Faster Rate of Correction with Distal Femoral Transphyseal Screws Versus Plates in Hemiepiphysiodesis for Coronal-Plane Knee Deformity

Abstract

Background: Hemiepiphysiodesis (guided-growth) procedures have become the primary method of treatment for coronal-plane knee deformities in skeletally immature patients. Two leading techniques involve the use of a transphyseal screw or a growth modulation plate. However, clinical references for the estimation of correction are lacking, and no consensus has been reached regarding the superiority of one technique over the other. Therefore, the purpose of this study was to compare the rates of correction for distal femoral transphyseal screws and growth modulation plates in age- and sex-matched cohorts with coronal deformities. Methods: Thirty-one knees were included in each cohort on the basis of propensity scoring by chronological age and sex, and radiographic images were retrospectively reviewed preoperatively and postoperatively. Each case was measured for limb length, mechanical axis deviation (MAD), mechanical lateral distal femoral angle (LDFA), and bone age. Results: Both the MAD and LDFA rate of correction significantly differed between the screw and plate cohorts. The MAD rate of correction was observed to be 0.42 ± 0.37 mm/week (1.69 mm/month) in the plate cohort and 0.66 ± 0.51 mm/week (2.64 mm/month) in the screw cohort. The LDFA rate of correction was observed to be 0.12° ± 0.13°/week (0.50°/month) in the plate cohort and 0.19° ± 0.19°/week (0.77°/month) in the screw cohort. Conclusions: The current study provides simple clinical references for the rate of correction of MAD and the LDFA for 2 methods of hemiepiphysiodesis. The results suggest that transphyseal screws may correct coronal knee deformities during the initial treatment stage more quickly than growth modulation plates in distal femoral guided growth. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

What’s New in Pediatric Orthopaedics

“…Another study of multiple types of coronal plane deformity evaluated the rate of correction for transphyseal screws and growth modulation plates from the time of the surgical procedure to the first postoperative radiograph. Transphyseal screws corrected both the mechanical axis deviation and lateral distal femoral angle more rapidly in the initial treatment phase 20 .…”

Children’s orthopaedics

“…A paper from Frisco (Texas, USA) looked at 62 knees in a case-matched cohort to evaluate the rate of angular correction in the coronal plane. 8 The research involved 31 knees in each cohort, selected based on propensity scoring for chronological age and sex. Preoperative and postoperative radiological images were retrospectively reviewed.…”