Early experience with medial femoral tension band plating in idiopathic genu valgum

Guzmán, Humberto; Yaszay, Burt; Scott, Vanessa; Bastrom, Tracey P.; Mubarak, Scott J.

doi:10.1007/s11832-010-0310-6

Cited by 42 publications

(29 citation statements)

References 20 publications

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“…6,7 At correction, the angles had improved to a mean of 9.56° and 5.72° (Table-2 In a study conducted by Guzman et al, the TFA had improved from a pre-operative mean of 11.2° to 6° at correction and the mean LDFA improved from a preoperative mean of 77.5° to 88.14° at correction. 8 In our study, the tibio-femoral angles had improved from 16.1° to 4.67° post-operatively. Mean LDFA had improved from 77.5° pre-operatively to 88.14°at correction.…”

Section: Discussionsupporting

confidence: 53%

Outcome of Growth Modulation Using the Tension Band Principle of 8 Plate for Paediatric Genu Valgum Deformity

Boddapalli¹,

Solanki²,

Ajmera³

2019

jebmh

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BACKGROUNDOsteotomies have traditionally been the mainstay of treating deformities not only in adults but also in children. Osteotomies involve extensive soft tissue dissection, complications of wound closure, infection, delayed union, malunion, and prolonged immobilization, which increase the morbidity of the patients. Depending upon the aetiology, recurrent deformity may lead to need for repeat osteotomy. While osteotomy is necessary for rotational correction and limb lengthening, angular correction may be achieved by other means. Several techniques of epiphyseal growth modulation have evolved, enabling gradual correction of angular deformities and/or length equalization through guided growth. Dallas Phemister introduced the concept of open epiphysiodesis which had the risk of permanent arrest of the physis. Walter Blount gave the idea of staples, but were susceptible to migration, bending and loosening. Permanent physeal closure might ensue with staples. Transphyseal screws by Metaizeau had a major risk of intra-articular perforation and also violated the physis. The 8-plate method of guided growth provides a tension band that expedites angular correction compared to stapling and transphyseal screws which rely upon the principle of compression. METHODSThe study design was prospective and interventional. The parameters measured and documented were:1. Tibio femoral angle 2. Lateral distal femoral angle 3. Medial proximal tibial angle 4. Mechanical axis zone These parameters were collected at each follow up until the deformity was corrected. Data was analysed statistically. A paired t-test was applied to compare the pre-operative tibio-femoral angles, and the tibio-femoral angles at various durations of follow-up. RESULTSEighteen patients were included in the study. They were evaluated by the alignment of tibio-femoral axis at each post-operative visit. The mean pre-operative and the mean post-operative tibio-femoral axes alignment was subjected to a paired t-test. The final outcome was taken at an angle of zero degrees between both axes. We observed a t-value of 7.23, which corresponds to a p-value of 0.02 which is significant i.e., less than 0.05. CONCLUSION8-plate hemi-epiphysiodesis is an effective means for correcting genu valgum deformities in skeletally immature patients. It is minimally invasive, and there is no permanent damage to the bone. It is a modular, diverse and a reversible procedure which accommodates the dynamic and ever-changing physis while promoting angular correction. The outlook for guided growth looks very promising, but as with all the new techniques, the results have to be evaluated carefully and the indications refined. HOW TO CITE THIS ARTICLE:Boddapalli RT, Solanki M, Ajmera A. Outcome of growth modulation using the tension band principle of 8 plate for paediatric genu valgum deformity.

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Section: Discussionsupporting

confidence: 53%

Outcome of Growth Modulation Using the Tension Band Principle of 8 Plate for Paediatric Genu Valgum Deformity

Boddapalli¹,

Solanki²,

Ajmera³

2019

jebmh

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“…Schroerlucke et al [14] reported that eight failures occurred in patients with Blount disease and involved breakage of the tibial metaphyseal screw in the proximal tibia. Other authors have reported infections [11,17], knee effusion [17], rebound deformity, or uncorrected deformity [11,12,18,19]. These failures were more likely to occur in overweight or obese patients with Blount disease and more likely in the metaphyseal screw with resultant screw failure.…”

