1
|
Abood AA, Rölfing JD, Halloum A, Ringgaard S, Byskov JS, Kold S, Rahbek O. An Innovative Plate Concept for Rotational Guided Growth: A Porcine Pilot Study. Cureus 2024; 16:e58169. [PMID: 38616978 PMCID: PMC11015357 DOI: 10.7759/cureus.58169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 04/16/2024] Open
Abstract
Background Rotational deformities in children are currently treated with an osteotomy, acute de-rotation, and surgical fixation. Meanwhile, guided growth is now the gold standard in pediatric coronal deformity correction. This study aimed to evaluate the feasibility of a novel implant intended for rotational guided growth (RotOs Plate) in a large porcine animal model. Methodology A submuscular plate was inserted on the medial and lateral aspect of the distal femoral physis of the left femur in 6 pigs. Each plate was anchored with a screw in the metaphysis and epiphysis respectively. The plates were expected to rotate the femur externally. The right femur acted as a control in a paired design. The animals were housed for 12 weeks after surgery. MRI scanning of both femora was performed before euthanasia after 12 weeks. Rotation was determined as the difference in the femoral version on MRI between the operated and non-operated femur after 12 weeks. Results External rotation in all operated femurs was observed. The mean difference in the femoral version on MRI between operated and non-operated femurs was 12.5° (range 9°-16°). No significant changes in axial growth were detected. Conclusions This study shows encouraging results regarding rotational guided growth, which may replace current invasive surgical treatment options for malrotation in children. However, further studies addressing potential secondary deformities are paramount and should be carried out.
Collapse
Affiliation(s)
- Ahmed A Abood
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, DNK
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, DNK
| | - Jan D Rölfing
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, DNK
| | - Ahmed Halloum
- Department of Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, DNK
| | | | - Jeppe S Byskov
- Department of Additive Manufacturing, Danish Technological Institute, Aarhus, DNK
| | - Søren Kold
- Department of Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, DNK
| | - Ole Rahbek
- Department of Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, DNK
| |
Collapse
|
2
|
Liang M, Zhang X, Liu H, Gao R, Guo D, Yao Z. Robot-assisted Temporary Hemiepiphysiodesis With Eight-plates for Lower Extremity Deformities in Children. J Pediatr Orthop 2024; 44:260-266. [PMID: 38312109 DOI: 10.1097/bpo.0000000000002631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
PURPOSE This study was performed to compare the radiographic results of robot-assisted and traditional methods of treating lower extremity deformities (LEDs). METHODS From January 2019 to February 2022, 55 patients with LEDs were treated by temporary hemiepiphysiodesis with eight-plates. They were divided into a robot group and a freehand group. The fluoroscopy time and operation time were recorded. The accuracy of screw placement was measured after the operation using the following parameters: coronal entering point (CEP), sagittal entering point (SEP), and angle between the screw and epiphyseal plate (ASEP). The limb length discrepancy (LLD) and femorotibial angle (FTA) were measured before the operation, after the operation, and at the last follow-up. Patients were followed up for 12 to 24 months, and the radiographic results of the 2 groups were compared. RESULTS Among the 55 patients with LEDs, 36 had LLD and 19 had angular deformities. Seventy-six screws were placed in the robot group and 85 in the freehand group. There was no difference in the CEP between the 2 groups ( P >0.05). The robot group had a better SEP (2.96±1.60 vs. 6.47±2.80 mm) and ASEP (3.46°±1.58° vs. 6.92°±3.92°) than the freehand group ( P <0.001). At the last follow-up, there was no difference in the LLD or FTA improvement between the two groups ( P >0.05). The incidence of complications was significantly lower in the robot group than in the freehand group (0/27 vs. 5/28, P <0.05). CONCLUSION Robot-assisted temporary hemiepiphysiodesis with eight-plates is a safe and effective method for treating LEDs in children. Robotic placement of screws is superior to freehand placement with respect to the entering position and direction. Although the correction effect for LLD and angular deformity is similar, screw dislocation is less common when using robot assistance. LEVELS OF EVIDENCE Level-III. Retrospective comparative study.
Collapse
Affiliation(s)
- Mingqian Liang
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | | | | | | | | | | |
Collapse
|
3
|
Starobrat G, Danielewicz A, Szponder T, Wójciak M, Sowa I, Różańska-Boczula M, Latalski M. The Influence of Temporary Epiphysiodesis of the Proximal End of the Tibia on the Shape of the Knee Joint in Children Treated for Leg Length Discrepancy. J Clin Med 2024; 13:1458. [PMID: 38592267 PMCID: PMC10934898 DOI: 10.3390/jcm13051458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Leg length discrepancy (LLD) is a common problem in the daily clinical practice of pediatric orthopedists. Surgical treatment using LLD temporary epiphysiodesis with eight-plate implants is a minimally invasive, safe, and well-tolerated procedure that provides good treatment effects with a relatively low percentage of complications. The main aim of this retrospective study was to determine the effect of epiphysiodesis on the shape of the proximal tibia. Methods: The retrospective study was based on medical records from 2010 to 2019. Radiographs taken before the epiphysiodesis and at 6-month intervals until the end of the treatment were investigated. A total of 60 patients treated for LLD were included in the study (24 girls, 36 boys). They were divided into three groups depending on the duration of the LLD treatment: group I (18 months), group II (30 months), and group III (42 months of treatment). Radiological parameters were assessed, including the roof angle (D), the slope angles (α and β), and the specific parameters of the tibial epiphysis, namely LTH (lateral tubercle height), MTH (medial tubercle height), and TW (tibial width). Results: The roof angle decreased in all the groups, which was accompanied by an increase in the β or α angle. LTH, MTH and TW also increased, and the differences before and after the treatment for the treated legs were statistically significant in all the studied groups. The greatest change in the shape of the articular surface of the proximal tibia occurred after 42 months of treatment. Conclusions: The study showed that epiphysiodesis affects the proximal tibial articular surface over prolonged treatment. Thus, there is a need for future long-term follow-up studies to elucidate the potential effects of LLD egalization.
