Guided Growth: Current Perspectives and Future Challenges

Yang, Irene; Gottliebsen, Martin; Martinkevich, Polina; Little, David

doi:10.2106/jbjs.rvw.16.00115

Cited by 12 publications

(9 citation statements)

References 91 publications

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“…rickets, neurofibromatosis type 1, disuse). This series and other reported cases again assigned the failure of construct either due osteopenic bones or technical errors (short screws, epiphyseal screw too close to physis) [1][2][3][4][5][6][7][8][9]. In our series too, seven patients were postrachitic although all patients were treated medically prior to surgery.…”

Section: Discussionsupporting

confidence: 60%

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Predisposing factors for migration of epiphyseal screws into physis in tension band plating

Jain

Agarwal

Jethwa

et al. 2022

Journal of Pediatric Orthopaedics B

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The migration of epiphyseal screws into growing physis in tension band plating is a known complication. We investigated the screw migration into physis in 10 patients (18 plates) to study the various technical details, which may have contributed to this complication. The methodology involved retrospective review of radiological records. Among these 10 affected patients, in four patients, there were eight additional tension band plates, which had remained uncomplicated ('controls') at the time when implant failure was detected. We statistically compared the length of epiphyseal screw, proximity of screw start point to the physis, screw trajectory angle, interscrew angle and correction rate between the migrated and other uncomplicated plates. Majority patients were postrachitic (n = 7). The mean time from primary procedure to detection of radiological complication was 15.1 months. The mean epiphyseal screw length proportion in migrated and uncomplicated plates matched. The starting point of epiphyseal screw was relatively closer to physis in migrated plates. The trajectory of epiphyseal screw with respect to physis was more divergent in the migrated plates (P = 0.02). All implants were inserted in a divergent manner with mean interscrew angle being 22.3° for migrated and 13.8° for the uncomplicated plates (P = 0.02). The correction rate of the implant reduced as it failed. Osteopenic bone and pathological physis predispose to migrated plates. Technically, a wider trajectory of epiphyseal screw and too divergent screws should be avoided. A migrated implant becomes less effective in its function.

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Section: Discussionsupporting

confidence: 60%

“…The complication of migration of epiphyseal screw into physis in tension band plating is known for quite some time [1][2][3][4][5][6][7][8][9]. Although infrequently reported, this problem can be potentially harmful to the growing physis and need to be avoided [2].…”

Section: Introductionmentioning

confidence: 99%

Predisposing factors for migration of epiphyseal screws into physis in tension band plating

Jain

Agarwal

Jethwa

et al. 2022

Journal of Pediatric Orthopaedics B

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“…In general, pathologic CPAD is an indication for IMGG of the lower extremities [30]. The degree of coronal plane malalignment leading to degenerative changes is unknown, and thus there is no absolute cut-off value for consideration of IMGG.…”

Section: Discussionmentioning

confidence: 99%

Use of Implant-Mediated Guided Growth With Tension Band Plate in Skeletally Immature Patients With Knee Pathology: A Retrospective Review

et al. 2021

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Background: Skeletally immature patients with coronal plane angular deformity (CPAD) may be at increased risk for intra-articular pathology and patellofemoral instability (PFI). These patients may be candidates for implant-mediated guided growth (IMGG) procedures with tension band plates to address CPAD in addition to procedures for concomitant knee pathology. However, there are limited data on performing these procedures simultaneously. Questions/Purpose: We sought to demonstrate the feasibility of combined procedures to address both knee pathology and concomitant CPAD using IMGG in skeletally immature patients. Methods: We conducted a retrospective review of skeletally immature patients who underwent IMGG and concomitant surgery for anterior cruciate ligament reconstruction, osteochondritis dissecans repair, meniscus pathology, or PFI at a single institution by 2 surgeons between 2008 and 2019. Data on demographics, surgical details, follow-up, and complications were recorded. Deformity correction was assessed in a subset of eligible patients. Results: Of 29 patients meeting inclusion criteria, deformity correction was assessed in a subset of 17 patients (15 valgus, 2 varus). At final follow-up, 16 of 17 patients had mechanical tibiofemoral (mTFA) angles of <5° of varus or valgus. One patient developed “rebound” valgus >5° after plate removal. Conclusions: The IMGG performed in the setting of treating intra-articular knee pathology is feasible and should be considered for skeletally immature patients with CPAD undergoing surgery for concomitant knee pathology.

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“…The complications of growth modulation could be screw migration and infection, overcorrection and permanent physeal arrest, knee stiffness, fracture, and the failure of growth inhibition (7,8,18,27). The associated risk factors include BMI, age, and underlying etiologies (7,28). Bodyweight is an essential factor in breakage (29).…”

Section: Discussionmentioning

confidence: 99%

Growth Modulation With Reconstruction Plate for Genu Valgum Deformity in Twins: A Case Report and Literature Review‌

Ghaffari

amini

2020

J. Pediatr. Rev.

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Genu valgum is an angular deformity caused by several reasons, such as congenital syndromes, post-traumatic bone dysplasia, or an idiopathic form. It generates cosmetic problems, difficulties in function, and pain. Manipulating the growth plate by hemiepiphysiodesis with implants helps to achieve the correct alignment. We presented twin girls diagnosed with genu valgum deformity who were suffering from cosmetic problems and pain. We used growth modulation to temporarily arrest the growth plate. This procedure was followed by photographs and after 8 months, the implants were removed without having overcorrection. A brief literature review was also performed concerning the reported cases in the international databases, such as PubMed and Google Scholar on growth modulation for genu valgum deformity in twins. Twin girls with genu valgum deformities underwent hemiepiphysiodesis surgeries. We used reconstruction plates and 3.5 mm non-cannulated screws to fix both the distal femur and proximal tibia to temporarily arrest the growth plate. When we achieved the correct alignment the devices were removed.

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Guided Growth: Current Perspectives and Future Challenges

Cited by 12 publications

References 91 publications

Predisposing factors for migration of epiphyseal screws into physis in tension band plating

Predisposing factors for migration of epiphyseal screws into physis in tension band plating

Use of Implant-Mediated Guided Growth With Tension Band Plate in Skeletally Immature Patients With Knee Pathology: A Retrospective Review

Growth Modulation With Reconstruction Plate for Genu Valgum Deformity in Twins: A Case Report and Literature Review‌

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