Affecting Factors and Correction Ratio in Genu Valgum or Varum Treated with Percutaneous Epiphysiodesis Using Transphyseal Screws

Lee, Si-Wook; Lee, Kyung-Jae; Cho, Chul-Hyun; Ye, Hee-Uk; Yon, Chang-Jin; Choi, Hyeong-Uk; Kim, Younghun; Song, Kyung‐Bin

doi:10.3390/jcm9124093

Cited by 7 publications

(11 citation statements)

References 30 publications

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“…This is the originality of this study, which is different from previous studies on hemi-PETS. [6][7][8]11,12,17 Similar to our results of growth inhibition at the distal femur, Park et al 12 reported the overcorrection of the distal femur after hemi-PETS and screw removal, while the proximal tibia was stable. Different from their study, 12 we included surgery-related factors and concluded that an excessive peripheral position of a screw might be associated with excessive correction.…”

Section: Discussionsupporting

confidence: 85%

“…However, studies dealing with factors affecting postoperative courses after the removal of transphyseal screws are still rare and limited. 7,11,12 With this background, we conducted a study on hemi-PETS performed in adolescent patients with idiopathic genu valgum at our institution. The aim of our study was to investigate factors determining the final outcomes of hemi-PETS, especially focusing on postoperative courses after screw removal.…”

mentioning

confidence: 99%

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Factors Affecting Postoperative Courses After Removal of Transphyseal Screws Inserted for Correction of Genu Valgum

Shim,

Ko,

Lim

et al. 2024

Journal of Pediatric Orthopaedics

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Background: The aim of this study was to investigate factors determining the final outcomes of hemipercutaneous epiphysiodesis using transphyseal screw (PETS) for the genu valgum, especially focusing on postoperative courses after screw removal. Methods: Fifty-five patients with idiopathic genu valgum treated with hemi-PETS were included. The mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA) were measured to calculate the degree of correction and rebound. Regarding factors related to surgical techniques, the number of screw threads beyond the physis, the moment arm of the screw, and screw insertion angles were measured. Results: In 54 femoral segments (randomly selected in bilateral cases), hemi-PETS was performed with a growth remaining of 2.0±0.6 years. The screw was removed after 6.5±2.1 months, and the degree of correction was 5.0±1.5 degrees. The mean rebound angle was -0.4±2.4 (the negative value means further correction after screw removal). A late time of surgery and an extreme peripheral position of a screw were associated with the growth inhibition. In 50 tibial segments (also randomly selected in bilateral cases), a screw was inserted with a growth remaining of 2.0±0.6 years and removed after 6.3±1.9 months. The degree of correction was 2.9±1.7 degrees during the interval, and the rebound angle was 0.8±1.7 degrees. An earlier time of surgery and a greater correction angle before screw removal were associated with the rebound phenomenon. Conclusions: Growth inhibition of >1.6 degrees was observed in about one-fourth of femoral segments. An extreme peripheral position of a screw should be avoided when performing hemi-PETS at the distal femur. We also recommend not performing hemi-PETS at distal femur with too short a period of growth remaining. Level of Evidence: Level III—retrospective comparative series.

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Section: Discussionsupporting

confidence: 85%

mentioning

confidence: 99%

Factors Affecting Postoperative Courses After Removal of Transphyseal Screws Inserted for Correction of Genu Valgum

Shim,

Ko,

Lim

et al. 2024

Journal of Pediatric Orthopaedics

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“…It has recently been advocated by many surgeons, because it is a minimally invasive procedure compared with other methods that need a wider exposure. 8,10,15,17 However, physeal damage is one of concerns when performing PETS because it directly involves the physes. In our study, the mean rebound angle in the SG was 1.1 ± 3.1 degrees, and it was significantly lesser than that in the PG.…”

Section: Discussionmentioning

confidence: 99%

“…The principle finding of this study was that the use of tension-band plates and faster correction speed were associated with the rebound phenomenon after temporary hemiepiphysiodesis for idiopathic genu valgum in adolescent patients. Different from previous studies on temporary hemiepiphysiodesis for genu valgum, 3,4,[6][7][8][9][10]15 we analyzed various parameters including the type of implant based on the regression analyses to suggest significant factors of the rebound phenomenon. By referencing our results of the linear regression model (model 2 in Table 4), the use of tension-band plates (compared with transphyseal screws) averagely resulted in an increase of 1.7 degrees rebound angle, and an increase of 1 degrees/month correction speed averagely resulted in an increase of 1.7 degrees rebound angle.…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous epiphysiodesis using transphyseal screws (PETS), introduced by Metaizeau et al,16 is a popular method of temporary physeal suppression. It has recently been advocated by many surgeons, because it is a minimally invasive procedure compared with other methods that need a wider exposure 8,10,15,17. However, physeal damage is one of concerns when performing PETS because it directly involves the physes.…”

