Epiphysiodesis for the treatment of tall stature and leg length discrepancy

Willegger, Madeleine; Schreiner, Markus; Kolb, Alexander; Windhager, Reinhard; Chiari, Catharina

doi:10.1007/s10354-021-00828-8

Cited by 8 publications

(9 citation statements)

References 49 publications

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“…This surgical technique is applicable from the age of 3-4 years and it may be successful until a residual growth is present. Therefore, guided growth must be carried out at least 2-3 years before skeletal maturity (age 14 in girls and age 16 in boys) (48)(49)(50)(51)(52). The rationale for the use of guided growth is to correct the deformity at the physis before the occurrence of severe diaphyseal deformity; however, the exact timing for the application of the guided growth techniques may be difficult to identify.…”

Section: Surgical Treatmentmentioning

confidence: 99%

X-Linked Hypophosphatemic Rickets: Multisystemic Disorder in Children Requiring Multidisciplinary Management

Baroncelli

Mora

2021

Front. Endocrinol.

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X-linked hypophosphatemic rickets (XLH) is the commonest inherited form of rickets. It is caused by an impaired regulation of fibroblast growth factor 23 (FGF23) due to a PHEX gene mutation, which leads to reduced tubular reabsorption of phosphate and renal 1α-hydroxylase activity and increased renal 24-hydroxylase activity. Hypophosphatemia associated with renal phosphate wasting, normal serum levels of calcium, parathyroid hormone, and 25-hydroxyvitamin D represents the main biochemical sign in affected patients. Patients with XLH show rickets and osteomalacia, severe deformities of the lower limbs, bone and muscular pain, stunted growth, and reduced quality of life. However, XLH is a multisystemic disorder requiring multidisciplinary approaches in specialized subdisciplines. Severe complications may occur in patients with XLH including craniosynostosis, hearing loss, progressive bone deformities, dental and periodontal recurrent lesions, and psychosocial distress. Moreover, long-term conventional treatment with active vitamin D metabolites and oral inorganic phosphate salts may cause endocrinological complications such as secondary or tertiary hyperparathyroidism, and adverse events in kidney as hypercalciuria, nephrocalcinosis, and nephrolithiasis. However, conventional treatment does not improve phosphate metabolism and it shows poor and slow effects in improving rickets lesions and linear growth. Recently, some trials of treatment with recombinant human IgG1 monoclonal antibody that targets FGF23 (burosumab) showed significant improvement of serum phosphate concentration and renal tubular reabsorption of phosphate that were associated with a rapid healing of radiologic signs of rickets, reduced muscular and osteoarticular pain, and improved physical function, being more effective for the treatment of patients with XLH in comparison with conventional therapy. Therefore, a global management of patients with XLH is strongly recommended and patients should be seen regularly by a multidisciplinary team of experts.

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Section: Surgical Treatmentmentioning

confidence: 99%

X-Linked Hypophosphatemic Rickets: Multisystemic Disorder in Children Requiring Multidisciplinary Management

Baroncelli

Mora

2021

Front. Endocrinol.

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“…2 General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany. 3 Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.…”

Section: Abbreviationsmentioning

confidence: 99%

“…While certain endocrine or genetic conditions are known to cause pathognomonic excessive growth, tall stature is most commonly constitutional or familial [2]. Tall stature itself should not be regarded as a disorder, and hence does not require treatment per se [1,3]. Nevertheless, it may lead to psychosocial impairments; for instance, due to difficulties in finding adequate clothes or a partner [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…Tall stature itself should not be regarded as a disorder, and hence does not require treatment per se [1,3]. Nevertheless, it may lead to psychosocial impairments; for instance, due to difficulties in finding adequate clothes or a partner [2][3][4][5][6]. In general, surgical options to reduce the final height of a skeletally immature individual should be discouraged.…”

Section: Introductionmentioning

confidence: 99%

“…pED has historically been conducted according to the techniques originally described by Phemister [16] and Bowen [17]. However, while the Phemister technique is deemed inappropriately invasive, percutaneous drilling is associated with an increased fluoroscopy time and demands precise execution [3]. Our study group has developed a new device (EpiStop ™ bone trephine; Eberle, Wurmberg, Germany) for pED, which is a synthesis of the Phemister and percutaneous techniques [18].…”

