Development of distal metaepiphysis of the femur in conditions of temporary bilateral blocking of the growth zone (experimental study)

Authors

  • Sergey Khmyzov
  • Victor Rokutov
  • Dmytro Iershov

DOI:

https://doi.org/10.15674/0030-59872017348-53

Keywords:

experimental research, growth zone, temporary bilateral blocking, secondary deformations

Abstract

The use of minimally invasive methods of blocking the long bones growth zone to eliminate the difference in the length of the lower extremities in children is a modern and promising direction. The technique of temporary bilateral blocking of growth zone with screw plates has potential advantages, however, the formation of secondary frontal deformations remains an insufficiently studied issue.

Objective: to evaluate the formation of the distal metaepiphysis of the femur in conditions of temporary bilateral blocking of growth zone with plates of different types.

Methods: temporary bilateral blocking of the distal growth zone of the right femur is performed in 10 white rabbits at the age of 8 weeks and weighing (1.8 ± 0.2) kg. Animals were divided into groups: 1 (5 rabbits) — non-blocking plates were used, 2 (5) — blocked. An overview radiograph of the lower extremities of the animals was performed immediately after the operation after 3, 5 and 7 weeks. The radiographs were evaluated according to the Paley protocol, mLDFA, PSA, DSA, distance between the «wires-growth zone» in three zones (medial, middle and lateral) were determined.

Results: the inhibition of longitudinal growth of growth zone was revealed when both types of plates were used. There were no differences in the angular parameters of the distal femur (mLDFA) between the groups. In group 1, the PSA and DSA values increased significantly during the growth process (p < 0.05), in group 2 — remained unchanged for the entire follow-up period. A significant increase in the «spine-growth zone» distance on the limb in question was noted in group 1 rabbits in the middle zone in dynamics.

Conclusions: temporary bilateral blocking growth zone using both types of plates with screws leads to inhibition of its longitudinal growth. During blocking, there were no secondary deformations of the distal metaepiphysis of the femur. Slight growth of the distal growth zone, especially in the middle zone, indicates a residual growth in temporary bilateral blocking conditions with non-blocking plates.

Author Biographies

Sergey Khmyzov

Sytenko Institute of Spine and Joint Pathology, Kharkiv. Ukraine

MD, Prof. in Orthopaedics and Traumatology

s.khmyzov@gmail.com

Victor Rokutov

CI «Dnipropetrovsk city hospital of emergency care». Ukraine

v_rokutov@ua.fm

Dmytro Iershov

CI «Dnipropetrovsk clinical medical center for mother and child named by prof. Rudnev» DRC». Ukraine

PhD

tnm100@gmail.com

References

  1. Ghanem I. Karam JA, Widmann RF. Surgical epiphysiodesis indications and techniques: update. Curr Opin Pediatr. 2011;23(1):53-9. doi: 10.1097/MOP.0b013e32834231b3.
  2. Burnei G, Vlad C, Gavriliu S, Georgescu I, Hodorogea D, Pârvan A, Burnei C, El Nayef T, Drăghici I. Upper and lower limb length equalization: diagnosis, limb lengthening and curtailment, epiphysiodesis. Rom J Intern Med. 2012;50(1):43-9.
  3. Ilharreborde B, Gaumetou E, Souchet P, Fitoussi F, Presedo A, Penneçot GF, Mazda K. Efficacy and late complications of percutaneous epiphysiodesis using transphyseal screws. J Bone Joint Surg Br. 2012;94(2):270-5. doi: 10.1302/0301-620X.94B2.27470.
  4. Pendleton AM, Stevens PM, Hung M. Guided growth for the treatment of moderate leg-length discrepancy. Orthopedics. 2013;36(5):e575-80. doi: 10.3928/01477447-20130426-18.
  5. Stewart D, Cheema A, Szalay EA. Dual 8-plate technique is not as effective as ablation for epiphysiodesis about the knee. J Pediatr Orthop. 2013;33(8):843-6. doi: 10.1097/BPO.0b013e3182a11d23.
  6. Gaumétou E, Mallet C, Souchet P, Mazda K, Ilharreborde B. Poor efficiency of eight-plates in the treatment of lower limb discrepancy. J Pediatr Orthop. 2016;36(7):715-9. doi: 10.1097/BPO.0000000000000518.
  7. Ross TK, Zionts LE. Comparison of different methods used to inhibit physeal growth in a rabbit model. Clin Orthop Relat Res. 1997;340:236-43.
  8. Widmann RF, Amaral TD, Yildiz C, Yang X, Bostrom M. Percutaneous radiofrequency epiphysiodesis in a rabbit model. A pilot study. Clin Orthop Relat Res. 2010;468(7):1943-8. doi: 10.1007/s11999-010-1286-8.
  9. Gottliebsen M, Mоller-Madsen B, Stоdkilde-Jоrgensen H, Rahbek Controlled O. longitudinal bone growth by temporary tension band plating: an experimental study. Bone Joint J. 2013;95-B(6):855-60. doi: 10.1302/0301-620X.95B6.29327.
  10. Komur B, Coskun M, Komur AA, Oral A. Permanent and temporary epiphysiodesis: an experimental study in a rabbit model. Acta Orthop Traumatol Turc. 2013;47(1):48-54.
  11. Hall-Craggs EC, Lawrence CA. The effect of epiphysial stapling on growth in length of the rabbits tibia and femur. J Bone Joint Surg Br. 1969;51(2):359-65.
  12. Paley D, Pfeil J. Principles of deformity correction around the knee. Orthopade. 2000;29(1):18-38.
  13. Filipenko VA, Miteleva ZM, Petrenko DE, et al. Theoretical substantiation of the selection of the leg of cementless endoprosthetic of the hip joint. Bulletin of Orthopedics, Traumatology and Prosthetics. 2003;2:32–36. (in Ukrainian)

How to Cite

Khmyzov, S., Rokutov, V., & Iershov, D. (2017). Development of distal metaepiphysis of the femur in conditions of temporary bilateral blocking of the growth zone (experimental study). ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (3), 48–53. https://doi.org/10.15674/0030-59872017348-53

Issue

Section

ORIGINAL ARTICLES