Correction of Angular Deformities by Physeal Distraction

Cañadell, J.; J, de Pablos

doi:10.1097/00003086-199210000-00014

Cited by 30 publications

(9 citation statements)

References 13 publications

(11 reference statements)

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“…The published results related to this pathology, however, are rare and inconsistent at the age of 11 years [2,6,20,[25][26][27].…”

Section: Discussionmentioning

confidence: 99%

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Infantile Blount's disease treated by hemiplateau elevation and epiphyseal distraction using a specific external fixator: preliminary report

Janoyer¹,

Jabbari²,

Rouvillain

et al. 2007

Journal of Pediatric Orthopaedics B

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The treatment of infantile Blount's disease remains controversial. The progressive development of epiphysiodesis of the medial tibial physis induced a complex deformity of the lower limb such as severe genu varum, joint incongruity, torsion instability and leg length discrepancy with major functional consequences. Nine knees on eight children (average age was 7 years and 2 months) were treated by a one-time procedure using a specific external fixator that combined elevation of the medial tibial plateau, axial correction in the valgus, complete sterilization of the upper tibial growth cartilage, leg lengthening anticipation and de-rotation if necessary. Magnetic resonance imaging was useful to describe the deformity and to prepare for surgery. Corrections were progressively obtained through the physis plan by means of short incisions and the use of a specific external fixator. The primary results at an average of 24 months were good with a low rate of complications but final evaluation will be conducted at the end of the children's growth period.

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“…The published results related to this pathology, however, are rare and inconsistent at the age of 11 years [2,6,20,[25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…Our main objective consisted of adapting the treatment to biomechanical situations. As the centre of rotation and angulation is situated near the physis, consequently, the best mechanical solution is a correction at the level of the physis [2,10,16,25,28]. The surgical procedure was percutaneously monitored by fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

Infantile Blount's disease treated by hemiplateau elevation and epiphyseal distraction using a specific external fixator: preliminary report

Janoyer¹,

Jabbari²,

Rouvillain

et al. 2007

Journal of Pediatric Orthopaedics B

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“…Although various angular deformities are often treated by gradual correction with external fixators [2], surgeons may prefer to correct a deformity surgically in select situations.…”

Section: Introductionmentioning

confidence: 99%

Deformity correction with submuscular plating technique in children

Song²,

Kim

et al. 2010

Journal of Pediatric Orthopaedics B

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The results of femoral or tibial deformities corrected with the submsucular plating technique were evaluated. Nineteen deformities of 16 patients (mean age 9.8 years) were included. Through percutaneous corrective osteotomy, submuscular plating was carried out with locking plate. All deformities were successfully corrected and united without bone grafts in an average of 12 weeks. The average correction of deformity was 22.5 degrees . Except one patient of complex deformity, most patients recovered the desired alignment without major complications. Submuscular plating may be an effective alternative for treating deformities in children, providing adequate stability without disadvantages of external fixator or intramedullary nail.

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“…Traditionally, these deformities have been addressed by conventional osteotomies. However, with the introduction in the Western world in the 1980s of the Ilizarov methods and principles of distraction osteosynthesis, many centres today are using this technique in the management of complex limb deformities associated with skeletal dysplasias [6,8,9,17,24]. While the application of the Ilizarov technique of gradual and slow distraction through an osteotomy in the metaphysis or diaphysis is a well-accepted method, the use of this technique for slow (0.5 mm/day) distraction through the physis, chondrodiatasis, remains very controversial.…”

Section: Discussionmentioning

confidence: 99%

Chondrodiatasis in a patient with spondyloepimetaphyseal dysplasia using the Ilizarov technique: successful correction of an angular deformity with ensuing ossification of a large metaphyseal lesion

Valdívia

Fassier

Hamdy

1998

International Orthopaedics

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Case historyThe patient was born at term following a normal pregnancy. His family history was unremarkable, and all his anthropometric parameters at birth were normal, except for a height of 43 cm (below 3rd percentile). Psychomotor development was adequate for his age. Chromosomal and metabolic studies were normal. By the age of 5 years, extensive involvement of the proximal femora was evident, and the diagnosis of spondyloepimetaphyseal dysplasia was made. He underwent bilateral valgus derotational osteotomies of the proximal femur for the correction of severe coxa vara deformities.At 11 years of age he developed a progressive left genu recurvatum deformity of 30° (Fig. 1). Radiographs showed anterior collapse of the tibial plateau into a large, cystic radiolucent lesion of the proximal tibial metaphysis which lay adjacent to the physis and measured 3.0×3.2×1.2 cm (Fig. 2). It was decided to correct the deformity by slow, controlled distraction through the physis. An Ilizarov external fixator was percutaneously applied to the left tibia, and no osteotomy was performed. One ring was secured to the proximal tibial epiphysis oriented in the plane of the tibial plateau. The distal rings were secured to the proximal tibial shaft and then crosslinked. The proximal ring was connected to the distal ones by three hinged distracting rods, two anterior and one posterior. The distraction rate did not exceed 0.5 mm/day (Figs. 3 and 4). A simultaneous lengthening of 3 cm was performed to compensate for the expected growth arrest of the proximal tibial metaphysis following the physeal distraction. The fixator was removed 10 months after its application. The patient then remained in a cast for a period of 6 weeks followed by a brace for an additional 9 weeks. The only complication that occurred during treatment was a pin-tract infection which was successfully treated with oral antibiotics. Clinical and radiologic examination at the end of treatment and 8 months after showed complete correction of the angular deformity. The patient maintained a full range of motion of the affected knee. Surprisingly, the large metaphyseal cystic lesion ossified completely. At the latest follow-up, 3 years after the end of treatment, the patient was functioning well. The 3-cm lengthening performed was judicious, as there was no limb-length discrepancy at the end of growth (Figs. 5 and 6).

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Correction of Angular Deformities by Physeal Distraction

Cited by 30 publications

References 13 publications

Infantile Blount's disease treated by hemiplateau elevation and epiphyseal distraction using a specific external fixator: preliminary report

Infantile Blount's disease treated by hemiplateau elevation and epiphyseal distraction using a specific external fixator: preliminary report

Deformity correction with submuscular plating technique in children

Chondrodiatasis in a patient with spondyloepimetaphyseal dysplasia using the Ilizarov technique: successful correction of an angular deformity with ensuing ossification of a large metaphyseal lesion

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