Growth Modulation for Knee Coronal Plane Deformities in Children With Nutritional Rickets: A Prospective Series With Treatment Algorithm

El-Sobky, Tamer A.; Samir, Shady; Baraka, Mostafa M; Fayyad, Tamer A; Mahran, M; Aly, Ahmad Saeed; Amen, John; Mahmoud, Shady

doi:10.5435/jaaosglobal-d-19-00009

Cited by 11 publications

(18 citation statements)

References 35 publications

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“…Two-hole plate mediated guided growth working as a tension band was described by Stevens[ 12 ] and this guided growth technique with two-hole tension band plates for correction of coronal plane deformities of knee has been widely accepted by pediatric orthopedic surgeons. [ 13 ] However, studies with large populations with longer follow-up are still missing in the literature. In this study, we aimed to present the ten-year results and complications of two-hole tension band plate hemiepiphysiodesis for coronal deformities around knee in a large population from a single center.…”

Section: Introductionmentioning

confidence: 99%

Correction of coronal plane deformities around knee in children with two-hole tension band plates

et al. 2021

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Objectives This study aims to present the 10-year results and complications of two-hole tension band plate hemiepiphysiodesis for coronal deformities around knee in a large population from a single center. Patients and methods Seventy-seven patients (46 boys, 31 girls; mean age 93±36 months; range, 22 to 181 months) who underwent temporary hemiepiphysiodesis around knee between January 2009 and January 2019 with two-hole tension band plates were retrospectively evaluated. Improvement of joint orientation angles and mechanical axis deviations, deformity correction rates, etiology groups, and complications were noted. Results A total of 166 bone segments (93 femurs, 73 tibias) were included in the study. Mean follow-up duration after the implantation was 36±17 (range, 12 to 88) months. Plates were removed at mean 18±8 (range, 7 to 47) months of implantation. Of the bone segments, 95.2% (n=158) responded successfully to the plates. Mean correction rate of mechanical lateral distal femoral angle in femoral valgum deformity was 0.94±0.43° (range, 0.17 to 2.22)/month and mean correction rate of mechanical medial proximal tibial angle in tibial valgum deformity was 0.62±0.36° (range, 0.11 to 1.55)/month. Mean correction rate of mechanical lateral distal femoral angle in femoral varum deformity was 1.3±0.8° (range, 0.48 to 2.92)/month and mean correction rate of mechanical medial proximal tibial angle in tibial varum deformity was 0.94±0.49° (range, 0.26 to 1.67)/month. The most common complication observed was rebound deformity seen in 41.2% (n=70) of the bone segments. Nine bone segments had persistent hemiepiphysiodesis despite plate removal. Four screw breakages (three metaphysial and one epiphysial) were observed. Conclusion Two-hole tension band plate hemiepiphysiodesis appears to be an effective and safe method for the correction of coronal deformities around knee.

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Section: Introductionmentioning

confidence: 99%

Correction of coronal plane deformities around knee in children with two-hole tension band plates

et al. 2021

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“…In 2007, Stevens published a preliminary series that showed successful correction with a low risk of rebound deformity 12 . More reports of the success of the technique were to follow; specifically, in post-traumatic tibia valgus 13 , pathological condition i.e rickets 14 and also in knee flexion deformities 15 . Other authors also concurred with the effectiveness of the 8-plate in treating angular deformities.…”

Section: Discussionmentioning

confidence: 99%

Angular Deformities of the Knee in Children Treated with Guided Growth

Jamil¹,

My²,

Af³

et al. 2021

Malays Orthop J

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Introduction: The guided growth technique is an alternative to corrective osteotomy for treating angular deformities of the extremities. It has the advantage of being minimally invasive and is effective in a growing child. This study reports on the outcome of guided growth technique using a plate in correcting knee angular deformities. Material and Methods: We conducted a retrospective study of children with angular deformity of the knee treated by the guided growth technique from January 2010 to December 2015 in a tertiary centre. The guided growth technique was done using either the flexible titanium plate (8-plate) or the 2-hole reconstruction plate. Correction of deformity was assessed on radiographs by evaluating the mechanical axis deviation and tibiofemoral angle. The implants were removed once deformity correction was achieved. Results: A total of 17 patients (27 knees) were evaluated. Twenty-two knees (81.5%) achieved complete correction of the deformity. The median age was 4.0 (interquartile range 3.0-6.0) years and the median Body Mass Index (BMI) was 26.0 (25.0-28.0). There were 7 unilateral and 10 bilateral deformities with different pathologies (14 tibia vara, 3 genu valgus). The median rate of correction was 0.71° per month. One patient (1 knee) had screw pull-out and two patients (4 knees) had broken screws in the proximal tibia. Three patients (5 knees) failed to achieve complete correction and were subsequently treated with corrective osteotomies. Out of five patients (8 knees) who were followed-up for at least 12 months after removal of hardware, two had rebound deformities. No permanent growth retardation occurred in our patients. Conclusion: Our outcome for guided growth to correct knee angular deformity was similar to other studies. Guided growth is safe to perform in children below 12 years old and has good outcome in idiopathic genu valgus and Langeskiold II for tibia vara. Patients should be observed for recurrence until skeletal maturity following implant removal.