Section: Introductionmentioning

confidence: 99%

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Preliminary results of two novel devices for epiphysiodesis in the reduction of excessive predicted final height in tall stature

et al. 2022

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Background: In the treatment of tall stature, the reduction of excessive predicted final height can either be achieved by hormonal treatment or surgically by temporary (tED) or permanent (pED) epiphysiodesis. The present study evaluates the preliminary results of two novel devices for tED and pED around the knee to reduce the predicted final height. Materials and methods:A retrospective analysis was performed to evaluate the clinical and radiographic outcome after bilateral epiphysiodesis for the treatment of tall stature. A cohort of 34 patients (16 girls, 18 boys) who underwent either tED or pED between 2015 and 2020 were eligible for analysis based on the electronic patient records and picture archiving and communication system of our orthopaedic teaching hospital. tED was conducted in 11 patients (32%) through bilateral implantation of four RigidTacks ™ (Merete, Berlin, Germany) around the knee. Twenty-three patients (68%) received pED, performed with an EpiStop ™ trephine (Eberle, Wurmberg, Germany). The mean overall follow-up time was 2.9 years. Results:The mean age at surgery was 12.3 years in girls and 13.2 years in boys. Patients had a mean body height of 175.2 cm in girls and 184.7 cm in boys at surgery. The mean predicted final height was 191.4 cm in girls and 210.4 cm in boys. At the last follow-up, 26 patients (76.5%) had achieved skeletal maturity. The mean height of skeletally mature patients was 187.2 cm in girls and 198.5 cm in boys. A mean reduction of the predicted final height of 5.9 cm in girls and 8.7 cm in boys was achieved, corresponding to a reduction in remaining growth of 46% in girls and 38% in boys. Secondary frontal plane deformities of the knee were detected in 5/11 patients (45.5%) in the tED group and 1/23 treatments (4.3%) in the pED group.Conclusions: tED and pED have both proven to be efficient at achieving growth inhibition to reduce excessive predicted height. However, tED has been associated with an increased risk of secondary angular deformities of the knee. Furthermore, the risk of implant-related complications and the necessity of a subsequent surgical intervention

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Epiphysiodesen und Hemiepiphysiodesen

et al. 2022

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ZusammenfassungDurch das Prinzip der Wachstumsblockade mittels Epiphysiodese und der Wachstumslenkung durch Hemiepiphysiodese können sowohl Beinlängendifferenzen als auch sagittale, koronare und schräge Achsdeformitäten an der unteren Extremität während des Wachstums korrigiert werden. Es werden temporäre und permanente Techniken unterschieden. Der große Vorteil liegt in der minimal-invasiven Anwendung und den geringen Komplikationen. Essenziell sind die genaue Planung sowie das exakte Timing, besonders wenn permanente Verfahren angewandt werden. Die Anwendung rund um das kindliche Kniegelenk kann als Goldstandard der Behandlung von Beinlängendifferenzen und Varus- und Valguskorrekturen bezeichnet werden. Die Wachstumslenkung an der unteren Extremität hat über die letzten Jahre viele neue Einsatzmöglichkeiten an der Hüfte und am Sprunggelenk gefunden. Die erfolgreichen klinischen Ergebnisse mit geringen Komplikationen unterstützen die breite Anwendung der Hemiepiphysiodese und Epiphysiodese am wachsenden Skelett bei Achsfehlstellungen und Beinlängendifferenzen.

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Epiphysiodesis for the treatment of tall stature and leg length discrepancy

Cited by 8 publications

References 49 publications

X-Linked Hypophosphatemic Rickets: Multisystemic Disorder in Children Requiring Multidisciplinary Management

X-Linked Hypophosphatemic Rickets: Multisystemic Disorder in Children Requiring Multidisciplinary Management

Preliminary results of two novel devices for epiphysiodesis in the reduction of excessive predicted final height in tall stature

Epiphysiodesen und Hemiepiphysiodesen

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