Collapse
Affiliation(s)
- Grzegorz Starobrat
- Department of Paediatric Orthopaedics, Medical University of Lublin, 20-093 Lublin, Poland; (G.S.); (M.L.)
| | - Anna Danielewicz
- Department of Paediatric Orthopaedics, Medical University of Lublin, 20-093 Lublin, Poland; (G.S.); (M.L.)
| | - Tomasz Szponder
- Department and Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, 20-612 Lublin, Poland;
| | - Magdalena Wójciak
- Department of Analytical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland; (M.W.); (I.S.)
| | - Ireneusz Sowa
- Department of Analytical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland; (M.W.); (I.S.)
| | - Monika Różańska-Boczula
- Department of Applied Mathematics and Computer Science, University of Life Sciences in Lublin, 20-033 Lublin, Poland;
| | - Michał Latalski
- Department of Paediatric Orthopaedics, Medical University of Lublin, 20-093 Lublin, Poland; (G.S.); (M.L.)
| |
Collapse
|
4
|
Galán-Olleros M, Sánchez Del Saz J, Miranda-Gorozarri C, Serrano JI, Egea-Gámez RM, Garríguez-Pérez D, Alonso-Hernández J, Martínez-Caballero I. Physeal Migration During Knee-guided Growth With Tension Band Plates: Influence of Implant Position. J Pediatr Orthop 2024; 44:e174-e183. [PMID: 38047324 DOI: 10.1097/bpo.0000000000002583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
OBJECTIVE Physeal migration during guided growth with tension band plates (TBPs) has been poorly described. The positioning factors associated with this phenomenon and its clinical implications are unknown. Our aim is to determine the influence of implant position on the risk of physeal migration during knee-guided growth with TBP. METHODS Retrospective study of 491 patients who underwent temporary hemi or epiphysiodesis with TBP around the knee between 2007 and 2019. We identified 29 patients who presented physeal migration during follow-up. Demographic and clinical data were collected, and the following measures were obtained from the immediate postoperative radiographs: epiphyseal screw base-physis distance/epiphyseal screw tip-physis distance, interscrew angle, epiphyseal screw-physis angle(ES-PHa)/metaphyseal screw-physis angle, plate-physis angle, epiphyseal screw-plate angle/metaphyseal screw-plate angle, and epiphyseal screw-physis length ratio. Using follow-up radiographs, the type of physeal migration of the epiphyseal screw (touch, occupy, or traverse) and the status of the physis after implant removal (unaltered, physeal bar, and skeletal maturity) were also recorded. A descriptive analysis of the cases and a case-control comparison of imaging studies were performed. RESULTS The median patient age at intervention was 12.2 years (interquartile range: 11.3 to 14.1), and 76% were males. A statistically significant difference between cases and controls was obtained for epiphyseal screw base-physis distance (3.7 vs 6.3; P = 0.029), epiphyseal screw tip-physis distance (3.6 vs 7.85; P = 0.002), ES-PHa (-0.1 vs 7.45; P = 0.007), and plate-physis angle (85.45 vs 88.60; P = 0.012). In a categorical analysis, a significant difference was found for the ES-PHa categories ( P = 0.002) and for the ES-PHa/metaphyseal screw-physis angle categorical pair ( P = 0.018). In 16, 17, and 12 cases the physis was touched, occupied, or traversed, respectively, although we found no physeal alterations after plate removal. CONCLUSIONS In our study, physeal migration of TBP is not an uncommon phenomenon, although no physeal abnormalities were detected. Convergent placement of the epiphyseal screw with the base or tip close to the physis should be avoided as this position is associated with a higher risk of physeal migration. LEVEL OF EVIDENCE Level III-case-control study.
Collapse
Affiliation(s)
- María Galán-Olleros
- Department of Orthopaedic Surgery and Traumatology, Hospital Infantil Universitario Niño Jesús
| | | | | | - Jose Ignacio Serrano
- Neural and Cognitive Engineering Group, Center for Automation and Robotics, CAR CSIC-UPM, Arganda del Rey, Madrid, Spain
| | - Rosa M Egea-Gámez
- Department of Orthopaedic Surgery and Traumatology, Hospital Infantil Universitario Niño Jesús
| | | | - Javier Alonso-Hernández
- Department of Orthopaedic Surgery and Traumatology, Hospital Infantil Universitario Niño Jesús
| | | |
Collapse
|
5
|
Hvidberg E, Antfang C, Gosheger G, Vogt B, Abood A, Møller-San Pedro A, Frommer A, Weyer-Elberich V, Møller-Madsen MK, Roedl R, Møller-Madsen B, Rölfing JD. Morphology of the knee after guided growth using tension-band devices: a retrospective multicenter study of 222 limbs and 285 implants. Acta Orthop 2023; 94:609-615. [PMID: 38153250 PMCID: PMC10755675 DOI: 10.2340/17453674.2023.34902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/08/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND AND PURPOSE Temporary hemiepiphysiodesis by tension-band devices is commonly applied to correct angular limb deformities in children. We aimed to evaluate knee joint morphology after guided growth using these devices. PATIENTS AND METHODS In a retrospective multicenter study we analyzed standardized anteroposterior long-leg radiographs of 222 limbs (285 implants) of patients treated by temporary hemiepiphysiodesis with either eight-Plates or FlexTacks for coronal angular deformities of the knee joint between 2013 and 2019. Femoral floor angle (FFA), femoral notch-intercondylar distance (FNID), and tibial roof angle (TRA) were measured pre- and postoperatively to assess the central knee joint morphology. Statistical exploratory analyses were performed using linear mixed models, t-tests, Wilcoxon signed-rank test, and Mann-Whitney U test. RESULTS 217 FlexTacks (femur 106, tibia 111) in 104 children and 68 eight-Plates (femur 61, tibia 7) in 35 children were identified. Median time period under growth guidance was 11 months (range 4-42). No statistically significant change in the FFA was detected (eight-Plate: P = 0.2; FlexTack: P = 0.3). A statistically significant difference of the FNID was found in the eight-Plate group (P = 0.02), but not in the FlexTack group (P = 0.3). While TRA increased in both groups, a statistical significance was observed only in the FlexTack group (P < 0.01). CONCLUSION We found minor but clinically irrelevant changes in knee morphology after the treatment.