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“…In other words, the patient and deformity characteristics that are associated with a favorable response namely spontaneous deformity remodelling are not clearly specified in the literature [8]. This is because the main bulk of publications on children with NR address prevention [9,10], non-skeletal presenting manifestations [11], medical treatment [7,12,13], underlying patho-aetiological factors [14], genetic susceptibility [15], identification of potentıal risk factors [16], orthopedic surgery management [17], animal experimentation [18] and epidemiological and public health aspects of the disease [19][20][21].…”

Section: Background and Significancementioning

confidence: 99%

“…Nor is it exactly known what the relative weight of each variable is in influencing spontaneous deformity correction. This creates surgical decision-making dilemmas with respect to the appropriate indications for intervention by guided growth surgery, a procedure which has demonstrated safety and efficacy in the treatment of childhood angular knee deformities of various etiologies including NR [17,24]. Guided growth has also demonstrated efficacy in treatment of torsional long bone deformities in clinical [17] and experimental settings [25].…”

Section: Background and Significancementioning

confidence: 99%

“…This creates surgical decision-making dilemmas with respect to the appropriate indications for intervention by guided growth surgery, a procedure which has demonstrated safety and efficacy in the treatment of childhood angular knee deformities of various etiologies including NR [17,24]. Guided growth has also demonstrated efficacy in treatment of torsional long bone deformities in clinical [17] and experimental settings [25]. Additionally, these decision-making challenges call for the execution of natural history-of-disease studies to elucidate disease/deformity remodelling or behavior over time.…”

Section: Background and Significancementioning

confidence: 99%

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Predictors of Spontaneous Remodelling of Angular Knee Deformities in Children with Healed Nutritional Rickets: A Prospective Cohort Study Protocol

Baraka¹,

Samir²,

Mahmoud³

et al. 2021

Preprint

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Background: Nutritional rickets is still considered as a global health problem especially in low-resource countries and immigrant societies of developed countries. Generalized skeletal deformities including angular knee deformities as genu varum and genu valgum are prominent features of nutritional rickets. Angular knee deformities can cause gait difficulties. However, the true remodelling potential of the healed knee deformities is largely unknown to the pediatric and orthopedic community. Aims: The primary objective of this study protocol is to investigate the natural history of disease in regard to the remodelling potential of angular knee deformities in children and adolescents with healed nutritional rickets. And determine the potential patient- and deformity-related factors that are associated with a favorable deformity remodelling as age and sex of patients and type, severity, laterality of deformities etc. Methods: This will be a prospective observational analytical cohort natural history of disease study. A minimum of at least 140 knees with healed nutritional rickets and angular knee deformities will be observed at regular three-monthly intervals over a period of at least one year. We will report two outcome variables namely; clinical and radiological tibio-femoral angle. And independent patient and deformity-related variables as age, sex, deformity type, severity and laterality. Inferential statistics namely bivariate and multivariate analysis will be employed accordingly to identify the relation between outcome variables and the different independent variables. Ethics and dissemination: This protocol study has been approved by the institutional research ethics committee. Results will be presented at conferences and submitted to relevant international and society publications. Authors will also communicate the results to their scholarly networks and post them on scholarly networking sites. Conclusions: This study has the potential for improving the decision-making process as to which patients deserve conservative treatment and which deserve surgical deformity correction. Results are expected to have an impact on the clinical practice of pediatricians, orthopedic surgeons and family physicians alike.

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Growth Modulation for Knee Coronal Plane Deformities in Children With Nutritional Rickets: A Prospective Series With Treatment Algorithm

Cited by 11 publications

References 35 publications

Correction of coronal plane deformities around knee in children with two-hole tension band plates

Correction of coronal plane deformities around knee in children with two-hole tension band plates

Angular Deformities of the Knee in Children Treated with Guided Growth

Predictors of Spontaneous Remodelling of Angular Knee Deformities in Children with Healed Nutritional Rickets: A Prospective Cohort Study Protocol

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