Section: Discussionmentioning

confidence: 97%

Failure of tension band plating: a case series

Masquijo

Firth²,

Sepúlveda³

2017

Journal of Pediatric Orthopaedics B

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Growth modulation with tension band plates (TBP) has been shown to be a very useful method for the treatment of angular deformities in growing children. Recently, we have observed cases of failure where the epiphyseal screw was drawn through the physis into the metaphysis. This study describes a series of children who developed this complication. Patients who developed TBP failure after operative treatment of lower limb angular deformities were identified from the databases at four institutions over a 5-year period. The medical records were reviewed to record demographics, primary diagnoses, details of the operative procedure, development of physeal arrest, and recurrence of the original deformity. Six patients (five girls) with nine implant failures were identified. The mean age of the children at the time of implant insertion was 7.2 years (range, 4-10 years). The primary diagnoses included hypophosphatemic rickets (n=7), congenital pseudoarthrosis of the tibia associated with neurofibromatosis 1 (n=1), and post-traumatic malunion after distal tibial fracture (n=1). Of the nine TBP that presented with the complication, four were inserted into the medial distal femur (one bilateral case), two into the medial proximal tibia (one bilateral case), two into the lateral distal tibia, and one into the medial distal tibia. None of these patients developed physeal growth arrest at the last follow-up as assessed on the latest radiographs. The use of TBP for guided growth in patients younger than 10 years old with rickets, neurofibromatosis, or other conditions that produce osteopenia leads to an increased risk for implant failure. In these cases, it is important to confirm that the epiphyseal screw has good purchase. Patients with these features should be monitored closely for early detection of this complication.

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“…4 Physiological GV in childhood have IMD of up to 8cm, the greatest distance being observed between 3 and 4 years, 5 disappearing gradually after the age of 7-8 years. 6 If the longitudinal axis of the knee joint is not aligned by then, and the IMD is more than 5cm, 7 physiotherapeutic intervention is called for. The degree of GV has a significant effect on the development of growing pains 8 and orthrosis because the imposed loads are no longer equally distributed between the outer and the inner halves of the knee.…”

Section: Introductionmentioning

confidence: 99%

Development of garment with elastic straps and pressure applicator in mechanotherapy to correct children’s genu valgum

Tamm

Linkberg

Vaher

et al. 2018

IPMRJ

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Objective: Genu valgum (GV), also known as valgus knee, or knock-knee, is a common orthopaedic condition in growing children. Physiological genu valgum have intermalleolar distance of up to 8 cm, the greatest distance being observed between 3 and 4 years, disappearing gradually after the age of 7-8 years. If the longitudinal axis of the knee joint is not aligned by then, physiotherapeutic intervention is called for. Aim:The aim of our study was to determine if garment with elastic straps and pressure applicator could be used in mechanotherapy to correct children's excessive GV. Methods:The study has lasted last 6 years and there has been three study periods. In all study-periods, practical part lasted six months. Inclusion criterias were: subjects were not involved in physical therapy and did not wear orthoses during the study. Once in every month myometric values (tone, biomechanical and viscoelastic properties of m. sartorius, tensor fasciae latae, semitendinosus, tibialis anterior, gastrocnemius caput mediale, m. peroneus longus) were determined with MyotonPro (Myoton AS, Estonia); anthropometric (height, body mass, intermalleolar distance), and goniometric (tibiofemoral angle) parameters were measured according to the standard technique. During the last three months children didn't wear garment and final measurement was done to evaluate long term effect of garment. Individual analysis was carried out to evaluate the results. Results:After wearing the garments with pressure and elastic components the changes in the lower limb joint alignment and biomechanical parameters promoted the correction of GV position. Three months after the wearing period the changes occurred the worsening of GV position, which indicates that the muscles could not maintain the condition achieved by wearing the garment. Conclusion:The relationship between applied mechano therapeutic stimulus and changes in the lower limb joint alignment and changes of the biomechanical parameters are individual. Study continues with upgrading a device where a new solution is found using digital technology to measure tensile strength at a desired period.

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Early experience with medial femoral tension band plating in idiopathic genu valgum

Cited by 42 publications

References 20 publications

Outcome of Growth Modulation Using the Tension Band Principle of 8 Plate for Paediatric Genu Valgum Deformity

Outcome of Growth Modulation Using the Tension Band Principle of 8 Plate for Paediatric Genu Valgum Deformity

Failure of tension band plating: a case series

Development of garment with elastic straps and pressure applicator in mechanotherapy to correct children’s genu valgum

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