Collapse
Affiliation(s)
- Emma Hvidberg
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Denmark; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark
| | - Carina Antfang
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | - Georg Gosheger
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | - Bjoern Vogt
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | - Ahmed Abood
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Denmark; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark
| | - Alexander Møller-San Pedro
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Denmark; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark
| | - Adrien Frommer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | | | | | - Robert Roedl
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | - Bjarne Møller-Madsen
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Denmark; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark
| | - Jan Duedal Rölfing
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Denmark; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany.
| |
Collapse
|
6
|
Vogt B, Rölfing JD, Rödl R, Tretow H. [Options and limits of leg length correction in paediatric orthopaedics]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:719-728. [PMID: 37561147 DOI: 10.1007/s00132-023-04420-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/11/2023]
Abstract
For paediatric orthopaedic surgeons treating leg length discrepancy, knowledge of the available procedures and their options and limits is just as important as mastery of the very different surgical methods and implants, as well as the possible complications, in order to be able to advise and treat the children and adolescents and their parents comprehensively and in the best interests. Both the growth inhibiting procedures and the complex bone lengthening procedures require a great deal of experience to successfully guide patients and families through what is often a lengthy and sometimes complicated treatment process. Careful preoperative indications and planning, precise surgical techniques with suitable instruments and implants, and attentive postoperative check-ups are mandatory prerequisites for the desired therapeutic success.
Collapse
Affiliation(s)
- Björn Vogt
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland.
| | - Jan Duedal Rölfing
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland
- Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Aarhus, Dänemark
| | - Robert Rödl
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland
| | - Henning Tretow
- Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland
| |
Collapse
|
7
|
Jain A, Agarwal A, Patel Y, Sharma L. Limb length deceleration or coronal plane deformity correction using tension band plates: does plate configurations determine the intraarticular deformity of proximal tibia? J Pediatr Orthop B 2023:01202412-990000000-00139. [PMID: 37548689 DOI: 10.1097/bpb.0000000000001114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
We studied whether the two-plate tension band configuration is more prone for intraarticular deformations than the single plate application used for coronal plane deformities (CPD). The study was based on radiological chart review (retrospective cross-sectional) of records of children [15 patients (30 plates) with limb length discrepancies (LLD) and 20 patients (36 plates) with CPD]. Interscrew angle, slope angle, and roof angle were compared in the initial postoperative and final radiographs to determine changes of tibial morphology. The mean patient age and follow up for the LLD and CPD groups respectively were 6.5 years, 39.8 months and 8.1 years, 15.5 months respectively. The interscrew angles widened between initial and final radiographs in the CPD group and for both sides in the LLD group. The initial and final slope angles were not significantly different in both LLD and CPD groups. Similar trend was observed for roof angle in either group. In the intergroup comparisons between LLD and CPD group, the slope angle of medial/lateral operated side in LLD group versus that of the operated side in CPD group matched statistically in the final radiographs. Similarly, the final roof angle in LLD and CPD groups was statistically similar. No significant intraarticular morphological change was demonstrated following tension band plating epiphysiodesis of the proximal tibia for our series involving young children. It was observed neither with the two-plate configuration used for limb length decelerations nor with the single plate application for coronal plane corrections.
Collapse
Affiliation(s)
- Ankit Jain
- Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | | | | | | |
Collapse
|
8
|
Vogt B, Hvidberg E, Rölfing JD, Gosheger G, Møller-Madsen B, Abood AA, Weyer-Elberich V, Laufer A, Toporowski G, Roedl R, Frommer A. Radiographic reference values of the central knee anatomy in 8-16-year-old children. Acta Orthop 2023; 94:393-398. [PMID: 37522246 PMCID: PMC10388364 DOI: 10.2340/17453674.2023.15336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND AND PURPOSE For correction of leg-length discrepancy or angular deformity of the lower limb in skeletally immature patients temporary or permanent (hemi-)epiphysiodesis can be employed. These are reliable treatments with few complications. Recently, radiographic analysis of treatment-related alterations of the central knee anatomy gained interest among pediatric orthopedic surgeons. To date the comparison and adequate interpretation of potential changes of the central knee anatomy is limited due to the lack of defined standardized radiographic references. We aimed to establish new reference values of the central knee anatomy. PATIENTS AND METHODS A retrospective analysis of calibrated longstanding anteroposterior radiographs of 254 skeletally immature patients with a chronological age ranging from 8 to 16 years was conducted. The following radiographic parameters were assessed: (1) femoral floor angle, (2) tibial roof angle, (3) width at femoral physis, and (4) femoral notch-intercondylar distance. RESULTS All observed radiographic parameters were normally distributed with a mean age of 12.4 years (standard deviation [SD] 2, 95% confidence interval [CI] 12.2-12.6). Mean femoral floor angle was 142° (SD 6, CI 141.8-142.9), mean tibial roof angle was 144° (SD 5, CI 143.7-144.1), mean width at femoral physis was 73 mm (SD 6, CI 72.8-73.9), and mean femoral notch-intercondylar distance was 8 mm (SD 1, CI 7.5-7.7). The estimated intraclass correlation coefficient values were excellent for all measurements. CONCLUSION This study provides new radiographic reference values of the central knee anatomy for children between 8 and 16 years and we suggest considering values within the range of 2 SD as the physiological range.
