Rebound growth after hemiepiphysiodesis may be
a normal event, but little is known about its causes, incidence
or factors related to its intensity. The aim of this study was to
evaluate rebound growth under controlled experimental conditions. A total of 22 six-week-old rabbits underwent a medial proximal
tibial hemiepiphysiodesis using a two-hole plate and screws. Temporal
growth plate arrest was maintained for three weeks, and animals
were killed at intervals ranging between three days and three weeks
after removal of the device. The radiological angulation of the proximal
tibia was studied at weekly intervals during and after hemiepiphysiodesis.
A histological study of the retrieved proximal physis of the tibia
was performed. The mean angulation achieved at three weeks was 34.7° (standard
deviation ( In our rabbit model, rebound was an event of variable incidence
and intensity and, when present, did not appear immediately after
restoration of growth, but took some time to appear. Cite this article:
The concept of guided growth was proposed by Andry in 1741. In the last decades the concept has been widely used as implants has been introduced that can modulate the growth of the bone and pediatric longitudinal and
Introduction. Epiphysiodesis, defined as the process of closing the growth plate (physis), have been used for several years as a treatment option of cases where the predicted leg-length discrepancy (LLD) falls between 2 to 5 cm. The aim of this study was to systematically review the existing literature on the effectiveness of three different epiphysiodesis techniques with implant usage for the treatment of leg-length discrepancy in the pediatric population. The secondary aim was to address the reported complications of staples, tension-band plates (TBP) and percutaneous epiphysiodesis screws (PETS). Method. This systematic review was performed according to PRISMA guidelines. We searched MEDLINE (PubMed), Embase, Cochrane Library, Web of Science and Scopus for studies on skeletally immature patients with LLD treated with epiphysiodesis with an implant. The extracted outcome categories were effectiveness of epiphysiodesis (LLD measurements pre/post-operatively, successful/unsuccessful) and complications that were graded on severity. Result. Forty-four studies (2184 patients) were included, from whom 578 underwent TBP, 455 PETS and 1048 staples. From pooled analysis of the studies reporting success rate, 64% (150/234) successful TBP surgeries (10 studies), 78% (222/284) successful PETS (9 studies) and 52% (212/407) successful Blount staples (8 studies). Severe complications rate was 7% for PETS, 17% for TBP and 16% for Blount staples. TBP had 43 cases of
The aim of this scoping review is to understand the extent and type of evidence in relation to the use of guided growth for correcting rotational deformities of long bones. Guided growth is routinely used to correct
Abstract. Objectives. Epiphysiodesis is a commonly used treatment for lower limb
Summary Statement. The implantation of scaffold-free CTE from suspension culture into growth-plate defects resulted in a significant reduction in growth arrest of the rabbit tibia. Introduction. In childhood and adolescence, the growth plate injury can cause partial premature arrest of growth plate, which can make problems such as leg length discrepancy and
The use of retrograde femoral intramedullary nails in children for deformity correction is controversial. It is unknown if the injury to the central part of the growth plate results in premature bony union, leading to limb deformities or discrepancies. The aim of this study was to assess physeal healing and bone growth after insertion of a retrograde femoral nail thorough the centre of the physis in a skeletally immature experimental porcine model. Eleven immature pigs were included in the study. One leg was randomised for operation with a retrograde femoral nail (diameter 10.7 mm), whilst the non-operated contralateral remained as control. All nails were inserted centrally in coronal and sagittal plane under fluoroscopic guidance, and the nails spanned the physis. The nails were removed at 8 weeks. Both femora in all animals underwent MRI at baseline (pre-operatively), 8 weeks (after nail removal) and 16 weeks (before euthanasia). Femoral bone length was measured at 5 sites (anterior, posterior, central, lateral and medial) using 3d T1-weighted MRI. Growth was calculated after 8 weeks (growth with nail) and 16 weeks (growth without nail). Physeal cross-sectional area and percentage violated by the nail was determined on MRI. Operated side was compared to non-operated. Corresponding 95% confidence intervals were calculated. No differences in axial growth were observed between operated and non-operated sides. Mean growth difference was 0,61 mm [−0,78;2,01] whilst the nail was inserted into the bone and 0,72 mm [−1,04;1,65] after nail removal. No signs of
