The 8-plate versus physeal stapling for temporary hemiepiphyseodesis correcting genu valgum and genu varum: a retrospective analysis of thirty five patients

Abstract

Purpose In skeletally immature patients, treatment of malalignment about the knee is possible by performing temporary hemi-epiphyseodesis. Following the well-established procedure of physeal stapling, the 8-plate was introduced as a new device. The purpose of this study was to compare physeal stapling with 8-plate hemi-epiphyseodesis. We focused on evaluating deformity correction, complication rate and duration of the procedures. Methods We retrospectively analysed 35 patients (61 extremities, age 2.9-16.0 years) who were treated by temporary hemi-epiphyseodesis about the knee for correction of genu varum or genu valgum by using Blount staples (32 extremities) or the 8-plate (29 extremities). Plain radiographs were analysed at the time of operation and at hardware removal that included measurement of mechanical axis deviation, mechanical lateral distal femoral angle and mechanical medial proximal tibial angle. Time until hardware removal, operation time and complications were recorded. Results A statistically significant improvement of all radiographic measurements could be achieved with comparable results in both groups. Complications were similar in both groups with no relevant differences in amount and severity. In the 8-plate group, however, the surgical time was significantly shorter by an average of ten minutes for implantation and 12 minutes for explantation.Conclusions Both Blount stapling and the 8-plate technique are methods for correction of genu varum and valgum deformity in skeletally immature patients; however, a shorter operating time for implantation and explantation was noted for the 8-plate technique.

Growth Retardation (Hemiepiphyseal Stapling) and Growth Acceleration (Periosteal Resection) as a Method to Improve Guided Growth in a Lamb Model

“…15,18 Human studies where deformity is corrected are impossible to completely compare the benefit of each implant as a result of differences in growth plate disease, magnitude of deformity, body habitus, and differences in individual growth rates. Animal studies where deformity is produced are easier to compare as there is no deformity to begin with and one is able to control gross variables such as size of the limb and method of implantation.…”

“…[13][14][15][16][17][18] Human studies would be ideal for comparison, yet no prospective trials could be possible as it would be difficult to control for variables such as individual patient growth rates; variations in limb deformity (location and magnitude); the disease process that caused deformity; and differences in surgical methodology. Studies in smaller animals usually evaluate the deformity produced in only 1 plane and fail to account for the fact that guided growth produces a deformity that may not be fully characterized by a single radiograph.…”

Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling

“…The use of tension-band plating for guided growth has been the subject of several recent clinical papers (Stevens 2007, Burghardt et al 2008, Wiemann et al 2009, Burghardt and Herzenberg, 2010, Ballal et al 2010, Niethard et al 2010, Jelinek et al 2012). Faster correction was initially reported in 1 retrospective study when using tension-band plating compared to stapling (Stevens 2007).…”

Post-operative delay in return of function following guided growth tension plating and use of corrective physical therapy

“…The Eight-Plate ® is designed as a “tension-band,” unlike the compressive force provided by the staple, and thus allows for a lower risk of physeal fusion. The rigid screws make the device more resistant to extrusion unlike the smooth staples, and a longer moment arm should lead to a faster correction [1, 8, 9]. …”