Two-Holes Reconstruction Plate for Correction of Coronal Plane Deformities of the Knee in Children, Khartoum, 2020

Abstract

Background: Angular deformities of lower limb in Pediatric age group present very commonly to orthopedic and pediatric clinics, and it may be physiological or may be true deformities. [8] In the past, Osteotomies have been the mainstays of treating deformities even in children. Recently, guided growth techniques become widely used in management of coronal plan angular deformities around the knees. It is a less invasive technique compared to osteotomies. The results are more predictable and the process is reversible. The implants can be removed after the desired correction is achieved. To our knowledge, no such study had been done in Khartoum, Sudan. Purposes and questions: ''Does guided growth techniques using two hole reconstruction plate for the treatment of coronal plan deformities around the knee decrease joint deformity and growth retardation in children?'', does there is a correlation between the radiological outcomes and the type of deformity, and to identify the post-operative complications. Methods: This is a cross sectional descriptive hospital based study of 22 patients (30 limbs) gathered and treated during a period from 2018 to 2020 by a single surgeon employing a standardized technique. The inclusion criteria were all patients with coronal plane deformities around the knee with an open physis, regardless of pathological background. Patients with physiological genuvarum or genuvalgum or who had previous or concurrent surgeries for the same problem were excluded from the study. Patient’s age and gender were recorded. Mechanical axis deviation (MAD) distance, tibio‑femoral angle (TFA), mechanical lateral distal femoral angle, and mechanical medial proximal tibia angle were measured from a long standing anteroposterior radiograph, including the hip, knee and ankle joints. Results: The average age was 7.0±3.5 years, and the mean duration of treatment was 10.4 months, with “sick physis” requiring longer durations. There was significant association between types of deformity was associated, with gender with P value 0.003 which found that, majority of genuvarum deformity found in females and genuvalgum found in males. The mean rate of correction of TFA was 1.4°/month. The MAD distance improved from 34.1±18.0 to 9.8± 6.4. Conclusion: This study confirms that success rate by guided growth technique using two- hole reconstruction plate in management of coronal plane deformity around the knee is high. Younger patients had better and faster outcomes. The direction of the future research is on continuous follow up for those children for any rebound coronal plane deformity.