Collapse
Affiliation(s)
- Bjoern Vogt
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany.
| | - Emma Hvidberg
- Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark
| | - Jan Duedal Rölfing
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany; Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark
| | - Georg Gosheger
- General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Bjarne Møller-Madsen
- Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark
| | - Ahmed A Abood
- Danish Pediatric Orthopedic Research, Aarhus University Hospital, Denmark; Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark
| | | | - Andrea Laufer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Gregor Toporowski
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Robert Roedl
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany
| | - Adrien Frommer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| |
Collapse
|
9
|
Motta DP, Faria JLR, Couto A, Aguiar DP, Amaral MVG, Kropf LL, Motta GAVA, Cerqueira FS, Leonetti BD. Gradual Correction of Valgus Deformities of the Tibia Using a Monolateral External Fixator. Strategies Trauma Limb Reconstr 2023; 18:123-132. [PMID: 37942429 PMCID: PMC10628620 DOI: 10.5005/jp-journals-10080-1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/03/2023] [Indexed: 11/10/2023] Open
Abstract
Objective To present a review of patients subjected to gradual correction of a valgus deformity of the tibia using a monolateral external fixator. Method This retrospective review included patients from January 2012 to May 2022 who met the following inclusion criteria: deviation of mechanical axis of the limb due to valgus deformity of the tibia; tibial deformity in the coronal plane on radiographic examination; a documented outpatient pre-operative evaluation by an orthopaedic surgeon and age between 10 and 70 years. The following exclusion criteria were applied: the presence of another tibia deformity preventing gradual correction using the proposed assembly; skin conditions incompatible with the surgical procedure; inadequate pre- or post-operative radiological evaluation; and insufficient information in the medical records. Results The mean age of patients with a valgus deformity of the tibia was 30.8 ± 15.9 years. These patients had a body mass index (BMI) of 26.1 ± 5.5 kg/m2. A congenital or developmental aetiology was attributed to 58.3% of the cases. Most commonly, the deformity was found in the middle third of the tibia with a mean deformity of 14.7 ± 6.6 degrees. The total external fixator time ranged from 73 to 229 days (average 149.7 ± 36.1 days). The mean medial proximal and lateral distal tibial angles differed significantly for pre- and post-operative measurements (p ≤ 0.05). There were complications in eight cases; five cases of pin site infections, two cases of medial cortical fracture and one case of peroneal nerve neuropraxia. Conclusion The proposed correction technique produces a satisfactory angular correction and with similar outcomes as described in the literature. How to cite this article Motta DP, Faria JLR, Couto A, et al. Gradual Correction of Valgus Deformities of the Tibia Using a Monolateral External Fixator. Strategies Trauma Limb Reconstr 2023;18(2):123-132.
Collapse
Affiliation(s)
- DP Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - JLR Faria
- Center for Specialized Care of Knee Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - A Couto
- National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - DP Aguiar
- Biophysics Chair, State University of Rio de Janeiro, Brazil
| | - MVG Amaral
- Center for Specialized Care Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - LL Kropf
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - GAVA Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - FS Cerqueira
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - BD Leonetti
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| |
Collapse
|
10
|
Jain A, Agarwal A, Jethwa R, Sareen JR, Patel Y. Predisposing factors for migration of epiphyseal screws into physis in tension band plating. J Pediatr Orthop B 2023; 32:165-169. [PMID: 36445355 DOI: 10.1097/bpb.0000000000001030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The migration of epiphyseal screws into growing physis in tension band plating is a known complication. We investigated the screw migration into physis in 10 patients (18 plates) to study the various technical details, which may have contributed to this complication. The methodology involved retrospective review of radiological records. Among these 10 affected patients, in four patients, there were eight additional tension band plates, which had remained uncomplicated ('controls') at the time when implant failure was detected. We statistically compared the length of epiphyseal screw, proximity of screw start point to the physis, screw trajectory angle, interscrew angle and correction rate between the migrated and other uncomplicated plates. Majority patients were postrachitic ( n = 7). The mean time from primary procedure to detection of radiological complication was 15.1 months. The mean epiphyseal screw length proportion in migrated and uncomplicated plates matched. The starting point of epiphyseal screw was relatively closer to physis in migrated plates. The trajectory of epiphyseal screw with respect to physis was more divergent in the migrated plates ( P = 0.02). All implants were inserted in a divergent manner with mean interscrew angle being 22.3° for migrated and 13.8° for the uncomplicated plates ( P = 0.02). The correction rate of the implant reduced as it failed. Osteopenic bone and pathological physis predispose to migrated plates. Technically, a wider trajectory of epiphyseal screw and too divergent screws should be avoided. A migrated implant becomes less effective in its function.
Collapse
Affiliation(s)
- Ankit Jain
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | | | | | | | | |
Collapse
|
11
|
Erdal OA, Gorgun B, Razi O, Sarikaya IA, Inan M. Effects of tension band plating on coronal plane alignment of lower extremities in children treated for idiopathic limb length discrepancy. J Child Orthop 2022; 16:505-511. [PMID: 36483641 PMCID: PMC9723863 DOI: 10.1177/18632521221135192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE One of the most common treatment methods for moderate limb length discrepancy in children is growth modulation using tension band plating. Coronal plane deformities after tension band plating for limb length discrepancy have been documented as an important complication in articles involving heterogeneous groups consisted of both idiopathic cases and patients with pathological physes. The aim of the study was to determine the rate of coronal plane deformities after treatment of a homogeneous group of idiopathic limb length discrepancy cases with tension band plating and to compare screw constructs of medial and lateral plates. METHODS Patient files were retrospectively reviewed for amount of limb length discrepancy, anatomical femorotibial angle, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, and inter-screw angles of each plate on both sides of the tibiae and femora. Measurements at each follow-up period were compared to each other. RESULTS A total of 26 patient files (37 bones) were included to the study. The mean age was 10.5 years. The mean limb length discrepancy was 27.5 mm. Implants were removed after mean 34.5 months. The mean follow-up period was 58.5 months. There was no significant difference in inter-screw angle on each side of the bones at the time of implantation and in lower limb alignments during follow-up. CONCLUSION Treatment of mild-to-moderate idiopathic limb length discrepancy with tension band plating in children was found to be safe against any coronal plane deformity during follow-up until skeletal maturity. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Ozan A Erdal
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey,Ozan A Erdal, Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Dikilitas Mah. Hakki Yeten Cad. No 10/D 34365 Besiktas, Istanbul, Turkey.
