussionmentioning

confidence: 99%

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

Schagemann

Kudernatsch

Russlies³

et al. 2022

Medicine

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

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Section: Discussionmentioning

confidence: 97%

“…It is yet questionable if intentional overcorrection is legitimate in order to retain imminent recurrence. [ 8 , 19 – 22 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Schagemann

Kudernatsch

Russlies³

et al. 2022

Medicine

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“…Nor is it exactly known what the relative weight of each variable is in influencing spontaneous deformity correction. This creates surgical decision-making dilemmas with respect to the appropriate indications for intervention by guided growth surgery, a procedure which has demonstrated safety and efficacy in the treatment of childhood angular knee deformities of various etiologies including NR [17,24]. Guided growth has also demonstrated efficacy in treatment of torsional long bone deformities in clinical [17] and experimental settings [25].…”

Section: Background and Significancementioning

confidence: 99%

Predictors of Spontaneous Remodelling of Angular Knee Deformities in Children with Healed Nutritional Rickets: A Prospective Cohort Study Protocol

Baraka¹,

Samir²,

Mahmoud³

et al. 2021

Preprint

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Background: Nutritional rickets is still considered as a global health problem especially in low-resource countries and immigrant societies of developed countries. Generalized skeletal deformities including angular knee deformities as genu varum and genu valgum are prominent features of nutritional rickets. Angular knee deformities can cause gait difficulties. However, the true remodelling potential of the healed knee deformities is largely unknown to the pediatric and orthopedic community. Aims: The primary objective of this study protocol is to investigate the natural history of disease in regard to the remodelling potential of angular knee deformities in children and adolescents with healed nutritional rickets. And determine the potential patient- and deformity-related factors that are associated with a favorable deformity remodelling as age and sex of patients and type, severity, laterality of deformities etc. Methods: This will be a prospective observational analytical cohort natural history of disease study. A minimum of at least 140 knees with healed nutritional rickets and angular knee deformities will be observed at regular three-monthly intervals over a period of at least one year. We will report two outcome variables namely; clinical and radiological tibio-femoral angle. And independent patient and deformity-related variables as age, sex, deformity type, severity and laterality. Inferential statistics namely bivariate and multivariate analysis will be employed accordingly to identify the relation between outcome variables and the different independent variables. Ethics and dissemination: This protocol study has been approved by the institutional research ethics committee. Results will be presented at conferences and submitted to relevant international and society publications. Authors will also communicate the results to their scholarly networks and post them on scholarly networking sites. Conclusions: This study has the potential for improving the decision-making process as to which patients deserve conservative treatment and which deserve surgical deformity correction. Results are expected to have an impact on the clinical practice of pediatricians, orthopedic surgeons and family physicians alike.

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“…[1,2] Various hemiepiphysiodesis techniques have been developed for preventing deformity. [3,4] Blount [5] showed that the growth disturbances such as angular deformities can be controlled by using minimally invasive hemiepiphysiodesis technique with U nails. Since U nail migration and breakage Objectives: In this study, we describe a novel hemiepiphysiodesis technique to prevent implant-related perichondrial ring injury in a rabbit model.…”

mentioning

confidence: 99%

Comparison of two types of fixation for proximal tibial epiphysiodesis: An experimental study in a rabbit model

Bayrak

Duramaz

Kızılkaya³

et al. 2021

Jt Dis Relat Surg

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Objectives: In this study, we describe a novel hemiepiphysiodesis technique to prevent implant-related perichondrial ring injury in a rabbit model. Materials and methods: Proximal tibial epiphyseal plates of a total of 16 white New Zealand rabbits were used for this animal model. The subjects were divided into three equal groups as follows: Group 1 (Kirschner wire [K-wire]/cerclage), Group 2 (8-plate) right-hind legs, Group 3 (Control) left hind legs. Using anteroposterior radiography, the medial slope angle (MSA), articular line-diaphyseal angle (ALDA), and the angle between screws of 8-plate in lateral X-ray tibial slope angle (TSA) were measured. The radiographs were taken early postoperative (Day 1) and on sacrification day (Week 8). The histological evaluation of the perichondrial ring was made on a 7-mm axial section that stained with Safranin O/fast green at X10 magnification. Results: In both K-wire and 8-plate groups, the early postoperative ALDA and TSA were greater than the sacrification ALDA and TSA (p=0.028 and p<0.001, respectively). The early postoperative MSA was lower than the sacrification MSA in groups, (p<0.001). The MSA in the control group was lower than the K-wire and 8-plate groups (p<0.001 and p=0.009; respectively). The perichondrial ring thickness of the K-wire group was greater than the 8-plate group in histological evaluation (p<0.001). Conclusion: Both of the K-wire and 8-plate groups showed similar angulation effects in the proximal tibia, although histologically less damage to the perichondrial ring was observed in the K-wire group, compared to the 8-plate group.

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Hemiepiphysiodesis Using Eight-Plate Versus Blount Staple to Correct Genu Valgum and Genu Varum

Cited by 5 publications

References 18 publications

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

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

Predictors of Spontaneous Remodelling of Angular Knee Deformities in Children with Healed Nutritional Rickets: A Prospective Cohort Study Protocol

Comparison of two types of fixation for proximal tibial epiphysiodesis: An experimental study in a rabbit model

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