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The Bone & Joint Journal
Vol. 100-B, Issue 8 | Pages 1112 - 1116
1 Aug 2018
Sinha R Weigl D Mercado E Becker T Kedem P Bar-On E

Aims

Guided growth using eight-plates is commonly used for correction of angular limb deformities in growing children. The principle is of tethering at the physeal periphery while enabling growth in the rest of the physis. The method is also applied for epiphysiodesis to correct limb-length discrepancy (LLD). Concerns have been raised regarding the potential of this method to create an epiphyseal deformity. However, this has not been investigated. The purpose of this study was to detect and quantify the occurrence of deformities in the proximal tibial epiphysis following treatment with eight-plates.

Patients and Methods

A retrospective study was performed including 42 children at a mean age of 10.8 years (3.7 to 15.7) undergoing eight-plate insertion in the proximal tibia for correction of coronal plane deformities or LLD between 2007 and 2015. A total of 64 plates were inserted; 48 plates (34 patients) were inserted to correct angular deformities and 16 plates (8 patients) for LLD. Medical records, Picture Archive and Communication System images, and conventional radiographs were reviewed. Measurements included interscrew angle, lateral and medial plateau slope angles measured between the plateau surface and the line between the ends of the physis, and tibial plateau roof angle defined as 180° minus the sum of both plateau angles. Measurements were compared between radiographs performed adjacent to surgery and those at latest follow-up, and between operated and non-operated plateaus. Statistical analysis was performed using BMDP Statistical Software.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 513 - 513
1 Aug 2008
Bar-On E Becker T Katz K Weigl D
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We present a new technique for corrective osteotomies in the lower limbs.

The method combines the advantages of both external and internal fixation as well as minimizing soft tissue disruption and scarring.

Material and Methods: Between January 2004 and August 2006, eleven osteotomies were performed on six patients. Mean age was 9.5 yrs. (6.4–15.9) Underlying pathology included cerebral palsy (3 pts), microcephaly (1), giant axonal neuropathy (1) and post traumatic growth disturbance (1). Osteotomies were performed in seven femurs (bilateral in 3 pts and unilateral in 1) and 4 tibias (2 pts bilaterally). Correction was in the transverse plane in four pts (4 femurs & 4 tibias), in the sagittal plane in one pt (2 femurs) and in multiple planes in one pt (1 femur).

Surgical Technique:

Insertion of Schanz screws perpendicular to the deformed segments

Osteotomy at planned level through small incision.

Correction of deformity and application of temporary external fixator.

Percutaneous insertion of submuscular extraperiosteal plate and fixation with locking screws.

Removal of external fixator.

Results: All limbs were corrected to within 3 degrees of planned correction.

Patients were allowed full ambulation. Casts were applied only if soft tissue releases were performed concomitantly. Ambulation as tolerated was initiated post operatively. There were no surgical complications. All osteotomies showed good callus formation within 6 weeks.

The plate was removed uneventfully from one patient.

Discussion: Multiple methods have been described for corrective osteotomies in long bones. They vary in the osteotomy level, degree of exposure, osteotomy technique and fixation method. The technique presented has the advantage of minimal violation of the periosteum and the surrounding musculature, inducing early bony union and good rehabilitation. The temporary external fixation enables accurate correction and intraoperative assessment.

Disadvantages include increased surgical time and radiation exposure – however these decrease with the learning curve and hardware improvements.