Temporary hemiepiphysiodesis with the eight-Plate for angular deformities: mid-term results (original) (raw)
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Growth Modulation in Children for Angular Deformity Correction around knee – Use of Eight Plate
Background: Angular deformities around the knee joint in skeletally immature children are treated with methods of reversible hemiepiphysiodesis like staples, transphyseal screw and eight plate. Hemiepiphysiodesis using Eight plate has showed good results with advantage being faster correction, less complications and can be used in younger age. Methods: The aim of this retrospective study is show the efficacy of eight plate application and its complication rate. Nineteen patients (37 physes) (unilateral: 3; bilateral: 16) with angular deformity were treated with eightplate application. Seven with pathological physes and twelve with idiopathic physes. Outcome assessment was done clinically with calculation of intermalleolar /intercondylar distance and radiologicaaly with mechanical and anatomical axis. Correction achieved was considered when anatomical/mechanical axis were within normal limits and intermalleolar/intercondylar distance was less than 5 cm. Results: The average age of in...
Journal of Children's Orthopaedics, 2008
Purpose Traditionally, angular deformities are treated by means of osteotomy. In patients who are skeletally immature, this major intervention can be avoided by influencing or guiding the growth of the affected physis. Recently, a new device was presented as an alternative to the widely used Blount staple. Stevens developed a technique using a two-hole, non-locking plate with two screws to perform temporary hemiepiphysiodesis in children. We studied the effectiveness of this new device in correcting angular deformities in children even younger than 5 years of age. Methods We evaluated our first series of 11 patients (17 eight-Plates) who underwent treatment for angular deformities of various origins and were followed to completion of correction. The average age at hemiepiphysiodesis was 10 years and 2 months (age range 4 years and 11 months-13 years and 8 months). The device was inserted in the lateral distal femur (two cases), the medial distal femur (eight cases), the lateral proximal tibia (two cases), the medial proximal tibia (four cases), and the medial distal tibia (one case). Results The eight-Plate was inserted for an average of 9.5 months (range 5-13 months). The joint orientation angles and the mechanical axis improved in all patients, with the exception of one 13-year and 8-month-old boy with a resected osteosarcoma and a compromised growth plate. In valgus cases (12 limbs, 13 eight-Plates), the mechanical axis deviation improved by an average of 30.7 mm (range 13-55 mm). In varus cases (four limbs, four eight-Plates), the mechanical axis deviation improved by an average of 38.8 mm (range 0-74 mm). No hardware failures, extrusion, growth arrest, or other complications were observed. None of our patients required an osteotomy or repeat eight-Plate insertion. Conclusions We consider the eight-Plate to be an ideal tool for treatment of angular deformities in growing children. It allows for precise insertion and is reliable. It is also less likely to extrude like the Blount staple.
Correction of Lower Extremity Angular Deformities in Skeletal Dysplasia With Hemiepiphysiodesis
Journal of Pediatric Orthopaedics, 2014
Background: Lower extremity angular deformities are common in children with skeletal dysplasia and can be treated with various surgical options. Both acute correction by osteotomy with internal fixation and gradual correction by external fixation have been used with acceptable results. Recently, the Guided Growth concept using temporary hemiepiphysiodesis for correction of angular deformities in the growing child has been proposed. This study presents the results of temporary hemiepiphysiodesis using eight-Plates and medial malleolus transphyseal screws in children with skeletal dysplasia with lower extremity angular deformities. Methods: Twenty-nine patients (50 lower extremities) with skeletal dysplasia of different types were treated for varus or valgus deformities at 2 centers. The mean age at the time of hemiepiphysiodesis was 10 ± 2.9 years. A total of 66 eight-Plates and 12 medial malleolus screws were used. The average follow-up time between the index surgery and the latest followup with the eight-Plate in was 25 ± 13.4 months. Erect longstanding anteroposterior and lateral view radiographs were obtained for deformity planning before the procedure. Angular deformities on radiograph were evaluated by mechanical axis deviation, mechanical lateral distal femoral angle, medial proximal tibial angle, and lateral distal tibial angle. Mechanical axis deviation was also expressed as a percentage to one half of the width of the tibial plateau, and the magnitude of the deformity was classified by determining the zones through which the mechanical axis of the lower extremity passed. Four zones were determined on both the medial and lateral side of the knee and the zones were labeled 1, 2, 3, and 4, corresponding to the severity of the deformity. A positive value was assigned for valgus alignment and a negative for varus alignment. Results: Patients were analyzed in valgus and varus groups. There was correction in 34 of 38 valgus legs and 7 of 12 varus legs. In the valgus group, the mean preoperative and postoperative mechanical lateral distal femoral angles were 82.1 ± 3.7 and 91.1 ± 4.9 degrees, respectively (P < 0.001). The mean preoperative and postoperative medial proximal tibial angles were 98.5 ± 8 and 87.8 ± 7.1 degrees, respectively (P < 0.001). Six patients with bilateral ankle valgus deformities (12 ankles) underwent single-screw medial malleolus hemiepiphysiodesis. The mean preoperative and postoperative lateral distal tibial angles were 73.9 ± 8.7 and 86.1 ± 6.8 degrees, respectively (P < 0.001). The numbers of plates in each anatomic location were not enough to make statistical conclusions in varus legs. Four patients in the valgus group and 3 patients in the varus group did not benefit from the procedure. Mechanical axes were in zone 2 or over in 94% of the legs preoperatively, whereas postoperatively, only 23% of the legs had mechanical axes in zone 2 or over in varus and valgus groups. Conclusions: Growth modulation with an eight-Plate is a relatively simple surgery and has low risk of mechanical failure or physeal damage. It can be performed in very young patients, which is an important advantage in skeletal dysplasia. Screw purchase is reliable even in the abnormal epiphysis and metaphysis. Our results show that Guided Growth using eight-Plates in skeletal dysplasia is safe and effective. Level of Evidence: Level IV.
