Abstract
The purpose of this study is TO describe and illustrate a new method of reversible hemi-physeal tethering utilized for correcting various angular deformities of the extremities. Since hemi-physeal stapling was first introduced by Dr. Blount in 1950, this method has waxed and waned in popularity. Some associated problems include staple migration or breakage necessitating premature revision surgery. The author has devised a new construct comprising a two-hole plate and two screws to achieve gradual correction of deformities while averting the problems of hardware migration or breakage. In a pilot study, 25 children with 40 physeal deformities have been treated since 2001 utilizing the plate method. The children ranged in age from 19 months to 15 years and had a variety of underlying diagnoses. The plate is placed extraperiosteally and is removed upon attaining a neutral mechanical axis. No postoperative immobilization or limitation of weightbearing is required. In all cases short-term follow-up reveals improvement or resolution of deformity without need for osteotomy. Complications have included two early migration of short screws (< 16 mm) necessitating exchange for longer screws. There have been no premature or permanent physeal closures and no other significant peripoerative complications. Growth guidance employing a two hole plate and screws offers a secure and flexible means of redirecting the physis (es) in order to accomplish safe and gradual correction of angular deformities in children. Growth is reversible; the treatment is modular and may be repeated prn.
