Epiphysiodesis for limb length discrepancy: a comparison of two methods

Abstract

A retrospective review of 42 patients from 1999 to 2008 with at least 1-year follow-up was performed. The type and location of epiphysiodesis, average operative time and hospital stay, complications, timing and the final limb length discrepancy (LLD) were recorded. Computer tomography scanograms and mechanical axis view with grids were done to assess LLD. Twenty-six patients underwent Canale type epiphysiodesis compared with 14 receiving Metaizeau screw epiphysiodesis. The average operation time for Canale type was 42 and 45 min for screw epiphysiodesis. In the Canale group, there was a mean reduction in 2.5 cm in LLD from 3.7 to 1.2 cm over an average follow-up of 2.1 years. There were 4 minor and 2 major complications with a 92 % success rate defined as achieving the desired discrepancy correction. In the screw epiphysiodesis group, the mean change was 1.8 cm from 3.2 to 1.4 cm, over 2.2 years with 2 minor and 2 major complications and a success rate of 85 %. Percutaneous epiphysiodesis by any method is a reliable, minimally invasive method with minimal morbidity and an acceptable complication rate when compared to a corrective osteotomy or an open Phemister-type epiphysiodesis. This study has led to our preference for the Canale method, which in our hands has fewer complications and is more successful at reaching the desired discrepancy correction.

Percutaneous Epiphysiodesis Using Transphyseal Screws: a Case Series Demonstrating High Efficacy

“…It is not clear whether all previous studies on epiphysiodesis were similarly diligent in this respect, as typically past publications have simply referred to using the multiplier method and did not specify whether different formulas were used for congenital versus developmental cases. If this is the case, it could explain why efficacy was greater in our series than in previous publications [1,4,14,24].…”

“…Prior studies on PETS reported variable complication rates and clinical outcomes [1,9,14,15,18]. The most common complications reported were angular deformity, screw failure with ongoing growth, and the need for revision surgery [1,14,15]. In 2012, Ilharreborde et al reported their experience with 45 patients and showed a mean efficacy of only 66% at skeletal maturity for both the distal femur and the proximal tibia [14].…”

What’s New in Limb Lengthening and Deformity Correction

“…When evaluating the effectiveness of percutaneous physeal ablation with a drill and burr technique (the Canale method) compared with that of transphyseal screws (the Metaizeau method), the drill ablation was slightly more effective and had a lower complication rate 10 . Siedhoff et al noted that temporary epiphysiodesis with use of either tension-band plates or staples can be effective for correcting leg-length discrepancy.…”

Intramedullary Elastic Transphyseal Tibial Osteosynthesis and Its Effect on Segmental Growth

“…Имеется ряд исследований, в которых установлено, что одномоментное формирование транс-физарного канала без расположения в нем стержней или сухожилий не ведет к образованию эпифизеодеза и не вызывает каких-либо нарушений продольного роста кости [18,21], в то время как образование узкой зоны эпифизеодеза, окружающей постоянно присутствующий имплант, является необратимой причиной торможения роста в данной части физиса [5,22]. В то же время именно относительно небольшие размеры эпифизеодеза (менее 7%) позволяют происходить спонтанному дезэпи-физеодезу в процессе активного роста.…”