Controlled longitudinal bone growth by temporary tension band plating

Abstract

Permanent growth arrest of the longer bone is an option in the treatment of minor leg-length discrepancies. The use of a tension band plating technique to produce a temporary epiphysiodesis is appealing as it avoids the need for accurate timing of the procedure in relation to remaining growth. We performed an animal study to establish if control of growth in a long bone is possible with tension band plating. Animals (pigs) were randomised to temporary epiphysiodesis on either the right or left tibia. Implants were removed after ten weeks. Both tibiae were examined using MRI at baseline, and after ten and 15 weeks. The median interphyseal distance was significantly shorter on the treated tibiae after both ten weeks (p = 0.04) and 15 weeks (p = 0.04). On T1-weighted images the metaphyseal water content was significantly reduced after ten weeks on the treated side (p = 0.04) but returned to values comparable with the untreated side at 15 weeks (p = 0.14). Return of growth was observed in all animals after removal of implants. Temporary epiphysiodesis can be obtained using tension band plating. The technique is not yet in common clinical practice but might avoid the need for the accurate timing of epiphysiodesis.

Rebound growth after hemiepiphysiodesis

“…Despite the fact that rebound growth has been widely discussed in the literature, 22 very little is known about the process. Many authors have referred to it as a normal reaction to epiphysiodesis, 1,4 which is only absent in older children in whom there is no time left for rebound, as bone growth Radiographs showing a rabbit tibia subjected to hemiepiphysiodesis, a) the immediate post-operative anteroposterior and lateral films, b) at removal of the device and c) at sacrifice three weeks later.…”

“…Tibial angulation was measured using the articular linediaphyseal angle (ALDA) as previously described, 21,22 and the following variables were analysed. ALDA angle.…”

Guided growth: Mechanism and reversibility of modulation

“…We performed an animal experimental study suggesting that temporary epiphysiodesis using tension band plating implants was feasible [23]. Clinical papers have now emphasised the problems arising with the clinical use of this technique which include failure of epiphysiodesis and problems with uncontrolled growth [24, 25].…”

Сучасний Погляд На Проблему Різниці Довжини Нижніх Кінцівок У Дітей Та Лікування Із Застосуванням Методів Керованого Росту (Літературний Огляд)

“…Згідно з J. Kenwright (1992), H. Wagner (1977) [15,53], метод є ефективним при лі-куванні РДНК у діапазоні від 2 до 4 см як у дітей, так і в дорослих. Даний метод зберіг своє значення лише при лікуванні РДНК на фоні захворювань, що супроводжу-ються гемігіпертрофією.…”