Tension-band Plating for Leg-length Discrepancy Correction

Abstract

A bstract Aim Dual tension-band plates are used for temporary epiphysiodesis and longitudinal guided growth. The study aim was to assess rate of correction, to identify development of femoral and tibial intra-articular deformity during correction and to document resumption of growth after plate removal. Materials and methods A retrospective study of 34 consecutive patients treated with dual tension-band plates between 2012 and 2020 was performed. Twenty-four patients had surgery at the distal femur, six at the proximal tibia and four at both. Twenty-five female patients were treated at a mean age of 11.6 (±1.4) years and nine male patients at 13.5 (±1.5) years. Measurements were performed on standardised long-leg radiographs and included leg-length discrepancy (LLD), joint line congruency angle (JLCA), tibial roof angle, femoral floor angle and notch-intercondylar distance. Measurements were taken pre-operatively, at the end of discrepancy correction and at skeletal maturity. Results The LLD reduced by a mean of 12.9 mm (95% CI 10.2–15.5) with the mean residual difference 8.4 mm (95% CI 5.4–11.4). The mean correction rate for the proximal tibia was 0.40 (SD 0.33) mm/month and 0.68 (SD 0.36) mm/month for the distal femur. A significant mean change in residual LLD [−2.5 mm (95% CI −4.2 to −0.7)] was observed between plate removal and skeletal maturity at the femoral level only. After length discrepancy correction, the tibial roof angle showed a significant difference of 8.4° (95% CI 13.4–3.4) between legs. In femoral epiphysiodesis patients, no important differences were observed. Conclusion A significant reduction in LLD can be achieved using dual tension-band plating. A change in intra-articular morphology was observed only in the proximal tibia and not in the distal femur. In the authors’ opinion, tension-band plating is a useful tool for leg-length equalisation but should be reserved for younger patients or when residual growth is difficult to predict. It is one of the management strategies for limb-length difference prior to skeletal maturity. How to cite this article Tolk JJ, Merchant R, Calder PR, et al . Tension-band Plating for Leg-length Discrepancy Correction. Strategies Trauma Limb Reconstr 2022;17(1):19–25.

Physeal Migration During Knee-guided Growth With Tension Band Plates: Influence of Implant Position

“…We believe that the more acute plate orientation angle with respect to the physis derives from the more convergent epiphyseal and more divergent metaphyseal screw placement. Although it seems logical that the use of shorter screws might increase the risk of physeal migration, 2 we found no significant differences in screw length between cases and controls, and therefore consider that all screws were of sufficient length.…”

“…Oda and Thacker 13 described a case of a physeal bar in the distal tibia after physeal migration. Joeris et al 14 recommended immediate measures when a physeal migration was detected, such as changing or modifying the screws to prevent partial or complete closure of the physis, and other authors propose definitive ablation of the physis to prevent secondary angular deformity during screw removal 2 . The possible explanation for this absence of physeal injuries lies in the fact that it is a slow process, which allows the physis to adapt during migration; an additional factor in our study may be that many patients were close to skeletal maturity, leaving insufficient time to cause alterations.…”

“…G uided growth allows gradual correction of coronal and sagittal plane deformities in children and can improve limb-length discrepancies by arresting physeal growth using different types of implants and harnessing the growth potential of the remaining physis. 1,2 The tension band plate (TBP) system, developed by Stevens 3 in 2007, is based on the biomechanical principle by which a tether is created in the periphery of the physis using a plate and 2 screws, thus acting as a tension band to halt growth. 4 The knee is the most common location in which the technique is used, although TBP has also been placed in other locations.…”

Limb length deceleration or coronal plane deformity correction using tension band plates: does plate configurations determine the intraarticular deformity of proximal tibia?

“…Following this report, there had been much speculation about use of tension band plates for LLD. Another research from United Kingdom by Tolk et al [5], took up study of 34 patients (28 femoral and 10 tibial physis) with LLD managed with tension band plates. The plates were inserted at a mean age 12.1 years and follow up was 22 months for tibial plates.…”

“…There is ample controversy whether this alteration of tibial morphology is indeed happening [2][3][4][5]. Sinha et al [2] brought attention to this complication in their study based on 42 children (64 plates).…”