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

Dodwell, Emily; Garner, Matthew R.; Bixby, Elise C.; Luderowski, Eva; Green, Daniel W.; Blanco, John S.; Widmann, Roger F.

doi:10.1007/s11420-017-9549-5

Cited by 16 publications

(24 citation statements)

References 25 publications

(54 reference statements)

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“…Unfortunately, we did not record our patients' BMI; however, in agreement with other experiences in ATV [9,25], we did not have implant failure. Dodwell et al [30] described four broken implants in 82 patients treated for leg length discrepancy that occurred 2-3 years after implantation. Normandin et al [31] described four cases of screw bending when using 4.0 mm screws; the technique was parallel placement for ankle valgus and knee flexion.…”

Section: Resultsmentioning

confidence: 99%

Percutaneous hemiepiphysiodesis using transphyseal screws for adolescent tibia vara

Braga

Akkari

Waisberg

et al. 2021

Journal of Pediatric Orthopaedics B

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Hemiepiphysiodesis around the knee is becoming the mainstay procedure in adolescents for a wide range of aetiological deformities, when considering adolescent tibia vara (ATV), the published series have variable results. The purpose of this study was to review our experience with the percutaneous transphyseal screw (PETS) in these patients followed until bone maturity. We analysed the charts from 13 patients (20 knees) that underwent lateral tibial hemiepiphysiodesis using PETS. The radiographs were accessed before surgery, at implant removal, when occurred, and at the final follow-up. The clinical evaluation noted if there were complaints regarding pain or range of motion, and the radiographic assessment included: the femorotibial angle, the mechanical axis zone, the anatomic lateral distal femoral angle, and medial mechanical proximal tibial angle. There was one overcorrection, and after the screw removal (14 knees), rebound was observed in two knees modifying the result from excellent to good in all three knees. No bone bars and no implant breakage were observed. At the last appointment, all patients had normal knee range of motion, and two patients had unilateral alignment complaints, one of whom referred to occasional pain. Overall, the surgery was excellent in 12 knees (60%), good in six knees (30%), and poor in two knees (10%). This technique is indicated to be well tolerated and effective for treating ATV. When a complete correction cannot be obtained, in our opinion, it is advantageous to at least stabilise the deformity and postpone osteotomies until after skeletal maturity. Level of Evidence: Level IV -Case Series, Therapeutic Study. J

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Section: Resultsmentioning

confidence: 99%

Percutaneous hemiepiphysiodesis using transphyseal screws for adolescent tibia vara

Braga

Akkari

Waisberg

et al. 2021

Journal of Pediatric Orthopaedics B

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“…However, axial deviations were still encountered in 8.5% of the 59 patients. Dodwell et al 21 reported high efficacy and low complication rate of PETS, with four (4.9%) of 81 cases developing angulation change ≥ 5°.…”

Section: Discussionmentioning

confidence: 99%

Tension band plates have greater risks of complications in temporary epiphysiodesis

Cheng

Lee

Tsai

et al. 2021

Journal of Children's Orthopaedics

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Purpose This study aimed to compare the efficacy of decreasing leg-length discrepancy (LLD) and postoperative complications between tension band plates (TBP) and percutaneous transphyseal screws (PETS). Methods This retrospective study reviewed LLD patients who underwent temporary epiphysiodesis at the distal femur and/or proximal tibia from 2010 to 2017 (minimum two years follow-up). Efficacy of decreasing LLD was assessed one and two years postoperatively. Complications were classified with the modified Clavien-Dindo-Sink complication classification system. Knee deformities were assessed by percentile and zone of mechanical axis across the tibial plateau. Results In total, 53 patients (25 boys, 28 girls) underwent temporary epiphysiodesis (mean age, 11.4 years). The efficacy of decreasing LLD at two years between the TBP (n = 38) and PETS (n = 15) groups was comparable. Seven grade III complications were recorded in six TBP patients and in one PETS patient who underwent revision surgeries for knee deformities and physis impingement. Four grade I and two grade II complications occurred in the TBP group. The mechanical axis of the leg shifted laterally in the PETS group and medially in the TBP groups (+7.1 percentile versus -4.2 percentile; p < 0.05). Shifting of the mechanical axis by two zones was noted medially in four TBP patients and laterally in two PETS patients. Conclusion More implant-related complications and revision surgeries for angular deformities were associated with TBP. A tendency of varus and valgus deformity after epiphysiodesis using TBP and PETS was observed, respectively. Patients and families should be informed of the risks and regular postoperative follow-up is recommended. Level of evidence Level III

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“…13 The PETS cohort in this population demonstrated a lower rehabilitation time (1.4 months versus 2.4 months) in similar fashion to the literature. Moreover, Dodwell et al 6 argued that complications related to the PETS technique such as revisions may be overstated, and occur less frequently than the established literature may suggest. At our institution, the current protocol allows early weight-bearing as tolerated in patients who have PETS.…”

Section: Discussionmentioning

confidence: 99%

A comparison of screw versus drill and curettage epiphysiodesis to correct leg-length discrepancy

Troy

Shore

Miller

et al. 2018

Journal of Children's Orthopaedics

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Abstract:PurposeTo compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) versus cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates.MethodsA retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted. Characteristics including age at surgery, gender, epiphysiodesis location, side, operative time, LOS and hardware removal were compared across treatment groups. LLD, expected growth remaining (EGR) and bone age were determined preoperatively and at most-recent visit. The correction ratio (change in EGR) was calculated along with a 95% confidence interval (CI) to assess if correction in leg length was achieved.ResultsA total of 115 patients underwent epiphysiodesis in the femur (53%), tibia (24%) or a combination (24%). The cohort was 47% male, with a mean age of 12.6 years (7.7 to 17.7) at surgery. Median follow-up was 3.7 years (2.0 to 12.7). In all, 23 patients underwent PETS and 92 patients had PDED. Both treatment groups achieved expected LLD correction. There was no significant difference in median operative time, complication rates or LOS. PETS patients returned to activity at a mean 1.4 months (interquartile range (IQR) 0.7 to 2.1) while PDED patients returned at a mean 2.4 months (IQR 1.7 to 3) (p < 0.001).ConclusionEffectiveness in achieving expected correction, LOS and operative time are similar between screw and drill/curettage epiphysiodesis. Patients undergoing PETS demonstrated a faster return to baseline activity than patients with PDED.Level of Evidence:III

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

Abstract: The efficacy of PETS may be more favorable than previously reported. Only 3.7% had serious complications requiring revision epiphysiodesis, lower than previous reports. Attention to sufficient screw threads across the physis may be important in optimizing PETS results.

Cited by 16 publications

References 25 publications

Percutaneous hemiepiphysiodesis using transphyseal screws for adolescent tibia vara

Percutaneous hemiepiphysiodesis using transphyseal screws for adolescent tibia vara

Tension band plates have greater risks of complications in temporary epiphysiodesis

A comparison of screw versus drill and curettage epiphysiodesis to correct leg-length discrepancy

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