Temporarily blocking of bone growth areas for the correction of angular epimetaphyseal deformities of the knee joint in children

Mykola Korzh, Sergey Khmyzov, Oleksandr Korolkov, Dmytro Iershov, Andrey Pashenko

Abstract


Objective: To present outcomes of applying of a method of tempo­rary blocking of long bones’ sprout area for treatment of frontal angular knee joint deformities (FAKJD) in children. Methods: From 2010 to 2014 at the clinic of the Institute we treated 14 patients (9 boys, 5 girls) with FAKJD (mean age 11 years 2 months). In 8 patients (57.1 %) we revealed varus, and in 6 (42.85 %) valgus deformity. Among children with varus FAKJD in 7 of them we diagnosed Erlacher-Blount disease, and in 1 we found postosteomyelitic deformation. In patients with valgus FAKJD in 5 cases we revealed dysplastic deformities, and in 1 — postosteomyelitic deformation. We performed clinical examination with measurement of tibial-femoral angle (TFA) and X-ray protocol proposed by D. Paley. The average value of clinical TFA in patients with varus FAKJD was 15° (10° to 24°), and with valgus — 13,25° (11° to 18°). In all patients we performed temporary blocking of long bones’ sprout area using the plate with two screws. Control examinations were performed every 3 months. We defined clinical TFA, radiological assessment of deformation conducted according to D. Paley. After reaching full correction of deformity we removed plates. Results: Full correction of FAKJD in 13 patients there was in a period of 7 to 16 months. In one child with varus FAKJD (age 10 years) correction for 14 months could not be reached because of the lack of growth of the patient. The average speed of correction of deformation was 0,9° per month. Complications during treatment were not recorded. Conclusions: Minimally invasive method presented is effective in treating FAKJD in children with Erlacher-Blount disease, and with deformities of dysplastic and postosteomyelitic etiology.


Keywords


temporary blocking of the sprout zone; genu valgum; genu varum; deformation of the lower extremities; treatment; children

References


Blount W. P. Control of bone growth by epiphyseal stapling: a preliminary report / W. P. Blount, G. R. Clarke // J. Bone Joint Surg. — 1949. — Vol. 3-A. — P. 464–478.

Burghardt R. D. A technical note on improved instrumentation for Blount staple insertion / R. D. Burghardt, A. D. Kanellopoulos, J. E. Herzenberg // J. Children’s Orthopaedics. — 2012. — Vol. 6 (4). — Р. 347–350, doi: 10.1007/s11832-012-0422-2.

Our experience with correction of angular deformities of knee by flexible figure of 8-plate hemiepiphysiodesis / S. P. Das, S. Pradhan, P. K. Sahoo [et al.] // IJPMR. — 2012. — Vol. 23 (2). — P. 68–73.

Eastwood D. M. Guided growth: recent advances in a deep-rooted concept / D. M. Eastwood, A. P. Sanghrajka // J. Bone Joint Surg. — 2011. — Vol. 93-B. — P. 12–18, doi: 10.1302/0301-620X.93B1.25181.

Engel G. M. The natural history of torsion and other factors influencing gait in childhood. A study of the angle of gait, tibial torsion, knee angle, hip rotation, and development of the arch in normal children // G. M. Engel, L. T. Staheli // Clin. Orthop. Relat. Res. — 1974. — Vol. 99. — P. 12–17.

Fraser R. K. Medial physeal stapling for primary and secondary genu valgum in late childhood and adolescence / R. K. Fraser, D. R. Dickens, W. G. Cole // J. Bone Joint Surg. — 1995. — Vol. 77-B. — P. 733–735.

Correction of bone angular deformities: experimental analysis of staples versus 8-plate / R. A. Goyeneche, C. E. Primomo, N. Lambert, H. Miscione // J. Pediatr. Orthop. — 2009. — Vol. 29 (7). — P. 736–740, doi: 10.1097/BPO.0b013e3181b529fc.

Growth-plate cartilage metabolic response to mechanical stress / F. Greco, L. de Palma, N. Specchia [et al.] // J. Pediatr. Orthop. — 1989. — Vol. 9. — P. 520–524.

Greene W. B. Infantile tibia vara / W. B. Greene // Instr. Course Lect. 1993. — Vol. 42. — P. 525–538.

Heath C. H. Normal limits of knee angle in white children- genu varum and genu valgum / C. H. Heath, L. T. Staheli // J. Pediatr. Orthop. — 1993. — Vol. 13. — P. 259–262.

Pediatric orthopedics in practice / F. Hefti, R. Brunner, F. Freuler [et al.]. — New York: Springer, 2007. — 781 p.

Hofmann A. Blount’s disease after skeletal maturity / A. Hofmann, R. E. Jones, J. A. Herring // J. Bone Joint Surg. — 1982. — Vol. 64-A (7). — P. 1004–1009.

Long-term results after infantile Blount’s disease / T. Ingvarsson, G. Hagglund, B. Ramgren [et al.] // J. Pediatr. Orthop. B. — 1998. — Vol. 7. — P. 226–229.

Paley D. Principles of deformity correction / D. Paley. — Berlin: Springer, 2002. — 806 p.

Sabharwal S. Blount disease / S. Sabharwal // J. Bone Joint Surg. — 2009. — Vol. 91-A (7). — P. 1758–1776, doi: 10.2106/JBJS.H.01348.

Saran N. Guided growth for the correction of pediatric lower limb angular deformity / N. Saran, K. E. Rathjen // J. Am. Acad. Orthop. Surg. — 2010. — Vol. 18 (9). — P. 528–536.

Salenius P. The development of the tibiofemoral angle in children / P. Salenius, E. Vankka // J. Bone Joint Surg. — 1975. — Vol. 57-A. — P. 259–261.

Stevens P. M. Guided growth for angular correction. A preliminary series using a tension band plate / P. M. Stevens // J. Pediatr. Orthop. — 2007. — Vol. 27. — P. 253–259.

Stevens P. M. Hemiepiphysiodesis for posttraumatic tibial valgus / P. M. Stevens, F. Pease // J. Pediatr. Orthop. — 2006. — Vol. 26 (3). — P. 385–392.

Trueta J. The vascular contribution to osteogenesis. III Changes in the growth cartilages caused by experimentally induced ischaemi / J. Trueta, V. P. Amato // J. Bone Joint Surg. — 1960. — Vol. 42. — P. 571–587.




DOI: https://doi.org/10.15674/0030-59872014470-74

Refbacks

  • There are currently no refbacks.


Copyright (c) 2014 Mykola Korzh, Sergey Khmyzov, Oleksandr Korolkov, Dmytro Iershov, Andrey Pashenko

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.