Section: Discussionmentioning

confidence: 99%

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Factors Affecting Rebound Phenomenon After Temporary Hemiepiphysiodesis and Implant Removal for Idiopathic Genu Valgum in Adolescent Patients

Shim

Shin

et al. 2022

Journal of Pediatric Orthopaedics

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Background: The aim of this study was to investigate factors determining postoperative courses, especially focusing on the rebound phenomenon, in adolescent patients with idiopathic genu valgum who underwent temporary hemiepiphysiodesis and implant removal. Methods: We identified and reviewed patients with idiopathic genu valgum treated with temporary hemiepiphysiodesis [using tension-band plates (plate group, PG) or transphyseal screws (screw group, SG)] and followed-up to skeletal maturity. Results: In our cohort [68 patients and their 68 limbs (randomly selected in bilateral cases)], the mean hip-knee-ankle alignment was -5.4 ± 1.8 degrees at the time of temporary hemiepiphysiodesis (negative means valgus), 2.6 ± 2.1 degrees at the time of implant removal, and 0.7 ± 2.6 degrees at the last followup, respectively. Regarding the implants, the correction speed was not significantly different (P = 0.192-0.315) between the PG (total 1.29 ± 0.37 degrees/mo, 0.71 ± 0.23 degrees/mo at distal femur, 0.59 ± 0.16 degrees/mo at proximal tibia, n = 19) and the SG (total 1.22 ± 0.49 degrees/mo, 0.65 ± 0.25 degrees/mo at distal femur, 0.57 ± 0.23 degrees/mo at proximal tibia, n = 49). The magnitude of rebound phenomenon in the PG (4.1 ± 1.9 degrees) was greater (P < 0.001) than that in the SG (1.1 ± 3.1 degrees). The use of plates and faster correction speed, rather than more severe preoperative deformity or greater correction angle, were positively associated with the rebound phenomenon in regression analyses. Among the 68 knees, 1 showed valgus alignment ≥ 5 degrees and 5 showed varus alignment ≥ 5 degrees at the last follow-up. All the 6 cases were observed in the SG. Surgical wound dehiscence was observed in 1 patient in the PG. Conclusions: The use of plates and faster correction speed were positively associated with the rebound phenomenon. Careful attention will be needed with the corresponding conditions for optimal results. Progressive genu varum after transphyseal screw removal, which was observed in this study, should be explored in future research.

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Treatment of pediatric genu varum by temporary hemiepiphysiodesis using 8-shaped plate

Adawy,

Meselhy,

Eliwa

2023

Benha Journal of Applied Sciences

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Background: Genu varum, a common juvenile orthopaedic disease, may cause gait problems and functional difficulties. Hemiepiphysiodesis using an 8-shaped plate is a new technique, although its clinical and radiological results need study. This research examined the clinical and radiological outcomes of hemiepiphysiodesis with 8-shaped plate for juvenile genu varum. Methods: Thirty children aged 3-15 with genu varum were investigated antegrade and retrogradely. The patients had clinical, radiological, and laboratory tests before surgery. Under general anaesthesia, patients were examined for operation time, intraoperative and postoperative problems, radiological follow-up, and hospital stay. Final follow-up was six months following surgery. Results: The research group had a mean age of 6.6 years and 43 percent females and 57 percent men. Correction was done bilaterally (7%), left (10%), and right (13%), targeting femur and tibia (50%) or femur just (10%) or tibia only (40 percent ). Mean hospitalisation was 0.8 days, and average correction was 10.6 months. Surface infections (7%), LIMITED ROM (10%), and damaged screws (3%) were the only difficulties, with 80% with no issues. Rebound correlates with complications. Intercondylar distance, mechanical axis deviation, proximal tibial angle, and distal femoral angle improved significantly. Logistic regression did not find rebound or complications risk variables. Conclusions: 8-plate insertion is a successful therapy for genu varum in children, although rebound and complications must be monitored.ssary.

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Affecting Factors and Correction Ratio in Genu Valgum or Varum Treated with Percutaneous Epiphysiodesis Using Transphyseal Screws

Cited by 7 publications

References 30 publications

Factors Affecting Postoperative Courses After Removal of Transphyseal Screws Inserted for Correction of Genu Valgum

Factors Affecting Postoperative Courses After Removal of Transphyseal Screws Inserted for Correction of Genu Valgum

Factors Affecting Rebound Phenomenon After Temporary Hemiepiphysiodesis and Implant Removal for Idiopathic Genu Valgum in Adolescent Patients

Treatment of pediatric genu varum by temporary hemiepiphysiodesis using 8-shaped plate

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