Percutaneous Epiphysiodesis Using Transphyseal Screws in the Management of Leg Length Discrepancy

Abstract

Level IV prognostic studies.

Percutaneous epiphysiodesis using transphyseal screws for limb-length discrepancies: High variability among growth predictor models

“…Although the three growth predictor methods were able to predict the final LLD between −0.1 and 1.4 cm, the large variability is concerning. Indeed, if PETS is reversible by removing the screws and allowing normal growth to resume as reported in two studies [ 7 , 17 ], it will resolve the shortcomings of the growth predictor methods, as they will no longer be needed.…”

“…Although crossed screws are more technically demanding to achieve precise placement, crossed screws may have less screw head prominence and decrease the risk of irritating the adjacent soft tissues. Song et al [ 17 ] treated 59 patients with PETS using crossed screws and reported no screw-related pain, infection, neurologic injury or hematoma. Three screws broke during attempted removal and the removal was abandoned in 2 others.…”

Percutaneous Epiphysiodesis Using Transphyseal Screws: a Case Series Demonstrating High Efficacy

“…Anteroposterior view (α) and lateral view (β) screw insertion angles were measured on intraoperative fluoroscopic images to calculate an overall screw insertion angle (δ) as described by Song et al (Fig. 2) [23]. For both the medial and lateral screws, the number of screw threads crossing the physis was counted.…”

“…PETS for epiphysiodesis has increased since its introduction in 1998 [16]. Efficacy (actual growth inhibition divided by expected growth inhibition) has been reported at 66-79% [14,23]. Some authors recommend treatment 6 months to 1 year before predicted optimal surgical timing to account for a hypothesized delay in growth arrest seen with this technique [14,23].…”

“…Efficacy (actual growth inhibition divided by expected growth inhibition) has been reported at 66-79% [14,23]. Some authors recommend treatment 6 months to 1 year before predicted optimal surgical timing to account for a hypothesized delay in growth arrest seen with this technique [14,23]. Complications including recurvatum, valgus deformities, and need for revision surgery are not uncommon, occurring in 18% of patients in one series [14,15].…”