Abstract
Purpose
To document the incidence and nature of complications associated with hemiepiphysiodesis using a screw and plate device (8-plate, Orthofix).
Methods
We reviewed case notes and radiographs of 71 children (130 segments) with lower limb deformities treated with temporary hemiepiphyseal arrest using the 8-plate. 96% of deformities were in the coronal plane, 4% sagittal. 72% of coronal deformities demonstrated valgus malalignment. We defined three types of complications:
early (perioperative) complications eg infection and/or wound breakdown, bleeding, neurological impairment
implant related complications such as soft tissue irritation, plate breakage or migration,
complications involving the growth plate including rebound deformity, early physeal closure or iatrogenic deformity.
Complications were related to variables of patient age, gender, diagnosis, location of deformity and associated surgery.
Results
The average age at surgery was 10 years (range 3-16). There were 41 boys, 30 girls. 3/70 patients were treated for an idiopathic deformity: the remainder were affected by a wide range of pathologies (20% skeletal dysplasia, 20% metabolic bone disease).
Full correction has occurred in 38% of patients. The remaining 45 children are all showing improvement in their deformity.
10 patients (14%) have had a complication: 3 patients had early complications (wound infection, wound breakdown and intra-operative hypotensive crisis) and 2 patients have had implant related complications (irritation and migration). In a further 5 patients there have been physis related problems: 1 over-correction, 1 recurrence and 3 cases in which the timing of the procedure or the ill-health of the physis did not allow correction to occur.
Conclusion
The 8-plate is an effective device in the management of deformity secondary to pathological conditions. 10% of patients had complications: the majority were minor but care should be taken regarding the timing of the procedure related to the growth potential of the pathological physis.