| | - Baris Gorgun
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
| | - Ozan Razi
- Ministry of Health, Burhan Nalbantoglu State Hospital, Lefkosa, Cyprus,Ozan A Erdal, Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Dikilitas Mah. Hakki Yeten Cad. No 10/D 34365 Besiktas, Istanbul, Turkey.
| | - Ilker A Sarikaya
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
| | - Muharrem Inan
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
| |
Collapse
|
12
|
Tolk JJ, Merchant R, Calder PR, Hashemi-Nejad A, Eastwood DM. Tension-band Plating for Leg-length Discrepancy Correction. Strategies Trauma Limb Reconstr 2022; 17:19-25. [PMID: 35734032 PMCID: PMC9166256 DOI: 10.5005/jp-journals-10080-1547] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jaap J Tolk
- Department of Orthopaedics and Sports Medicine, Erasmus MC–Sophia Children's Hospital, Rotterdam, South Holland, Netherlands; Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
- Jaap J Tolk, Department of Orthopaedics and Sports Medicine, Erasmus MC–Sophia Children's Hospital, Rotterdam, South Holland, Netherlands; Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom, e-mail:
| | - Rajiv Merchant
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom; Department of Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Peter R Calder
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Aresh Hashemi-Nejad
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Deborah M Eastwood
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom; Department of Orthopaedics, Great Ormond Street Hospital for Children, London, United Kingdom
| |
Collapse
|
13
|
Abood AA, Hellfritzsch MB, Møller-Madsen B, Brüel A, Westersø TS, Vedel-Smith NK, Rahbek O, Rölfing JD. Controlled rotation of long bones by guided growth: A proof of concept study of a novel plate in cadavers. J Orthop Res 2022; 40:1075-1082. [PMID: 34324215 DOI: 10.1002/jor.25148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/29/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023]
Abstract
Our novel plate design has been developed for controlled rotation of long bones by guided growth. The objective of this proof-of-concept study was to evaluate the precision of the rotation in the femur. Twelve cadaverous femora of six adults (right = 6, left = 6) underwent an osteotomy at the level of the physeal scar. The plates were inserted on each side of the distal femur. Growth was simulated by axial distraction of the bone segments. The femur was stabilized using a unilateral external fixator. Femoral torsion was assessed with computed tomography (CT) and with an electric goniometer before and after distraction. The obtained rotation was compared to the predicted rotation based on the dimension of the plate and the bone. All femora were rotated as intended. The mean obtained rotation was 26.3° (95% confidence interval [CI]: 23.5-29.0) and the mean predicted rotation was 28.2° (95% CI: 26.9-29.5) (p > 0.82). The mean axial distraction was 19.5 mm (95% CI: 17.7-21.3). The predicted rotation of the femora was similar to the obtained values on CT and by goniometer. The obtained rotation occurred as a result of an axial distraction of approximately 2 cm. This suggests a potential for controlled rotation of the femur based on the circumference of the bone and plate dimensions that occurs simultaneously with axial distraction. Clinical significance: These findings suggest a possible clinical application in the treatment of maltorsion in children by guided growth, where theplate design guides the bone into torsional axial growth correcting the deformity.
Collapse
Affiliation(s)
- Ahmed A Abood
- Department of Orthopaedics, Center for Clinical 3D Print, Aarhus University Hospital, Aarhus, Denmark.,Danish Paediatric Orthopaedic Research, Aarhus, Denmark
| | - Michel Bach Hellfritzsch
- Danish Paediatric Orthopaedic Research, Aarhus, Denmark.,Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne Møller-Madsen
- Department of Orthopaedics, Center for Clinical 3D Print, Aarhus University Hospital, Aarhus, Denmark.,Danish Paediatric Orthopaedic Research, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Annemarie Brüel
- Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark
| | | | | | - Ole Rahbek
- Danish Paediatric Orthopaedic Research, Aarhus, Denmark.,Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Duedal Rölfing
- Department of Orthopaedics, Center for Clinical 3D Print, Aarhus University Hospital, Aarhus, Denmark.,Danish Paediatric Orthopaedic Research, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
14
|
[Epiphysiodesis and hemiepiphysiodesis : Physeal arrest and guided growth for the lower extremity]. DER ORTHOPADE 2022; 51:415-432. [PMID: 35357554 PMCID: PMC9050799 DOI: 10.1007/s00132-022-04219-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 10/27/2022]
Abstract
The principals of growth arrest by epiphysiodesis and growth guidance by hemiepiphysiodesis are effective and powerful surgical techniques in pediatric orthopedics. These procedures can be used to correct leg length discrepancies as well as sagittal, coronal and oblique deformities. A differentiation is made between temporary and permanent techniques. The most significant advantage is that these techniques are minimally invasive and have low complication rates compared to acute osteotomy and gradual deformity correction. For optimal outcome an exact preoperative planning is needed to ensure accurate timing of the procedure, especially when permanent epiphysiodesis techniques are used. Although epiphysiodesis and hemiepiphysiodesis around the pediatric knee are most frequently used and can be considered the gold standard treatment of coronal plane deformities and leg length discrepancies, novel techniques for the hip and ankle are increasingly being performed. The successful clinical results with low complications support the broad use of hemiepiphysiodesis and epiphysiodesis for a variety of indications in the growing skeleton with deformities and leg length differences.
