Percutaneous epiphysiodesis using transphyseal
screws (PETS) has been developed for the treatment of lower limb discrepancies
with the aim of replacing traditional open procedures. The goal
of this study was to evaluate its efficacy and safety at skeletal
maturity. A total of 45 consecutive patients with a mean skeletal
age of 12.7 years (8.5 to 15) were included and followed until maturity.
The mean efficacy of the femoral epiphysiodesis was 35% (14% to 87%)
at six months and 66% (21% to 100%) at maturity. The mean efficacy
of the tibial epiphysiodesis was 46% (18% to 73%) at six months
and 66% (25% to 100%) at maturity. In both groups of patients the
under-correction was significantly reduced between six months post-operatively
and skeletal maturity. The overall rate of revision was 18% (eight
patients), and seven of these revisions (87.5%) involved the tibia.
This series showed that use of the PETS technique in the femur was
safe, but that its use in the tibia was associated with a significant
rate of complications, including a valgus deformity in nine patients
(20%), leading us to abandon it in the tibia. The arrest of growth
was delayed and the final loss of growth at maturity was only 66%
of that predicted pre-operatively. This should be taken into account
in the pre-operative planning.
It is a rare abnormality in children of which consequences are cosmetic and functional too.
The age of our patients ranged from 6 months to 13 years old. 50% of them were younger than 9 at the first visit. Functional consequences consisted in a modification of the plan of the movements of shoulder. Besides the omovertebral bone, many important abnormalities – mainly of the spine – have been noticed in our series. The cases were classified using the degree of elevation of the superomedial angle of scapula. Three grades could be set up. Concerning the treatment, 2 children have not been operated on. In the other cases, we used a modification of the Woodward procedure.
79% were considered as good on both aspects, cosmetically and functionally, with no complication. The age at which surgery has been performed seems to have no influence on the result. On the opposite, the number and the severity of the anatomic anomalies have to be taken into consideration for the prognostic assessment.