Angular Deformity Correction by Asymmetrical Physeal Suppression in Growing Children

Abstract

Level III.

The Efficacy and Complications of 2-Hole 3.5 mm Reconstruction Plates and 4 mm Noncanulated Cancellous Screws for Temporary Hemiepiphysiodesis Around the Knee

“…3,6,9,13,15 Transphyseal screws, 4,9,11,22 staples, 4,9,22,23 and tension-band plates 4,9,13 are considered effective and offer the advantage of reversibility after implant removal. Stapling has mixed results with problems of hardware failure, migration, and some concerns about permanent physeal arrest.…”

“…Hemiepiphysiodesis can be performed in various ways, including ablation of 1 side of the physis, 3,6,9,13,[15][16][17][18][19] stapling, 3,6,9,13,15,17,[19][20][21] percutaneous screw placement, 6 and the recent tension-band plating. 3,6,9,13,15 Transphyseal screws, 4,9,11,22 staples, 4,9,22,23 and tension-band plates 4,9,13 are considered effective and offer the advantage of reversibility after implant removal.…”

“…8 Permanent hemiepiphysiodesis, the Phemister method and its modifications, requires accurate calculation of the remaining growth, exact timing, and is exclusively applicable to the adolescents. 3,6 However, despite exact timing, sometimes growth of the diseased physis leads to undercorrection or overcorrection of the deformity 7,9,10 ; as a result, close follow-up is a necessity. 11 Stapling is associated with higher rates of breakage and extrusion 2,7,12,13 and transphyseal screws carry the risk for breakage and physeal bar formation.…”

Guided growth for the treatment of limb length discrepancy

“…The latter may result in iatrogenic permanent physeal arrest or, in contrast, rebound overgrowth [17][18][19]. When hemiepiphyseal stapling was compared with PETS for the correction of angular deformities, no significant difference was observed in the mean rate of angular correction, the physeal behavior after implant removal, or the number of complications [12]. We found a significant difference between the stapling and PETS techniques for the management of limb length discrepancies in terms of rate of correction but not in the residual postoperative limb length discrepancy.…”

“…To the best of our knowledge, there are a limited number of clinical studies comparing the effectiveness and complication rate after physeal stapling with that after plate hemiepiphysiodesis [8,10] or PETS for the correction of angular deformities about the knee [12]. However, there are no comparative studies evaluating the currently most commonly used techniques for the treatment of limb length inequalities.…”