Guided growth: Preliminary results of a multinational study of 967 physes in 537 patients

Abstract

BackgroundGuided growth by tension band plating is commonly used to correct coronal plane deformity. The purpose of this study was to measure the effect and further define parameters that influence results in coronal plane deformity around the knee.MethodsThe retrospective multicentre study included data on 967 physes in 537 patients, with an average follow-up of 16 months after plate insertion. Alignment analysis was compared preoperatively and in at least two measurements postoperatively, as well as with parameters that influence the rate and amount of correction.ResultsAverage age at plate implantation was 11.35 years (SD 3.29).Of those with femoral deformities, 85% of the patients finished the treatment and of those, 70% were corrected to standard alignment, while 14% have not yet achieved correction, and are still growing.Of those with tibial deformities, 75% of the patients finished the treatment and of those 80% were corrected to standard alignment, while 25% have not yet achieved correction and are still growing.The calculated rate of correction was 0.77°/month for the femur and 0.79°/month for the tibia.In terms of complications, the overall rate of infection was 1.48%. In three patients (0.55%) screw breakage was recorded.Factors found to significantly influence the amount of correction were age at plate implantation and direction of deformity.ConclusionTemporary hemiepiphysiodesis takes the advantage of physiological physeal growth to effectively treat angular deformities. Success of treatment is influenced by the age of the patient at plate implantation and direction of deformity.Level of EvidenceIV

Clinical practice recommendations for the diagnosis and management of X-linked hypophosphataemia

“…Substantial deformity might also exist in the sagittal and torsional planes. Deformity in three planes increases the difficulty of any surgical intervention, but often the coronal deformity dominates and correction of this plane improves the overall picture 160,165,166 .…”

“…Guided growth techniques have been gaining popularity 165 . This surgical strategy should commence early after 12 months if deformity persists despite maximized medical therapy.…”

Multidisciplinary patient care in X‐linked hypophosphatemic rickets: one challenge, many perspectives

“…Guided growth with hemiepiphysiodesis is a minimally invasive treatment option for mild deformities of the lower limbs. Several studies showed favourable results in children with healthy and pathological physis [34][35][36]. Depending on the deformity, the growth plate is temporarily blocked using a small plate with two screws on the medial or lateral distal femur or proximal tibia.…”

Treatment of deformities in patients with healed congenital pseudarthrosis of the tibia

“…Существующий метод управляемого роста (гемиэпифизиодез) дает возможность эффективно выполнять коррекцию деформаций длинных костей у растущих детей при различных патологиях [11][12][13][14][15][16]. Учитывая тенденцию к рецидиву деформации у больных с кВЛСКГ, мы предположили, что последовательное применение управляемого роста (гемиэпифизиодеза) после удлинения и коррекции деформации позволит повысить качество лечения данной группы пациентов.…”

“…Также хотелось бы остановиться на особенностях методики управляемого роста (гемиэпифизиодеза). Несмотря на крайне высокую популярность данного метода при лечении деформаций нижних конечностей у растущего ребенка на фоне разных заболеваний [11][12][13][14][15], мы не нашли какого-либо системного обзора применения данного метода у больных с деформациями на фоне консолидированного врожденного ложного сустава голени. В одной из публикаций p. Stevens [12], автора метода управляемого роста, в описании метода приведены рентгенограммы ребенка с консолидированным ложным суставом и применением гемиэпифизиодеза для коррекции вторичных деформаций.…”