Outcomes of Temporary Hemiepiphyseal Stapling for Correcting Genu Valgum in Children with Multiple Osteochondromas: A Single Institution Study

Abstract

Background: Multiple osteochondromas is a rare skeletal disorder characterized by the presence of osteocartilaginous protrusions causing bony deformities, especially around the knee. Guided growth by temporary hemiepiphyseal stapling is the treatment of choice to correct the deformity by modulating the residual physeal growth of the lower limbs. Although this procedure is increasingly practiced, inconclusive evidence exists regarding its effectiveness in children with multiple osteochondromas. The study aims to compare the outcomes of temporary hemiepiphyseal stapling for correcting genu valgum in children with multiple osteochondromas vs. idiopathic cases. Methods: In this retrospective cohort study, we included patients admitted at a single institution from 2008 to 2018. A total of 97 children (77 idiopathic, 20 multiple osteochondromas) were enclosed, accounting for 184 limbs treated by temporary hemiepiphyseal stapling. We investigated if children with multiple osteochondromas had a similar successful rate of correction, rate of complications, and correction velocity compared to children with idiopathic genu valgum. Results: Overall, 151 limbs (82%) achieved complete correction or overcorrection, with idiopathic cases having a significantly higher rate of success compared to pathologic cases (88% vs. 55%; p < 0.001). In addition, multiple osteochondromas children sustained a higher rate of major complications (p = 0.021) and showed significantly lower correction velocity (p = 0.029). Conclusion: Temporary hemiepiphyseal stapling is effective in both idiopathic and multiple osteochondromas children, although the latter often achieved incomplete correction, had a higher risk of complications, and required a longer time of stapling. We suggest to anticipate the timing of intervention; otherwise, children with multiple osteochondromas and severe valgus deformity, approaching skeletal maturity, could undergo combined femoral and tibial stapling.

Hemiepiphysiodesis for Genu Valgum in Patients With Multiple Hereditary Exostoses

“…Prior reported complication rates-including rebound valgus deformity after hemiepiphysiodesis plate or staple removal, overcorrection, and infection-have approached 30% in the literature after guided growth for patients with MHE. 9 In this study, there were no surgical site infections or hardware migration or malpositioning. However, 1 patient required subsequent proximal femoral osteotomy for a concomitant valgus proximal femur deformity, and 14% of patients experienced overcorrection past neutral of ≥ 5 degrees, in line with the prior rates of complications for this population.…”

“…Two past papers on this topic have reported successful outcomes, but overall there is a slower rate of correction and a higher frequency of overcorrection for patients with MHE. 8,9 However, matching was not performed in the study by Trisolino and colleagues, and in both articles, there were significant differences in the site of guided growth, with the study by Kang and colleagues reporting that 80% of patients with MHE underwent proximal tibial-guided growth compared with 49% in the idiopathic population. There are known differences in physeal growth rates for these 2 regions of interest that make accurate comparison of anatomic regions important, with an estimated 9 and 6 mm of annual growth for the distal femur and proximal tibial physes, respectively.…”

“…Prior small case reports in this patient population have demonstrated successful outcomes when using guided growth to correct hip, 5 knee, 6 and ankle 7 malalignment. However, the degree to which deformities can be corrected, the appropriate length of treatment, and comparison to a normative, idiopathic malalignment population are lacking 8,9 . This study sought to demonstrate the expected correction with deformity about the knee for MHE patients with genu valgum and compare this to an idiopathic genu valgum population.…”

“…population are lacking. 8,9 This study sought to demonstrate the expected correction with deformity about the knee for MHE patients with genu valgum and compare this to an idiopathic genu valgum population.…”

Outcomes of Eight‐Plate Epiphysiodesis for Residual Clubfoot Deformities

“…However, the bony deformity in children could also be corrected by manipulating the growth behavior of an open physis. Guided growth for angular correction was first introduced by Stevens when he reported on the use of hemiepiphysiodesis with tension band plating technique to correct deformities in growing children 19 , and it has become a mature method to correct frontal plane deformities around the knee in many studies 20 , 21 , 22 .…”