Prospective Study on Tension Band Plating: Most Patients are Not Returning to Normal Activities 1 Month Following Surgery

Abstract

Background: Tension band plating for temporary hemiepiphysiodesis has been reported by several authors as simple and effective for treating angular deformities of the lower limb. Anecdotally, patients have reported higher pain levels than expected given the small size of incision and relatively minimal amount of dissection, and we sought to investigate this further. Methods: Patients 16 years old or less with lower extremity angular deformities or limb length inequality were prospectively enrolled before tension band plating from 2 pediatric institutions from July 2016 to December 2018. Participants completed postoperative questionnaires regarding their pain and activity level. Pain was assessed using the FACES Pain Scale. Patients were included if they completed the 1 month survey. Results: Of the 48 patients that met inclusion criteria (mean age at surgery: 13.1 y; range: 7 to 16 y), 39 patients completed the survey at 3 months postoperatively. There was a significant change in pain level between 1 week and 1 month postoperatively (P < 0.001). Eighty-three percent (34/41) of patients were still taking pain medication at 1 week, which decreased to 38% (18/ 48) at 1 month. At 3 months, 21% (8/39) patients reported they were still using pain medication. At 1 month, 65% of patients (31/ 48) had not returned to their prior activity level. Of the 39 patients who played sports, 59% (23/39) still had not fully returned to sports at 1 month. Conclusion: At 1 month following tension band plating, 65% of patients had not returned to their preoperative activity level, and 38% were taking pain medications. Although the tension band plate and surgical incision is small in size, patients and parents should be counseled that there are significant activity limitations and pain levels for a month or longer in many patients. Level of Evidence: Level II.

Growth modulation for angular knee deformities: a practical guideline

“…Early ambulation and mobilization should be encouraged. Occasionally, there may be a delay in resuming activities and postoperative pain requiring physiotherapy, especially in the femur [51,52 ▪▪ ]. However, whether this delay may be because of hemarthrosis, accidental arthrotomy, injury, or impact on the medial patellofemoral ligament remains unclear [53].…”

What’s New in Limb Lengthening and Deformity Correction

“…Grégoire et al found that 65% of patients had not returned to their preoperative activity level and 38% of patients were taking pain medications at 1 month following tension-band plating. The authors determined that, although the tension-band plate and the surgical incision are small in size, patients and parents should be counseled that there are substantial activity limitations and pain levels for ≥1 month in many patients 60 . Kim et al demonstrated that the screw configuration did not affect the rate of correction of coronal angular deformity for guided growth using the tension-band plate.…”

What’s New in Pediatric Orthopaedics

“…Screw configuration in tension-band plating systems did not show an effect on the rate of correction 41 . A prospective study of 48 patients undergoing tension-band plating showed that, at 1 month postoperatively, 65% of the patients had not yet returned to their preoperative activity level, which can be used in guiding preoperative discussions 42 . The use of a percutaneous retrograde transphyseal screw was also effective for hemiepiphysiodesis 43 .…”