Control of Bone Growth by Epiphyseal Stapling

Blount, Walter P.; Clarke, George R. G.

doi:10.2106/00004623-194931030-00002

Cited by 391 publications

(171 citation statements)

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“…In 1949, Blount and Clarke first reported stapling of the epiphyseal plate as a method for controlling growth disturbances such as angular deformities. In clinical series, stapling appears to be a safe procedure (Stevens et al 1999, Courvoisier et al 2009), although the technique might have some complications such as staple migration or breakage, and the potential for premature closure of the growth plate (Blount and Clarke 1949). …”

mentioning

confidence: 99%

Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling

Gottliebsen¹,

Rahbek²,

Hvid³

et al. 2013

Acta Orthopaedica

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Background In children with angulating deformities of the lower limbs, hemiepiphysiodesis can be used to guide growth to achieve better alignment at skeletal maturity. Traditionally, this has been performed with staples. The tension-band plating technique is new and it has been advocated because it is believed to reduce the risk of premature closure of the growth plate compared to stapling. The benefit of the tension-band plating technique has not yet been proven in experimental or randomized clinical studies.Methods We performed a randomized clinical trial in which 26 children with idiopathic genu valgum were allocated to stapling or tension-band plating hemiepiphysiodesis. Time to correction of the deformity was recorded and changes in angles on long standing radiographs were measured. Pain score using visual analog scale (VAS) was recorded for the first 72 h postoperatively. Analgesics taken were recorded by the parents.Results Mean treatment times for stapling hemiepiphysiodesis (n = 10) and for tension-band plating hemiepiphysiodesis (n = 10) were similar. Postoperative VAS scores and consumption of analgesics were also similar in both groups. No hardware failure or wound-related infection was observed.Interpreatation Treatment time for the 2 treatment modalities was not significantly different in this randomized clinical trial. Tension-band plating and stapling appeared to have a similar effect regarding correction of genu valgum. We cannot rule out type-II error and the possibility that our study was underpowered.ClinicalTrials.gov Identifier: NCT01641354.

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mentioning

confidence: 99%

Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling

Gottliebsen¹,

Rahbek²,

Hvid³

et al. 2013

Acta Orthopaedica

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“…The introduction of staples to control epiphysial growth (Blount and Clarke, 1949) has enabled surgeons to correct knock-knee deformities in growing children with precision, over a period of 6-9 months; after removal of the staples, normal epiphysial growth at the operated site restarts. The operation is simple to perform and full knee function soon returns.…”

Section: Discussionmentioning

confidence: 99%

“…In 1945 Haas presented evidence that differential growth could be obtained in dogs by fixing the epiphyses to the diaphyses with wire loops. Subsequently, Blount and Clarke (1949) applied this principle to children using staples to halt epiphysial growth. This paper reports the results of stapling the epiphysis to the diaphysis on the medial aspect of both the lower end of the femur and the upper end of the tibia in 3 children in an attempt to improve their valgus deformities when growth was resumed, after stopping or reducing corticosteroid therapy.…”

mentioning

confidence: 99%

Valgus Knee Deformities in Children with Juvenile Chronic Polyarthritis Treated by Epiphysial Stapling

Ansell¹,

Arden²,

McLennan³

1970

Archives of Disease in Childhood

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“…In clinical practice most surgeons stick to the 2-year rule that states it is safe to leave staples over a physis for two years in a growing child. This rule originates from a 1949 paper by Blount et al who cites a personal non-published communication with Phemister [11]. …”

Section: Tension Band Platingmentioning

confidence: 99%

Guided growth: Mechanism and reversibility of modulation

Gottliebsen

Shiguetomi-Medina

Rahbek

et al. 2016

Journal of Children's Orthopaedics

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In paediatric orthopaedics, deformities and discrepancies in length of bones are key problems that commonly need to be addressed in daily practice. An understanding of the physiology behind developing bones is crucial for planning treatment. Modulation of the growing bone can be performed in a number of ways. Here, we discuss the principles and mechanisms behind the techniques. Historically, the first procedures were destructive in their mechanism but reversible techniques were later developed with stapling of the growth plate being the gold standard treatment for decades. It has historically been used for both angular deformities and control of overall bone length. Today, tension band plating has partially overtaken stapling but this technique also carries a risk of complications. The diverging screws in these implants are probably mainly useful for hemiepiphysiodesis. We also discuss new minimally invasive techniques that may become important in future clinical practice.

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Control of Bone Growth by Epiphyseal Stapling

Cited by 391 publications

References 0 publications

Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling

Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling

Valgus Knee Deformities in Children with Juvenile Chronic Polyarthritis Treated by Epiphysial Stapling

Guided growth: Mechanism and reversibility of modulation

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