Physeal distraction is an alternative to more conventional treatments for the correction of angular deformities of the long bones. Twenty deformities of the femur and tibia, vine of which also involved associated shortening, were partially or completely corrected. In eight cases, there was physeal bony bridge. Complete correction of the angular deformity was achieved in 17 patients, and in seven patients, more than 80% correction was achieved. There were complications in four patients that hindered complete correction of the deformity, or shortening, or both. The external control of the correction until consolidation occurs is progressive and fairly noninvasive. The method allows external control of the correction until consolidation; it acts at the site of the deformity itself and permits lengthening and angular correction during therapy. In deformities with a physeal bony bridge, correction can be achieved with physeal distraction alone, prior resection of the bridge is not unnecessary. The technique is indicated in cases of angular deformities in patients nearing skeletal maturity and particularly in subjects in whom there is associated shortening.

An alternative treatment is presented for late-onset Blount disease in a 14-year-old boy. The technique consists of asymmetric physeal distraction of the proximal tibial growth plate by using a modified Wagner fixator-distractor device that allows progressive angular correction. The patient had a 23 degrees varus deviation of the left tibia, and no physeal bone bridges were detected. Once the fixator was assembled, distraction started 24 h after surgery at a rate of 1.5 mm/day (2 x 0.75). Complete correction was achieved in 25 days. No osteotomy of the fibula was required. The Wagner device was removed in the outpatient clinic 10 weeks postoperatively. After a 4-year follow-up, there was no loss of correction, showing a satisfactory alignment of the operated-on lower extremity. As compared with acute conventional osteotomies, asymmetric physeal distraction entails several advantages for treatment of Blount disease such as less invasive surgery, progressive and adjustable correction taking place at the apex of the deformity, and the possibility of bone lengthening if needed. Furthermore, physeal distraction does not require a second surgical step for bonegraft harvesting or for removal of the internal fixation.