Treatment of the moderate leg length discrepancy in children using temporary bilateral blocking of the growth plate with plates and screws: first experience
The results of applying of temporary bilateral blocking (TBB) of the growth plate (GP) for moderate leg length discrepancy (LLD) treatment showed sufficient efficacy and safety. It is known some studies are skeptical to use this method.
Objective: to evaluate the results of moderate LLD treatment in children using TBB of the GP with plates and screws.
Methods: 33 patients (14 boys and 19 girls) with moderate LLD were treated using TBB of the GP with non-blocking plates with screws: in 24 patients TBB of the distal femoral GP, in 2 patients — TBB of the proximal tibial GP and in 7 patients — combined TBB of both GP was performed. The mean age of patients was 10.7 ± 2.6 years. LLD before treatment ranged from 2 to 5.5 cm (mean — 2.9 ± 0.68). Evaluation of LLD after TBB of the GP was performed in dynamics every 6–12 months using clinical and radiological methods. For assessment of the secondary deformities formation during treatment, we measured mLDFA and MPTA angles and the mechanical axis zone (MAZ).
Results: during the observation period, 25 patients have completed the treatment, 8 continued the treatment. Correction of the LLD of different values was noted in all patients (p < 0.05). At the time of TBB completion and removing of fixators, the mean LLD was 0.75 ± 0.82 cm. A good treatment results were obtained in 14 children (77.8 %), of which 7 children achieved a complete correction (50 %), fair — in 3 children (16.7 %), poor — in 1 child (5.5 %). The difference between the mean values of mLDFA and MPTA before and after the treatment was considered statistically insignificant (p > 0.05). Among the complications it should be noted moderate pain syndrome for 2 weeks — 2 cases (6 %), hemarthrosis — 1 case (3 %), contracture of the knee joint — 1 case (3 %), plate migration — 1 case (3 %), secondary angular deformation — 1 case (3 %).
Conclusions: the TBB of the GP with plates and screws using for moderate LLD treatment is effective and safe method. The amount of complications that required surgical intervention was 6 %.
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Ghanem, I., Karam, J. A., & Widmann, R. F. (2011). Surgical epiphysiodesis indications and techniques: update. Current Opinion in Pediatrics, 23 (1), 53–59. doi: 10.1097/mop.0b013e32834231b3
Eastwood, D. M., & Sanghrajka, A. P. (2011). Guided growth. The Journal of Bone and Joint Surgery. British volume, 93-B (1), 12–18. doi:10.1302/0301-620x.93b1.25181
Stevens, P. M. (2006). Guided growth: 1933 to the present. Strategies in Trauma and Limb Reconstruction, 1 (1), 29–35. doi:10.1007/s11751-006-0003-3
Burnei, G., Vlad, C., Gavriliu, S., Georgescu, I., Hodorogea, D., Pârvan, A., Burnei, C., El Nayef, T., & Drăghici, I. (2012). Upper and lower limb length equalization: diagnosis, limb lengthening and curtailment, epiphysiodesis. Romanian Journal of Internal Medicine, 50 (1), 43–59.
Stevens, P. M. (2016). The role of guided growth as it relates to limb lengthening. Journal of Children's Orthopaedics, 10 (6), 479–486. doi: 10.1007/s11832-016-0779-8
Lauge-Pedersen, H., & Hägglund, G. (2013). Eight plate should not be used for treating leg length discrepancy. Journal of Children's Orthopaedics, 7 (4), 285–288. doi: 10.1007/s11832-013-0506-7
Stewart, D., Cheema, A., & Szalay, E. A. (2013). Dual 8-Plate technique is not as effective as ablation for epiphysiodesis about the knee. Journal of Pediatric Orthopaedics, 33 (8), 843–846. doi: 10.1097/bpo.0b013e3182a11d23
Gaumétou, E., Mallet, C., Souchet, P., Mazda, K., & Ilharreborde, B. (2016). Poor efficiency of eight-plates in the treatment of lower limb discrepancy. Journal of Pediatric Orthopaedics, 36 (7), 715–719. doi:10.1097/bpo.0000000000000518
Lykissas, M. G., Jain, V. V., Manickam, V., Nathan, S., Eismann, E. A., & McCarthy, J. J. (2013). Guided growth for the treatment of limb length discrepancy. Journal of Pediatric Orthopaedics B, 22 (4), 311–317. doi: 10.1097/bpb.0b013e32836132f0
Pendleton, A. M., Stevens, P. M., & Hung, M. (2013). Guided growth for the treatment of moderate leg-length discrepancy. Orthopedics, 36 (5), e575–e580. doi: 10.3928/01477447-20130426-18
Gottliebsen, M., Shiguetomi-Medina, J. M., Rahbek, O., & Møller-Madsen, B. (2016). Guided growth: mechanism and reversibility of modulation. Journal of Children's Orthopaedics, 10 (6), 471–477. doi: 10.1007/s11832-016-0778-9
Siedhoff, M., Ridderbusch, K., Breyer, S., Stücker, R., & Rupprecht, M. (2014). Temporary epiphyseodesis for limb-length discrepancy. Acta Orthopaedica, 85 (6), 626–632. doi:10.3109/17453674.2014.960646
Paley, D. (2002). Principles of Deformity Correction. Berlin: Springer.
Stevens, P. M., MacWilliams, B., & Mohr, R. A. (2004). Gait analysis of stapling for genu valgum. Journal of Pediatric Orthopaedics, 70–74. doi: 10.1097/00004694-200401000-00013
Paley, D., Bhave, A., Herzenberg, J. E., & Bowen, J. R. (2000). Multiplier method for predicting limb-length discrepancy. The Journal of Bone and Joint Surgery. American Volume, 82 (10), 1432–1446. doi: 10.2106/00004623-200010000-00010
Kemnitz, S., Moens, P., & Fabry, G. (2003). Percutaneous epiphysiodesis for leg length discrepancy. Journal of Pediatric Orthopaedics, Part B, 12 (1), 69–71. doi: 10.1097/00009957-200301000-00013
Kemnitz, S., Moens, P., & Fabry, G. (2003). Percutaneous epiphysiodesis for leg length discrepancy. Journal of Pediatric Orthopaedics, Part B, 12(1), 69-71. doi: 10.1097/00009957-200301000-00013
Kömür, B., Coşkun, M., Kömür, A. A., & Oral, A. (2013). Permanent and temporary epiphysiodesis: an experimental study in a rabbit model. Acta Orthopaedica et Traumatologica Turcica, 47 (1), 48–54. doi: 10.3944/aott.2013.2949
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