Percutaneous vs Modified Phemister Epiphysiodesis of the Lower Extremity

Scott, Allison M.; Urquhart, Bradford A.; Cain, Thomas E.

doi:10.3928/0147-7447-19961001-07

Cited by 30 publications

(8 citation statements)

References 13 publications

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“…Several surgical procedures have been described for treating mild leg length discrepancy (LLD) [1][2][3][4][5][6][7], all of which have the disadvantage of being more or less irreversible, accomplishing total physeal arrest. The outcome of physiodesis with irreversible methods depends on correctly estimating the age of maturity and the final LLD or leg length.…”

Section: Introductionmentioning

confidence: 99%

Eight plate should not be used for treating leg length discrepancy

Lauge-Pedersen

Hägglund

2013

Journal of Children's Orthopaedics

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Purpose The Blount staple has been widely used for treating angular deformities and leg length discrepancy (LLD) of the lower limbs. In recent years, the Eight plate has replaced the Blount staple for treating angular deformities in many centres. Although not described in the literature, it has been proposed that the Eight plate could also be used for treating LLD. We studied the effectiveness of the device for this indication. Methods Ten patients with LLD were included prospectively. Medial and lateral plates were inserted for symmetrical growth reduction and the patients were followed by radiostereometric analysis (RSA) 0, 3, 6, 9, 12, 24, 52 and 80 weeks postoperatively. The error of measurement with this technique is less than 0.05 mm. Results Case 1 continued to grow an average of 0.08 mm per week (6.7 mm longitudinal growth in 1.5 years) postoperatively, while Case 2 showed 0.07 mm longitudinal growth per week (5.6 mm longitudinal growth in 1.5 years). The longitudinal growth, in both children, showed only slight growth retardation throughout the follow-up period. The study was interrupted and no further subjects were included after the results indicated that only minor growth reduction had occurred in both patients. Conclusion The Eight plate does not significantly reduce growth when applied both medially and laterally in a symmetrical way at the proximal tibial physis.

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Section: Introductionmentioning

confidence: 99%

Eight plate should not be used for treating leg length discrepancy

Lauge-Pedersen

Hägglund

2013

Journal of Children's Orthopaedics

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“…Follow-up until skeletal maturity is essential to monitor for recurrence as the failure rate of lateral epiphysiodesis is between 12 and 15%. 32 …”

Section: Discussionmentioning

confidence: 99%

Gradual Deformity Correction with a Computer-assisted Hexapod External Fixator in Blount's Disease

Maré¹,

Marais²

2022

Strategies in Trauma and Limb Reconstruction

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A bstract Aim To evaluate the results in terms of correction and complications from gradual correction with a computer-assisted hexapod circular external fixator in a mixed cohort of children with Blount's disease. Materials and methods A retrospective review was performed of the correction and complications of 19 children (25 limbs) with recurrent infantile (IBD) and late-onset Blount's disease (LOBD) treated by gradual correction with a hexapod external fixator. The correction was measured by the medial proximal tibial angle (MPTA), anatomic posterior proximal tibial angle (aPPTA) and anatomic tibio-femoral angle (TFA). Obesity was present in 76% (19/25) of cases. Fifteen limbs were classified as infantile Blount's disease and 10 limbs as late-onset Blount's disease. The mean age was 12.5 years (range 7–17 years). Results The mean pre-operative MPTA of 59° (SD 13°, range 33–79°) was corrected to a mean of 86° (SD 5°, range 77–93°). The mean pre-operative aPPTA of 64° (SD 14°, range 33–84°) was corrected to 79° (SD 6°, range 70–90°). The median pre-operative rotation of 15° internal rotation was corrected to normal (0–15° of external rotation). Eight out of 25 limbs had severe deformities with varus or procurvatum greater than 40° or both. The mean pre-operative TFA of 28° varus (SD 13°, range 4–53°) was corrected to 1.8° valgus (SD 6°, range 14° varus to 13° valgus). The median follow-up was 19 months (range 6–67 months). The alignment after correction was “good” in 55% (11/20), “acceptable” in 35% (7/20) and “poor” in 10% (2/20). The median duration for correction was 16 days (IQR 11–31 days, range 7–71 days). The median number of prescribed correction programmes was 1 (IQR 1–2, range 1–5). The mean total time in the frame was 136 days (SD 34 days, range 85–201 days). All patients developed minor pin track infections that resolved with oral antibiotics (Category 1 complications). Four patients developed complications that necessitated modification of the treatment plan (Category 2 complications). In two cases, treatment objectives could not be achieved (Category 3 complications). Two patients treated before skeletal maturity developed recurrent genu varum. Conclusion Gradual correction with a computer-assisted hexapod external fixator may be a useful technique for correcting recurrent IBD or LOBD even in children with severe deformities. The results of gradual correction were similar in the two groups. While complications occur, most can be mitigated by timely intervention during the correction phase of treatment. Recurrence remains a concern if correction is performed before skeletal maturity. Level of evidence 4. How to cite this article Mare PH, Marais LC. Gradual Deformity Correction with a Computer-assisted Hexapod External Fixator in Blount's Disease. Strategies Trauma Limb Reconstr 2022;17(1):32...