Aim. To investigate the effect of the eight plate position in sagittal plane on tibial slope in temporary epiphysiodesis technique applied to the proximal tibia and whether there is a rebound effect after removing the plate. Method. Forty New Zealand rabbits (6 weeks old) were divided into four groups. In all groups, two 1.3 mm mini plates and cortical screws implantation were placed on both medial and lateral side of the proximal epiphysis of the right tibia. In Group 1 and 3, the plates were placed on anterior of the proximal tibial anatomical axis in the sagittal plane, and placed posteriorly in Group 2 and 4. The left tibia was examined as control in all groups. Group 1 and Group 2 were sacrificed after four week-follow-up. In Group 3 and Group 4, the implants were removed four weeks after index surgery and the rabbits were followed four more weeks to investigate the rebound effect. The tibial slope was measured on lateral X-rays every two weeks. Both medial and lateral plateau slopes were evaluated on photos of the dissected tibia. Results. In Group 1, right MTPA (medial tibial plateau angle) and left MTPA, right LTPA (lateral tibial plateau angle) and left LTPA, and right 4wTPPA (the tibial proximal posterior angle at 4th week) and left 4wTPPA values were compared with each other. There was a significant difference in MTPA, LTPA, and 4wTPPA in Group 1 (p: 0.003, 0.006, 0.004). In Group 1, the medial and lateral slope significantly decreased after 4 weeks. There was no significant difference in MTPA, LTP and 4wTPPA measurements in Group 2 (p= 0.719, 0.306, 0.446, respectively). In Group 2, the slope did not change in four weeks. There was a significant difference in MTPA, LTPA, 4wTPPA, and 8wTPPA (tibial proximal posterior angle at 8th week) in Group 3 (p= 0.005, 0.002, <0.001, <0.001, respectively). In Group 3, the slope decreased at 4th week and remained stabile during the next four week-follow up and no rebound effect was observed. There was no significant difference in MTPA, LTPA, 4wTPPA, and 8wTPPA measurements in Group 4 (p= 0.791, 0.116, 0.232, 0.924), respectively. In group 4, slope did not change at 4th week of index surgery and no rebound effect was observed in the next four week-follow up. Conclusion. If eight plates were placed on anterior of lateral proximal tibia axis on both medial and lateral side, the tibial slope would reduce, and remain stabile after implant removal. Care should be taken to place the plates on the line of proximal tibial axis in sagittal plane in temporary epiphysiodesis technique performed due to
The aim is to report a rare technique for correction of intramedullary nail acute
Axial forces were measured during limb lengthening in a series of ten patients with varying pathologies in order to assess the mechanical characteristics of the distracted tissues and the levels of axial force to which soft tissues are subjected during leg lengthening. The pattern of force was found to vary according to the underlying pathology. For post-traumatic shortening in adults both the peak and the resting forces rose steadily during lengthening reaching maximum forces of the order of 300 N. Patients with congenitally short limbs developed very high peak forces (in some cases over 1000 N) and also showed large amounts of force relaxation (typically 400 to 500 N). When very high levels of force were recorded, there was a higher complication rate. In particular, there was a high instance of
We have assessed the influence of isolated and combined rotational malunion of the radius and ulna on the rotation of the forearm. Osteotomies were made in both the radius and the ulna at the mid-diaphyseal level of five cadaver forearms and stabilised with intramedullary metal implants. Malunion about the axis of the respective forearm bone was produced at intervals of 10°. The ranges of pronation and supination were recorded by a potentiometer under computer control. We examined rotational malunions of 10° to 80° of either the radius or ulna alone and combined rotational malunions of 20° to 60° of both the radius and ulna. Malunion of the ulna in supination had little effect on rotation of the forearm. Malunion of either the radius or of the ulna in pronation gave a moderate reduction of rotation of the forearm. By contrast, malunion of the radius in supination markedly reduced rotation of the forearm, especially with malunion greater than 60°. Combined rotational malunion produced contrasting results. A combination of rotational malunion of the radius and ulna in the same direction had an effect similar to that of an isolated malunion of the radius. A combination in the opposite direction gave the largest limitation of the range of movement. Clinically, rotational malunion may be isolated or part of a complex
The aim of this experimental study on New Zealand’s white rabbits
was to investigate the transplantation of autogenous growth plate
cells in order to treat the injured growth plate. They were assessed
in terms of measurements of radiological tibial varus and histological
characteristics. An experimental model of plate growth medial partial resection
of the tibia in 14 New Zealand white rabbits was created. During
this surgical procedure the plate growth cells were collected and
cultured. While the second surgery was being performed, the autologous
cultured growth plate cells were grafted at the right tibia, whereas
the left tibia was used as a control group. Objectives
Methods
This review is aimed at clinicians appraising
preclinical trauma studies and researchers investigating compromised bone
healing or novel treatments for fractures. It categorises the clinical
scenarios of poor healing of fractures and attempts to match them
with the appropriate animal models in the literature. We performed an extensive literature search of animal models
of long bone fracture repair/nonunion and grouped the resulting
studies according to the clinical scenario they were attempting
to reflect; we then scrutinised them for their reliability and accuracy
in reproducing that clinical scenario. Models for normal fracture repair (primary and secondary), delayed
union, nonunion (atrophic and hypertrophic), segmental defects and
fractures at risk of impaired healing were identified. Their accuracy
in reflecting the clinical scenario ranged greatly and the reliability
of reproducing the scenario ranged from 100% to 40%. It is vital to know the limitations and success of each model
when considering its application.