Temporary epiphyseodesis for limb-length discrepancy

Abstract

Background and purpose —For the treatment of leg-length discrepancies (LLDs) of between 2 and 5 cm in adolescent patients, several epiphyseodesis options exist and various complications have been reported. We reviewed the 8- to 15-year outcome after temporary epiphyseodesis in patients with LLD.Patients and methods —34 children with LLD of up to 5 cm were included in the study. Mean age at epiphyseodesis was 12.8 (10–16) years. Temporary epiphyseodesis was performed with Blount staples or 8-plates. The LLD was reviewed preoperatively, at the time of implant removal, and at follow-up. Every child had reached skeletal maturity at follow-up. Long-standing anteroposterior radiographs were analyzed with respect to the mechanical axis and remaining LLD at the time of follow-up. Possible complications were noted.Results —The mean LLD changed from 2.3 (0.9–4.5) cm to 0.8 (–1.0 to 2.6) cm at follow-up (p < 0.001). 21 patients had a final LLD of < 1 cm, and 10 had LLD of < 0.5 cm. At the time of follow-up, in 32 patients the mechanical axis crossed within Steven’s zone 1. No deep infections or neurovascular lesions were seen. 4 implant failures occurred, which were managed by revision.Interpretation —Temporary epiphyseodesis is an effective and safe option for the treatment of LLD. The timing of the procedure has to be chosen according to the remaining growth, facilitating a full correction of the LLD. If inaccurate placement of staples is avoided, substantial differences between the mechanical axes of both legs at skeletal maturity are rare.

Lower extremity growth and deformity

“…Complications include inducing deformity at the joint due to placement of the tension device anterior or posterior to the center of the lateral physis and can be corrected by repositioning the implants [19]. Long-term outcomes of temporary epiphysiodesis are favorable, with deformities corrected during treatment time with removing one side of the tether [20].…”

Epiphysiodesis for the treatment of tall stature and leg length discrepancy

“…In these patients fully threaded cannulated stainless steel screws were used [37]. Siedhoff et al achieved a mean LLD correction of 1.6 cm with temporary epiphyseodesis using mainly Blount staples [42]. Mechanical axis deviation following epiphysiodesis has been associated with the use of Blount staples.…”

Рентгенологічна Оцінка Функціонування Наросткової Зони Після Припинення Її Тимчасового Двобічного Блокування Пластинами Різних Типів: Експериментальне Дослідження

“…Метод тимчасового двобічного блокування (ТДБ) наросткової зони (НЗ) пластинами є сучасним та досить широко застосовується при лі-куванні помірної РДНК у дітей. З моменту як у 2007 році Stevens вперше застосував блокування НЗ пластинами, ефективність цього методу неодноразово доведена багатьма авторами [1][2][3][4]. Загальноприйнятий безпечний термін тимчасового блокування НЗ у дітей описується правилом 2 років.…”