Abstract:Background In children with angulating deformities of the lower limbs, hemiepiphysiodesis can be used to guide growth to achieve better alignment at skeletal maturity. Traditionally, this has been performed with staples. The tension-band plating technique is new and it has been advocated because it is believed to reduce the risk of premature closure of the growth plate compared to stapling. The benefit of the tension-band plating technique has not yet been proven in experimental or randomized clinical studies.… Show more
“…Limb length discrepancy of more than 1 cm was seen in three cases in the staple group and two cases in the eight plate group. This has not been described in previous studies [ 14 – 16 ]. There was no case of sagittal plane deformity (flexion deformity or recurvatum deformity) in either group.…”
Section: Discussioncontrasting
confidence: 56%
“…In our study also, we had maintained this wide range (3.5–12 years in the staples group and 4–12 years in the eight plate group). To the best of our knowledge, only three previous studies have compared the results of staples with eight plate [ 14 – 16 ]. These are summarized in Table 4 .…”
Section: Discussionmentioning
confidence: 99%
“…Eight plates have been shown to have fewer complications [ 9 , 13 ]. Although costlier, figure of eight plates are considered a better alternative to staples because of the fewer complications in comparative studies [ 14 – 16 ]. In this study, we have shared our experience with use of figure of eight plates (Orthofix) and staples (locally manufactured stainless steel staples) for the correction of coronal plane deformities around the knee joint.…”
PurposeTo compare two commonly used methods of temporary hemiepiphysiodesis (staples and figure of eight plate) in the management of coronal plane deformities of the knee in skeletally immature children.MethodsThis prospective study was conducted between November 2012 and November 2015. A total of 40 patients with 67 affected knee joints, having at least 1 year of skeletal growth remaining, were included in the study. Angular correction was measured by recording the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and anatomical tibio-femoral angle (TFA) (for the overall alignment of lower limbs). Implant removal was done after 5° of overcorrection was achieved. The rate of correction (° per month) and complications related to each technique were recorded.ResultsThe most common diagnosis was idiopathic genu valgum. The overall rate of correction (TFA) was 1.2° for staples and 1.4° for eight plate (p = 0.70, not statistically significant). The correction in mLDFA was statistically better in the eight plate group, whereas an opposite trend was recorded in mMPTA. Implant-related complications were present in two cases of the staples group.ConclusionAlthough the overall correction rate was similar in both groups, implant-related complications were lower with figure of eight plate. In idiopathic genu valgum (the most common diagnosis), the correction was statistically better in the eight plate group. We recommend figure of eight plate over staples in managing these deformities.
“…Limb length discrepancy of more than 1 cm was seen in three cases in the staple group and two cases in the eight plate group. This has not been described in previous studies [ 14 – 16 ]. There was no case of sagittal plane deformity (flexion deformity or recurvatum deformity) in either group.…”
Section: Discussioncontrasting
confidence: 56%
“…In our study also, we had maintained this wide range (3.5–12 years in the staples group and 4–12 years in the eight plate group). To the best of our knowledge, only three previous studies have compared the results of staples with eight plate [ 14 – 16 ]. These are summarized in Table 4 .…”
Section: Discussionmentioning
confidence: 99%
“…Eight plates have been shown to have fewer complications [ 9 , 13 ]. Although costlier, figure of eight plates are considered a better alternative to staples because of the fewer complications in comparative studies [ 14 – 16 ]. In this study, we have shared our experience with use of figure of eight plates (Orthofix) and staples (locally manufactured stainless steel staples) for the correction of coronal plane deformities around the knee joint.…”
PurposeTo compare two commonly used methods of temporary hemiepiphysiodesis (staples and figure of eight plate) in the management of coronal plane deformities of the knee in skeletally immature children.MethodsThis prospective study was conducted between November 2012 and November 2015. A total of 40 patients with 67 affected knee joints, having at least 1 year of skeletal growth remaining, were included in the study. Angular correction was measured by recording the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and anatomical tibio-femoral angle (TFA) (for the overall alignment of lower limbs). Implant removal was done after 5° of overcorrection was achieved. The rate of correction (° per month) and complications related to each technique were recorded.ResultsThe most common diagnosis was idiopathic genu valgum. The overall rate of correction (TFA) was 1.2° for staples and 1.4° for eight plate (p = 0.70, not statistically significant). The correction in mLDFA was statistically better in the eight plate group, whereas an opposite trend was recorded in mMPTA. Implant-related complications were present in two cases of the staples group.ConclusionAlthough the overall correction rate was similar in both groups, implant-related complications were lower with figure of eight plate. In idiopathic genu valgum (the most common diagnosis), the correction was statistically better in the eight plate group. We recommend figure of eight plate over staples in managing these deformities.
“…also found no difference in treatment times in patients inserted with either the tension band plate or the staple. 58 With regards to surgery time, Jelinek et al . noted that the time required for either insertion or removal of the tension band plate to be significantly shorter than staples.…”
Background:Guided growth through temporary hemiepiphysiodesis has gained acceptance as the preferred primary treatment in treating pediatric lower limb deformities as it is minimally invasive with a lesser morbidity than the traditional osteotomy. The tension band plate is the most recent development in implants used for temporary hemiepiphysiodesis. Our aim was to determine its safety and efficacy in correcting coronal plane deformities around the knee in children younger than 10 years.Materials and Methods:A total of 24 children under the age of 10 were operated for coronal plane deformities around the knee with a single extra periosteal tension band plate and two nonlocking screws. All the children had a pathological deformity for which a detailed preoperative work-up was carried out to ascertain the cause of the deformity and rule out physiological ones. The average age at hemiepiphysiodesis was 5 years 3 months (range: 2 years to 9 years 1 month).Results:The plates were inserted for an average of 15.625 months (range: 7 months to 29 months). All the patients showed improvement in the mechanical axis. Two patients showed partial correction. Two cases of screw loosening were observed. In the genu valgum group, the tibiofemoral angle improved from a preoperative mean of 19.89° valgus (range: 10° valgus to 40° valgus) to 5.72° valgus (range: 2° varus to 10° valgus). In patients with genu varum the tibiofemoral angle improved from a mean of 28.27° varus (range: 13° varus to 41° varus) to 1.59° valgus (range: 0-8° valgus).Conclusion:Temporary hemiepiphysiodesis through the application of the tension band plate is an effective method to correct coronal plane deformities around the knee with minimal complications. Its ease and accuracy of insertion has extended the indication of temporary hemiepiphysiodesis to patients younger than 10 years and across a wide variety of diagnosis including pathological physis, which were traditionally out of the purview of guided growth.
Objective: Our objective is to evaluate whether the use of guided growth with eight-plates is more effective than the use of Blount staples for the correction of the idiopathic genu varum or idiopathic genu valgum. Methods: A systematic review (SR) was carried out according to the appropriate methodology for randomized clinical trials (RCTs). We searched seven databases through a previously defined methodology, and we included RCTs, regardless of language, period of publication and status of publication. Results: Resulted in 6830 articles retrieved. Of theses, we identified 14 potential eligible studies. but just one RCT was included for the SR. The included RCT compares the eight-plate and the Blount staple and showed no statistically significant difference for the outcomes of time to correct the deformity, postoperative pain after 24 hours and postoperative pain after 72 hours. The study is of low or very low level of evidence to determine the most effective technique. We didn’t find a RCT that compared the correction of the genu varum. Conclusion: Good quality randomized clinical trials comparing Blount staples versus eight-plaque must be performed to determine which technique is superior for coronal plane corrections. Level of Evidence I, Systematic review of Level RCTs.
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