The biomechanics of guided growth

Schoenleber, Scott J.; Iobst, Christopher; Baitner, Avi C.; Standard, Shawn C.

doi:10.1097/bpb.0000000000000026

Cited by 15 publications

(16 citation statements)

References 13 publications

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“…Based on this hypothesis, a faster correction should be expected when the tension band plate screws are prepositioned in divergence. In a biomechanical study by Schoenleber et al, 18 parallel screws achieved faster correction compared with divergent screws, seemingly contradicting the hypothesis suggested in the Burghardt et al 17 study.…”

Section: Introductionmentioning

confidence: 83%

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Hemiepiphysiodesis using tension band plates: Does the initial screw angle influence the rate of correction?

Eltayeby

Iobst

Herzenberg

2019

Journal of Children's Orthopaedics

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Purpose When using tension band plates for angular deformity correction, the literature is unclear regarding the most effective screw insertion angle to use. This study evaluates the correlation between initial screw angle and the average rate of correction during hemiepiphysiodesis using tension band plates Methods This retrospective study includes 35 patients (47 physes) with genu valgum deformity (17 idiopathic and 18 fibular hemimelia) who underwent insertion of Eight-Plates between 2010 and 2015. Initial screw angle was determined from the intraoperative fluoroscopic images. Radiographs were obtained within three months of surgery, and follow-up films were obtained every three to six months. Change in mechanical lateral distal femoral angle, medial proximal tibial angle and screw angle was obtained from each follow-up radiograph. Initial screw angle was correlated with the average rate of correction during the entire treatment period. The average rate of angular correction during first and last follow-up periods was also compared. Results The relationship between the initial screw angle and the mean rate of angular correction was not statistically significant (p = 0.2). The rate of angular correction during the first follow-up period (mean of 4.7 months) was 0.86° per month compared with 0.71° per month during the last follow-up period (mean of 5.1 months). Conclusion Application of a tension band plate with a divergence angle ranging from 0° to 30° results in similar rates of angular correction. For surgeons inserting screw-plate tension band devices, there does not seem to be any necessity to make the screws parallel or divergent. We recommend that screw placement be anatomically correct, i.e. not impinging on the physis, rather than favouring any particular divergence angle. Level of evidence IV

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Section: Introductionmentioning

confidence: 83%

“…The biomechanical study by Schoenleber et al 18 investigated the influence of screw configuration on angular correction. The authors used a plastic bone model of angular correction using an Eight-Plate with different screw angles: parallel, divergent and hyper divergent screws.…”

Section: Discussionmentioning

confidence: 99%

Hemiepiphysiodesis using tension band plates: Does the initial screw angle influence the rate of correction?

Eltayeby

Iobst

Herzenberg

2019

Journal of Children's Orthopaedics

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“…Burghardt et al [ 15 ] suggested that the rate of correction is slower when the screws are initially inserted in parallel, and the correction accelerates when the screws become more divergent as growth progresses. In contrast, Schoenleber et al [ 16 ] demonstrated in a biomechanical study that initial parallel screw positioning results in faster correction compared to divergent screws. Eltayeby et al [ 17 ] showed that the initial screw angle ranging from parallel to 30° in divergence had no significant effect on the speed of correction during hemiepiphysiodesis.…”

Section: Discussionmentioning

confidence: 98%

Factors for Prolonged Pain and Restriction of Movement Following Hemiepiphysiodesis Plating for the Correction of Lower Limb Malalignment in the Frontal Plane: An Explorative Analysis

et al. 2023

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The correction of valgus leg malalignment in children using implant-mediated growth guidance is widely used and effective. Despite the minimal invasive character of the procedure, a relevant number of patients sustain prolonged pain and limited mobility after temporary hemiepiphysiodesis. Our aim was to investigate implant-associated risk factors (such as implant position and screw angulation), surgical- or anesthesia-related risk factors (such as type of anesthesia, use, and duration), and pressure of tourniquet or duration of surgery for these complications. Thirty-four skeletally immature patients with idiopathic valgus deformities undergoing hemiepiphysiodesis plating from October 2018–July 2022 were enrolled in this retrospective study. Participants were divided into groups with and without prolonged complications (persistent pain, limited mobility of the operated knee between five weeks and six months) after surgery. Twenty-two patients (65%) had no notable complications, while twelve patients (35%) had prolonged complications. Both groups differed significantly in plate position relative to physis (p = 0.049). In addition, both groups showed significant differences in the distribution of implant location (p = 0.016). Group 1 had a shorter duration of surgery than group 2 (32 min vs. 38 min, p = 0.032) and a lower tourniquet pressure (250 mmHg vs. 270 mmHg, p = 0.019). In conclusion, simultaneous plate implantation at the femur and tibia and metaphyseal plate positioning resulted in prolonged pain and a delay of function. In addition, the amplitude of tourniquet pressure or duration of surgery could play a factor.

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“…There is some controversy about the optimum position for screws in guided growth. At least one study argues for initial parallel placement [ 16 ]. However, on a practical note, it is not always possible to anatomically get the screws parallel as the growth plate is undulating, and the surface of the bone is sloped.…”

Section: Discussionmentioning

confidence: 99%

Solid screw insertion for tension band plates: A surgical technique tip

Kadhim

Hammouda

Herzenberg

2016

Journal of Children's Orthopaedics

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PurposeGrowth modulation with tension band plates (TBPs) and cannulated screws is the current mainstay of treatment for pediatric lower extremity angular deformities. Solid screws have been used as an alternative to cannulated screws to decrease the risk of screw failure, particularly in obese children. The downside of solid screws is the decrease in precision of placement. This study describes a surgical technique to insert solid TBP screws accurately.MethodsTBP insertion starts with the same conventional steps by inserting the guidewires into the epiphysis and metaphysis, straddling the physis. After fluoroscopic confirmation of the position of the guidewires, the cannulated drill bit is used to broach the cortex to a depth of 5 mm in the bone. A standard 4.5-mm cannulated screw from the TBP set is used to tap the screw tract over the guidewires for approximately three-quarters of the planned screw length. After removing the guidewires, the solid screws are then inserted in each hole to follow the tapped tracts.ResultsThis technique was used in five patients including four with Blount disease and one with bilateral genu varum.ConclusionIt is recommended to use solid screws with TBPs in patients with a high body mass index to avoid screw fracture. Our technique describes using a cannulated screw as a tap to create a tract to ease accurate insertion of the solid screws, and prevent the solid screw from deviating outside the desired path.

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The biomechanics of guided growth

Cited by 15 publications

References 13 publications

Hemiepiphysiodesis using tension band plates: Does the initial screw angle influence the rate of correction?

Hemiepiphysiodesis using tension band plates: Does the initial screw angle influence the rate of correction?

Factors for Prolonged Pain and Restriction of Movement Following Hemiepiphysiodesis Plating for the Correction of Lower Limb Malalignment in the Frontal Plane: An Explorative Analysis

Solid screw insertion for tension band plates: A surgical technique tip

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