Collapse
|
15
|
Ozdemir E, Cetik RM, Ayvaz M, Yilmaz G. The efficacy of two-hole tension band plates in the treatment of lower extremity limb length discrepancy. J Pediatr Orthop B 2022; 31:e31-e36. [PMID: 33720078 DOI: 10.1097/bpb.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The main purpose of our study was to investigate the efficacy of dual two-hole tension band plates in the treatment of lower extremity limb length discrepancy (LLD). We retrospectively reviewed patients who underwent epiphysiodesis utilizing dual two-hole tension band plates due to lower extremity LLD between January 2012 and June 2018. The efficacy of epiphysiodesis was defined as the inhibited percentage of the expected growth of the physis between two time intervals and was calculated between 0-6 months and 6-18 months as the primary outcome. The relationship of efficacy of epiphysiodesis with time intervals, bone segments, physeal coverage percentage by the screws, age and interscrew angle and physeal health was also assessed. A total of 11 patients' 17 bone segments (9 femurs and 8 tibias) with a mean age of 8.7 ± 2.3 were included. The mean efficacy of the epiphysiodesis in the first 6 months for femurs was 23 ± 20 % (range, 0-53%) and for tibias was 21 ± 19 % (range, 0-53%); between 6 and 18 months it was 27 ± 19 % (range, 0-56%) for femurs and 15 ± 19 % (range, 0-50%) for tibias. In the first 6 months, physeal coverage percentage by the screws (r = 0.503, P = 0.04) and age (r = -0.534, P = 0.027) had a strong correlation with the epiphysiodesis efficacy. Dual two-hole tension band plating has variable efficacy in the treatment of LLD. Age and physeal coverage percentage by the screws could be related to epiphysiodesis efficacy.
Collapse
Affiliation(s)
- Erdi Ozdemir
- Department of Orthopaedics and Traumatology, Hacettepe University, Ankara, Turkey
| | | | | | | |
Collapse
|
16
|
Guided Growth in Leg Length Discrepancy in Beckwith-Wiedemann Syndrome: A Consecutive Case Series. CHILDREN 2021; 8:children8121152. [PMID: 34943348 PMCID: PMC8700625 DOI: 10.3390/children8121152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022]
Abstract
Beckwith-Wiedemann Syndrome (BWS) is a rare genetic disorder characterized by overgrowth, macroglossia, abdominal wall defects, neonatal hypoglycemia, predisposition to embryonal tumor, lateralized overgrowth, and leg length discrepancy (LLD), which can affect normal posture and gait. Aim of this study was to evaluate the effects of guided growth (temporary epiphysiodesis technique) as LLD management in BWS patients. Between 2007 and 2021, 22 BWS patients (15 F, 7 M) with a mean age of 7.9 years (2.9–14.4) and a mean LLD at first surgery of 3.65 cm (2–10), underwent temporary proximal tibial (PTE) and distal femur epiphysiodesis (DFE). In 18 patients the first surgical procedure was PTE, in one, DFE, and in 3 cases, PTE and DFE at the same time, respectively. Eleven patients reached equality of leg length after a mean follow-up of 7.7 years (3.7–13.0) and mean age of 13.3 years (12.7–27.5); 10 patients underwent 3 surgical procedures, one 7 procedures. Fifteen patients had no complications. No severe complications, infection, articular stiffness, or neuro-vascular lesions occurred in remaining patients; complications included secondary varus or valgus axial deviation in a total of 6 patients, and two screw breakages in two patients. Guided growth as a minimally invasive procedure seems efficient for LLD treatment with low complication rate in BWS patients.
Collapse
|
17
|
Sagade B, Jagani N, Chaudhary I, Chaudhary M. Congenital Posteromedial Bowing of Tibia: Comparison of Early and Late Lengthening. J Pediatr Orthop 2021; 41:e816-e822. [PMID: 34387229 DOI: 10.1097/bpo.0000000000001935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Congenital posteromedial bowing of tibia (CPMBT), a rare anomaly, is characterized by a decreasing deformity and a gradually increasing limb shortening. Lengthening in CPMBT has not been studied extensively. Our series compares the duration and complications of lengthening in younger versus older children to determine early lengthening safety and benefits. METHODS We studied 28 tibial lengthenings performed by a single surgeon in 23 patients, divided into 2 equal groups of 14 segments: group A 5 years or younger (preschool) and group B above 5 years. All were lengthened with circular external fixators, of which 3 were lengthened over a nail. We measured preoperative (bo) and postoperative (po) sagittal, coronal, and oblique plane deformities, initial limb length discrepancy (LLD), percentage LLD (% LLD), amount of lengthening (AmtL), percentage lengthening (%L), external fixator duration (EFD), and external fixator index (EFI). We graded complications by Lascombes' criteria, results by Association for the Study and Application of the Methods of Ilizarov bone score. RESULTS The mean age was 8.8±7.1 years; the mean follow-up was 7.9 years. Group A had significantly greater bo-sagittal, coronal, and oblique plane deformities. Mean LLD (3.4 cm in group A vs. 4.1 cm in group B) was similar in both. Expected LLD at maturity (LLDM) using the multiplier method was greater than previously reported (mean, range in group A: 7.2 cm, 4.4 to 9.5 cm; group B: 5 cm, 2.5 to 9.7 cm). Though AmtL (3.5 and 4.1 cm) was similar in both, %L was 24% in group A and 15.7% in group B (P=0.002). EFD (116.6 days) and EFI (33.7 days/cm) were lesser in group A compared with group B (200.3 days, P=0.001; 50.2 days/cm, P=0.01). Lascombes' triple contract was fulfilled in 11/14 lengthenings in group A versus 3/14 in group B. Association for the Study and Application of the Methods of Ilizarov bone score was good and excellent in both groups (P=0.44). CONCLUSIONS In a large series of lengthenings in CPMBT, we found younger children presenting with large deformities and large projected length discrepancies could be safely lengthened with significantly lesser EFD and complications than in older children. LEVEL OF EVIDENCE Level IV-therapeutic study.
