Long-Term Results of Lower Limb Lengthening by Physeal Distraction

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%

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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“…Epiphyseal distraction [6][7][8][9][10][11][19][20][21][22][23][24][25][26][27][28][29] is a technique in which the epiphysis is pulled away from the metaphysis at a controlled slow rate. The physis separates without osteotomy (bloodless limb lengthening), and the epiphysis can be distracted with the use of an appropriate external jig.…”

Section: Discussionmentioning

confidence: 99%

“…Distraction alone does not stimulate the physis, and any increase in length is caused by a controlled fracture and physeal separation. 10,11,[25][26][27]29 The tensile properties of the physis have been investigated in studies emphasizing anatomic location, strain rate, age, cartilage thickness, and species. 25,28,30 The plane of physeal failure under tension loading has been variously reported.…”

Section: Discussionmentioning

confidence: 99%

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Chondrocyte injection in distraction epiphysiolysis (rabbit model)

Ahn

Erdin

Smith

et al. 2005

Journal Orthopaedic Research

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The purpose of this study was to determine if cultured chondrocytes could prevent premature closure of the physis after physeal distraction in a rabbit model. Epiphyseal distraction at the proximal tibial epiphysis was performed in 24 immature rabbits. Chondrocytes were harvested from the iliac apophysis. The animals were divided into three groups: A, epiphyseal distraction alone; B, injection of phosphate buffered saline (PBS) after epiphyseal distraction; and C, injection of cultured chondrocytes after epiphyseal distraction. After epiphyseal separation was noted radiographically, each animal was evaluated at routine intervals. At 2 to 4 weeks, significant tibial lengthening as compared to the contralateral tibia was noted in all three groups. At 10 weeks, lengthening was apparent only in group C; in groups A and B, the operated tibia was shorter than the unoperated one. Histologic examination at 4 weeks revealed partial bony bridge formation with cell clustering in the fibrocartilaginous matrix in groups A and B. In group C , the matrix showed a typical hyaline aspect with cells organized in columns at the injection site. The zone of hypertrophic chondrocytes was enlarged. It appears that the injected cells differentiated into hypertrophic chondrocytes and delayed premature physeal closure. At 10 weeks after distraction of the physis, the width of the physis was restored to 75% of normal, but disordered chondrocyte growth with cell clustering was present in the cell-injected group. ß

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“…Today, most orthopaedic centers have abandoned these methods due to disturbance of remaining growth in the distracted physis (Bjerkreim 1989, de Pablos and Canadell 1990, Fjeld and Steen 1990. Even if Zarzycki et al (2002) did not observe any premature growth cartilage fusions after physeal distraction in 40 patients, reduced growth potential could not be excluded.…”

Section: Physeal Distractionmentioning

confidence: 99%