Insertion of One-third Tubular Plate for Hemiepiphysiodesis in Children: Surgical Technique
Texila International Journal of Academic Research, 2023
Limb length discrepancy and angular deformities are among the main issues in paediatric patients. There are various ways to manage these two problems which includes growth modulation with eight-Plate. For certain reasons, the use of the eight-Plate is limited, thus conventional plates have been selected for the guided growth, for example two-hole one-third tubular plate or reconstruction plate. Literatures reported good results on its use but none of them explained the surgical technique in details. Therefore, we proposed the surgical technique of inserting the two-hole one-third tubular plate in hemiepiphysiodesis in children, which includes pre-skin incision preparation, placement of one-third tubular plate and screw insertion. The three steps are surgeon-friendly and less demanding, being suitable to apply to paediatric patients that require growth modulation.
National journal of clinical orthopaedics, 2021
Background: Idiopathic genu valgum is one of the common deformity encountered in OPD of orthopaedics. After a fair conservative trail to treat the deformity fails, temporary epiphysiodesis become the standard treatment. This deformity can also be treated with several types of osteotomies with additional risk of extensive soft tissue handling, infection, delayed union, non-union, malunion etc. various method of temporary epiphysiodesis are present but most of them are on the principle of compression such as stapling, transphyseal screws fixation etc. On the other hand 8 plate, works on the principle of tension band. Hereby the aim of this study is to see the functional outcome and complications related to 8 plate generated growth modulation. Method: Study design was prospective and interventional, between June 2018 to May 2020.Eight plate was implanted on 16 patients aged between 6 years to 15 years suffering from genu valgum deformity. Plate was implanted over distal femur medially. Patients were evaluated pre-operatively and postoperatively by determining various joint angles both clinically and radiologically. Following are the various joint angles evaluated: 1. Tibio femoral angle 2. Medial proximal tibial angle 3. Lateral distal femoral angle 4. Mechanical axis zone All these paraments were recorded in each follow up and data collected was analyzed statistically. Result: 16 patients were included in the study with a median follow up of 16 months. Out of 16 patients operated 6 were females. A mean pre-operative and post-operative tibio femoral axis were recorded. We observed a p-value of 0.001 which is statistically significant. Conclusion: Growth modulation using 8 plate method proves to be an effective method for correcting genu valgum deformity in skeletally immature patients. It is a reversible procedure and surgeon friendly and at the same time 8 plate adjust dynamically to the ever changing physeal anatomy.
American Research Journal of Orthopedics and Traumatology, 2020
Background: Angular deformities of the lower extremities cause activity-related pain, altered gait mechanics, and joint instability, and these are exacerbated by periods of growth. Conservative usually fails to correct deformity; correction of deformity by hemiepiphysiodesis has become the standard surgical technique of treatment. Objective: The aim of this study to evaluate temporary hemiepiphysiodesis around the knee to modulate growth with eight-Plate technique in patient with genu valgum. Material and method: A prospective study between January 2015 and December 2019, we evaluated the patients as a single group to assess the effectiveness of temporary hemiepiphysiodesis as a method of correction of genu valgum. The study included 29 patients with one patient was male and had unilateral valgus left knee and was lost in the follow up after removal of the plate and the remaining 28 patients were 22 bilateral 78.6% and 6 unilateral 22.4% (50 knees) four patients with right side14.3% and two patient left side 7.1% with coronal genu valgum deformity indicated for surgical treatment. There were 19 boys (67.8%) and 9 girls (32.2%) and all of them were treated by temporary hemiepiphysiodesis using eight-plate technique. The mean average age of the children at a time of the operation was 7.8±2.3`years (range, 4-12.5 years). Result: The entire patient had complete correction of the deformity. The mean follow-up was 31±7.8 months (range 20-48 months) after plate removal. Two patients reached skeletal maturity at the final follow up. The eightplates were inserted on the medial distal femur (MDF) in 6 patients (21.4%), in proximal tibia (MPT) in 6 (21.4%) patients and on both femur and tibia (MPT+MDF) in 16 patients (57.2%). All patients achieved complete deformity correction after plate removal mean duration 19±4.6 months (14-29 months) and the mean Intermalleolar distances before the procedure was 19.2±4.3 changed postoperative to 1.2±1 with P. value > 0.001 and the mean mLDFA changed from 79.2±5 to 87.2±1.5 and the P. value > 0.001 after the procedure. Conclusion: Temporary hemiepiphysiodesis using eight-Plates is a delicate, straight forward and successful strategy used to treat genu valgum by modulating growth. Slight overcorrection is alluring because of the rebound phenomenon, particularly in young patients with high development potential and risk groups, for example, obese children.