Collapse
Affiliation(s)
- Bhushan Sagade
- Centre for Ilizarov Techniques, Chaudhary Hospital, Akola
| | | | - Ishani Chaudhary
- Sancheti Institute for Orthopedics and Rehabilitation, Pune, Maharashtra, India
| | | |
Collapse
|
18
|
Vogt B, Roedl R, Gosheger G, Frommer A, Laufer A, Kleine-Koenig MT, Theil C, Toporowski G. Growth arrest: leg length correction through temporary epiphysiodesis with a novel rigid staple (RigidTack). Bone Joint J 2021; 103-B:1428-1437. [PMID: 34334047 PMCID: PMC9948429 DOI: 10.1302/0301-620x.103b8.bjj-2020-1035.r4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Temporary epiphysiodesis (ED) is commonly applied in children and adolescents to treat leg length discrepancies (LLDs) and tall stature. Traditional Blount staples or modern two-hole plates are used in clinical practice. However, they require accurate planning, precise surgical techniques, and attentive follow-up to achieve the desired outcome without complications. This study reports the results of ED using a novel rigid staple (RigidTack) incorporating safety, as well as technical and procedural success according to the idea, development, evaluation, assessment, long-term (IDEAL) study framework. METHODS A cohort of 56 patients, including 45 unilateral EDs for LLD and 11 bilateral EDs for tall stature, were prospectively analyzed. ED was performed with 222 rigid staples with a mean follow-up of 24.4 months (8 to 49). Patients with a predicted LLD of ≥ 2 cm at skeletal maturity were included. Mean age at surgery was 12.1 years (8 to 14). Correction and complication rates including implant-associated problems, and secondary deformities as well as perioperative parameters, were recorded (IDEAL stage 2a). These results were compared to historical cohorts treated for correction of LLD with two-hole plates or Blount staples. RESULTS The mean LLD was reduced from 25.2 mm (15 to 45) before surgery to 9.3 mm (6 to 25) at skeletal maturity. Implant-associated complications occurred in 4/56 treatments (7%), and secondary frontal plane deformities were detected in 5/45 legs (11%) of the LLD cohort. Including tall stature patients, the rate increased to 12/67 legs (18%). Sagittal plane deformities were observed during 1/45 LLD treatments (2%). Compared to two-hole plates and Blount staples, similar correction rates were observed in all devices. Lower rates of frontal and sagittal plane deformities were observed using rigid staples. CONCLUSION Treatment of LLD using novel rigid staples appears a feasible and promising strategy. Secondary frontal and sagittal plane deformities remain a potential complication, although the rate seems to be lower in patients treated with rigid staples. Further comparative studies are needed to investigate this issue. Cite this article: Bone Joint J 2021;103-B(8):1428-1437.
Collapse
Affiliation(s)
- Bjoern Vogt
- Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany,Correspondence should be sent to Bjoern Vogt. E-mail:
| | - Robert Roedl
- Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany
| | - Georg Gosheger
- General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany
| | - Adrien Frommer
- Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany
| | - Andrea Laufer
- Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany
| | - Marie-Theres Kleine-Koenig
- Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany
| | - Christoph Theil
- General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany
| | - Gregor Toporowski
- Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany
| |
Collapse
|
19
|
Struwe C, Walter SG, Druschel C, Bornemann R, Ploeger M, Koob S, Placzek R. Biomechanical evaluation of temporary epiphysiodesis at the femoral epiphysis using established devices from clinical practice. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:41. [PMID: 33792782 PMCID: PMC8016773 DOI: 10.1007/s10856-021-06515-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
The aim of this study is to compare biomechanical features of different devices used in clinical routine for temporary epiphysiodesis (eight-Plate® and FlexTackTM). The tested implants were divided into four different groups (eight-Plate® vs. FlexTackTM for lateral and anterior implantation) á 10 samples for testing implanted eight-Plate® vs. FlexTackTM in fresh frozen pig femora for maximum load forces (Fmax) and axial physis distance until implant failure (lmax). A servo hydraulic testing machine (858 Mini Bionix 2) was used to exert and measure reproducible forces. Statistical analyses tested for normal distribution and significant (p < 0.05) differences in primary outcome parameters. There were no significant differences between the eight-Plate® lateral group and the FlexTackTM lateral group for neither Fmax (p = 0.46) nor lmax (p = 0.65). There was a significant higher Fmax (p < 0.001) and lmax (p = 0.001) measured in the eight-Plate® group compared to the FlexTackTM group when implanted anteriorly. In anterior temporary ephiphysiodesis, eight-Plate® demonstrated superior biomechanical stability. At this stage of research, there is no clear advantage of either implant and the choice remains within the individual preference of the surgeon.
Collapse
Affiliation(s)
- Charlotte Struwe
- Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Sebastian G Walter
- Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany.