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“…However, failure to achieve fusion of the operated physis has been described. Scott et al [17] found three failures of the epiphysiodesis in 20 patients, and Surdam et al [18] reported two failures in 56 patients. Both single-portal and double-portal techniques for percutaneous epiphysiodesis have been described.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous epiphysiodesis in the proximal tibia by a single-portal approach: Evaluation by radiostereometric analysis

Horn

Gunderson

Wensaas

et al. 2013

Journal of Children's Orthopaedics

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Purpose We modified the method for tibial epiphysiodesis by solely using a lateral approach to the physis. From this small-incision approach, the lateral as well as the medial part of the tibial physis were ablated. The aim of our study was to see if this operative technique might be as effective as a bilateral approach, and reduce the operation time and usage time of the image intensifier. The epiphysiodeses were monitored by radiostereometric analysis (RSA), which is a well-established method for the analysis of micro movements and has been used to monitor percutaneous epiphysiodesis with the bilateral approach. There are no reports in the literature comparing single-with double-portal approaches for percutaneous epiphysiodesis evaluated by RSA. Methods Twenty children were treated by percutaneous epiphysiodesis for leg length discrepancies ranging from 15 to 70 mm, comprising 14 boys and 6 girls with a mean age of 13 (11-15) years. The timing of epiphysiodesis was determined by using Moseley's straight-line graph and Paley's multiplier method. For the tibial epiphysiodesis, ten patients were operated with a single surgical approach from the lateral side (Group I) and ten patients were operated with a surgical approach from both the medial and the lateral sides (Group II). The percutaneous epiphysiodesis was monitored by RSA, a method which allows analysis of the three-dimensional dynamics of the epiphysis relative to the metaphysics. RSA examinations were performed postoperatively and after 6 weeks, 12 weeks, and 6 months.Results From 0 to 6 weeks after epiphysiodesis, the mean longitudinal growth across the operated physis in the tibia in Group I was 0.26 (0.01-0.6) mm. In Group II, the mean growth for the first 6 weeks after surgery was 0.17 (0.01-0.5) mm. During the time period from 6 weeks to 12 weeks after surgery, there was a mean growth of 0.06 (0.00-0.18) mm in Group I and 0.03 (0.00-0.2) mm in Group II. The mean growth from 0 to 6 weeks after epiphysiodesis for all patients was 0.22 mm, which corresponds to 30 % of the normal growth rate. From 6 to 12 weeks, the mean growth for all patients was 0.046 mm, i.e., 6 % of the normal growth rate. From 12 weeks to 24 weeks, no significant growth across the operated physis was observed in neither Group I nor Group II. The mean surgical time was 26 (21-30) min in Conclusions In our study, a single-portal technique from the lateral side for percutaneous epiphysiodesis of the proximal tibia was as effective as the double-portal technique. Actual growth arrest appeared within 12 weeks after surgery. A single-portal technique for epiphysiodesis of the tibia is a safe technique, with less surgical time and less time for image intensification compared to the doubleportal technique.

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Percutaneous vs Modified Phemister Epiphysiodesis of the Lower Extremity

Cited by 30 publications

References 13 publications

Eight plate should not be used for treating leg length discrepancy

Eight plate should not be used for treating leg length discrepancy

Gradual Deformity Correction with a Computer-assisted Hexapod External Fixator in Blount's Disease

Percutaneous epiphysiodesis in the proximal tibia by a single-portal approach: Evaluation by radiostereometric analysis

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