Guided growth for angular correction in children
Journal of Pediatric Orthopaedics B, 2017
This retrospective cohort study examined 20 patients (48 physes), 11 boys and nine girls, who were treated with hinge-plate or eight-plate. The mean age of the patients at surgery was 11.9 ± 2.6 years. The mean follow-up duration was 13 ± 2.7 months. The radiographic measurement of both distal femoral and proximal tibial deformity showed significant correction, with no difference between the hingeplate and the eight-plate. Both screw divergence angle and the hinge angle showed significant changes at the last follow-up. The deformity correction of the distal femoral physis was quicker than the proximal tibial physis. The rate of mechanical femoral-tibial angle correction was 0.97°/ month if both femoral and tibial physes were treated. Level of evidence: III.
Journal of Bone and Joint Surgery - British Volume, 2010
A total of 25 children (37 legs and 51 segments) with coronal plane deformities around the knee were treated with the extraperiosteal application of a flexible two-hole plate and screws. The mean age was 11.6 years (5.5 to 14.9), the median angle of deformity treated was 8.3° and mean time for correction was 16.1 months (7 to 37.3). There was a mean rate of correction of 0.7° per month in the femur (0.3° to 1.5°), 0.5° per month in the tibia (0.1° to 0.9°) and 1.2° per month (0.1° to 2.2°) if femur and tibia were treated concurrently. Correction was faster if the child was under 10 years of age (p = 0.05). The patients were reviewed between six and 32 months after plate removal. One child had a rebound deformity but no permanent physeal tethers were encountered. The guided growth technique, as performed using a flexible titanium plate, is simple and safe for treating periarticular deformities of the leg.
Hemiepiphysiodesis for Correction of Angular Deformity in Pediatric Amputees
Journal of Pediatric Orthopaedics, 2013
Background: Angular deformities at the knee are common in children with congenital or acquired below-knee or Syme amputations. These deformities can be well compensated and accommodated with prosthetic modifications. However, as children grow, these prosthetic modifications become more difficult and mechanical axis correction becomes necessary. These deformities have previously been treated with osteotomies and internal or external fixation devices, which necessitate prolonged periods without use of their prosthesis. This study examines the results of hemiepiphysiodesis to correct the mechanical axis and improve prosthetic fitting in a pediatric amputee population. Methods: Mechanical axis correction using hemiepiphysiodesis in 22 pediatric Symes or transtibial amputees with 22 involved limbs were retrospectively reviewed. Hemiepiphysiodesis was performed with 8-plates (10), staples (6), or drilling and curetting (6). Postoperatively, children were allowed to resume prosthetic use after their wounds healed and they indicated no pain while wearing their prosthesis. Seventeen patients presented with valgus and 5 with varus deformity of their residual limb. Mean age at time of surgery was 11 years and 11 months (range, 7 y and 11 mo to 15 y and 8 mo). Mechanical axis deviation (MAD) was measured before initial surgery and again after hardware removal or physis closure. Results: The mean preoperative MAD was À29.6 mm for the valgus deformities and +10.6 mm for the varus deformities. The mean postoperative MAD was +3.1 mm for the varus knees and À6.0 mm for the valgus knees The mean total mechanical axis correction was 21.8 mm. One patient failed to achieve any mechanical axis correction and 1 hardware failure (broken 8-plate) occurred. Most patients had the staples or 8-plates removed, either after correction was achieved and physes were still open, or due to hardware prominence after physeal closure. Conclusions: Hemiepiphysiodesis provides reliable correction of angular deformity in pediatric amputees. Surgical intervention while skeletally immature allows for correction using guided growth, without the need for osteotomy with internal or external fixation and the resultant disruptions in prosthetic wear. Level of Evidence: Case Series, Level IV.
Growth guidance of angular lower limb deformities using a one-third two-hole tubular plate
Journal of Children's Orthopaedics, 2013
Purpose The eight-plate system for angular deformity correction is well known, reliable and effective at any age during growth. Due to high implant costs, we sought to evaluate the effectiveness and safety of a less expensive alternative. Methods Between 2006 and 2011, 41 children with angular deformities were managed using a two-hole one-third tubular plate in cases where an eight plate would normally be indicated. Inclusion criteria in this retrospective study were: genu valgum and genu varum. X-ray documentation was performed before and after surgery and patients were followed clinically every 3 months after surgery. The cost per implant was 361.40 Sfr (Swiss Francs) compared to the eight plate at 737 Sfr. Results Mean time for correction was 13 months. A mean LDFA/MPTA after correction of 89.9°/86.8° was recorded, as well as a mean correction angle of 6.8°/6.6°. The complication rate was 6.6 % (one superficial wound infection and one insufficient correction in an older child). T...