| | - Claudia Druschel
- Department for Orthopedic Surgery and Traumatology, Carl-Gustav-Carus-Universität, Dresden, Germany
| | - Rahel Bornemann
- Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Milena Ploeger
- Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Sebastian Koob
- Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Richard Placzek
- Department for Orthopedic Surgery and Traumatology, Rheinische-Friedrich-Wilhelms-Universität, Bonn, Germany
| |
Collapse
|
20
|
Ballhause TM, Stiel N, Breyer S, Stücker R, Spiro AS. Does eight-plate epiphysiodesis of the proximal tibia in treating angular deformity create intra-articular deformity? Bone Joint J 2020; 102-B:1412-1418. [DOI: 10.1302/0301-620x.102b10.bjj-2020-0473.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Eight-plates are used to correct varus-valgus deformity (VVD) or limb-length discrepancy (LLD) in children and adolescents. It was reported that these implants might create a bony deformity within the knee joint by change of the roof angle (RA) after epiphysiodesis of the proximal tibia following a radiological assessment limited to anteroposterior (AP) radiographs. The aim of this study was to analyze the RA, complemented with lateral knee radiographs, with focus on the tibial slope (TS) and the degree of deformity correction. Methods A retrospective, single-centre study was conducted. The treatment group (n = 64 knees in 44 patients) was subclassified according to the implant location in two groups: 1) medial hemiepiphysiodesis; and 2) lateral hemiepiphysiodesis. A third control group consisted of 25 untreated knees. The limb axes and RA were measured on long standing AP leg radiographs. Lateral radiographs of 40 knees were available for TS analysis. The mean age of the patients was 10.6 years (4 to 15) in the treatment group and 8.4 years (4 to 14) in the control group. Implants were removed after a mean 1.2 years (0.5 to 3). Results No significant differences in RA (p = 0.174) and TS (p = 0.787) were observed. The limb axes were significantly corrected in patients with VVD (p < 0.001). The change in tibial slope (∆TS) did not correlate ( r = -0.026; p = 0.885) to the plate’s position on the physis when assessed by lateral radiographs. Conclusion We were not able to confirm the reported change in the bony morphology of the proximal tibia on AP radiographs in our patient population. In addition, no significant change in TS was detected on the lateral radiographs. A significant correction of the VVD in the lower limb axes was evident. Position of the implant did not correlate with TS change. Therefore, eight-plate epiphysiodesis is a safe and effective procedure for correcting VVD in children without disturbing the knee joint morphology. Cite this article: Bone Joint J 2020;102-B(10):1412–1418.
Collapse
Affiliation(s)
- Tobias M. Ballhause
- Department of Paediatric Orthopaedics, Altonaer Children’s Hospital, Hamburg, Germany
- Department of Traumatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Norbert Stiel
- Department of Paediatric Orthopaedics, Altonaer Children’s Hospital, Hamburg, Germany
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Breyer
- Department of Paediatric Orthopaedics, Altonaer Children’s Hospital, Hamburg, Germany
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Stücker
- Department of Paediatric Orthopaedics, Altonaer Children’s Hospital, Hamburg, Germany
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander S. Spiro
- Department of Paediatric Orthopaedics, Altonaer Children’s Hospital, Hamburg, Germany
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
21
|
Abstract
Over the past 5 years, published literature regarding treatment of pediatric limb deformity and limb length discrepancy demonstrates much interest in better understanding, categorizing and treating these challenging problems. Many studies explore expanding and refining indications for traditional treatment methods like guided growth techniques. Other studies have evaluated the results of new techniques such as lengthening via mechanized intramedullary nails. Additionally, series comparing older and newer techniques such as lengthening with external devices versus mechanized nails are becoming increasingly available.
Collapse
|
22
|
Hillebrand H, Sattelberger J, Gosheger G, Frommer A, Moller-Madsen B, Rahbek O, Gottliebsen M, Abood AAH, Roedl R, Vogt B. Comparison of Temporary Epiphysiodesis With RigidTacks™ and Blount-Staples in a Porcine Animal Model Using Magnetic Resonance Imaging. J Orthop Res 2020; 38:946-953. [PMID: 31743488 DOI: 10.1002/jor.24532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/25/2019] [Indexed: 02/04/2023]
Abstract
RigidTack™ is a newly developed implant for total temporary epiphyseodesis. The implant combines the technical advantages of the traditionally used rigid Blount-staples and the newer flexible eight-plates™. Thus, the implant is rigid like the Blount-staples, which may be a biomechanical advantage in temporary epiphyseodesis, and has an easy and guided implantation technique like the eight-plate™. As in eight-plates™, supposedly only two RigidTacks™ are sufficient for temporary epiphyseodesis compared to six Blount-staples in traditional treatment. The goal of this study was to compare Blount-staples and RigidTacks™ in regard to the total potential of growth arrest, the occurrence of postoperative implant-associated complications, secondary angular deformities, and central joint deformations. Twelve pigs were allocated in two groups (n = 6) for treatment of the proximal tibia. Total temporary epiphysiodesis was performed with either four Blount-staples or two RigidTacks™. Magnetic resonance imaging (MRI)-scans were performed before and 14 weeks after surgery, and the amount and distribution of growth arrest were evaluated by measuring the interphyseal distance in nine defined zones. Total temporary epiphysiodesis with two RigidTacks™ resulted in a similar amount of growth arrest as that of four Blount-staples. No significant coronal or sagittal angular deformities or joint deformities were observed in either group; however, one secondary loosening of a Blount-staple occurred. The study concluded that Blount-staples and RigidTacks™ are adequate implants for total temporary epiphysiodesis. Whether or not the precise implant-placement through the guided implantation technique of RigidTacks™ and a reduced number of implants indeed lead to a reduction of secondary angular deformities has to be investigated in further clinical trials. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 38:946-953, 2020.
Collapse
Affiliation(s)
- Hauke Hillebrand
- Paediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Munster, Germany
| | - Julia Sattelberger
- Paediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Munster, Germany
| | - Georg Gosheger
- General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Munster, Germany
| | - Adrien Frommer
- Paediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Munster, Germany
| | - Bjarne Moller-Madsen
- Danish Paediatric Orthopaedic Research, University Hospital Aarhus, Aarhus, Denmark
| | - Ole Rahbek
- Danish Paediatric Orthopaedic Research, University Hospital Aarhus, Aarhus, Denmark
| | - Martin Gottliebsen
- Danish Paediatric Orthopaedic Research, University Hospital Aarhus, Aarhus, Denmark
| | | | - Robert Roedl
- Paediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Munster, Germany
| | - Bjoern Vogt
- Paediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Munster, Germany
| |
Collapse
|