Correction of coronal plane deformities around knee in children with two-hole tension band plates

Erdi Özdemir, Abdülsamet Emet, Rafik Ramazanov, Güney Yılmaz, Erdi Özdemir, Abdülsamet Emet, Rafik Ramazanov, Güney Yılmaz

Abstract

Objectives: This study aims to present the 10-year results and complications of two-hole tension band plate hemiepiphysiodesis for coronal deformities around knee in a large population from a single center.

Patients and methods: Seventy-seven patients (46 boys, 31 girls; mean age 93±36 months; range, 22 to 181 months) who underwent temporary hemiepiphysiodesis around knee between January 2009 and January 2019 with two-hole tension band plates were retrospectively evaluated. Improvement of joint orientation angles and mechanical axis deviations, deformity correction rates, etiology groups, and complications were noted.

Results: A total of 166 bone segments (93 femurs, 73 tibias) were included in the study. Mean follow-up duration after the implantation was 36±17 (range, 12 to 88) months. Plates were removed at mean 18±8 (range, 7 to 47) months of implantation. Of the bone segments, 95.2% (n=158) responded successfully to the plates. Mean correction rate of mechanical lateral distal femoral angle in femoral valgum deformity was 0.94±0.43° (range, 0.17 to 2.22)/month and mean correction rate of mechanical medial proximal tibial angle in tibial valgum deformity was 0.62±0.36° (range, 0.11 to 1.55)/month. Mean correction rate of mechanical lateral distal femoral angle in femoral varum deformity was 1.3±0.8° (range, 0.48 to 2.92)/month and mean correction rate of mechanical medial proximal tibial angle in tibial varum deformity was 0.94±0.49° (range, 0.26 to 1.67)/month. The most common complication observed was rebound deformity seen in 41.2% (n=70) of the bone segments. Nine bone segments had persistent hemiepiphysiodesis despite plate removal. Four screw breakages (three metaphysial and one epiphysial) were observed.

Conclusion: Two-hole tension band plate hemiepiphysiodesis appears to be an effective and safe method for the correction of coronal deformities around knee.

Conflict of interest statement

Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Figures

Figure 1. (a) Preoperative full-length lower extremity…
Figure 1. (a) Preoperative full-length lower extremity weight-bearing radiograph of a 10-year-old female patient with idiopathic bilateral genu valgum deformity. (b) Latest radiograph before implant removal following 12 months of treatment with two-hole tension band plates demonstrated correction of deformity.
Figure 2. (a) Preoperative full-length lower extremity…
Figure 2. (a) Preoperative full-length lower extremity weight-bearing radiograph of a seven-year-old female patient with bilateral genu varum deformity due to Blount's disease. (b) Deformity was corrected in 23 months with two-hole tension band plate treatment.

References

    1. Boero S, Michelis MB, Riganti S. Use of the eight-Plate for angular correction of knee deformities due to idiopathic and pathologic physis: initiating treatment according to etiology. J Child Orthop. 2011;5:209–216.
    1. Metcalf MH, Barrett GR. Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Am J Sports Med. 2004;32:675–680.
    1. van Lieshout WAM, Martijn CD, van Ginneken BTJ, van Heerwaarden RJ. Medial collateral ligament laxity in valgus knee deformity before and after medial closing wedge high tibial osteotomy measured with instrumented laxity measurements and patient reported outcome. J Exp Orthop. 2018;5:49–49.
    1. Tanamas S, Hanna FS, Cicuttini FM, Wluka AE, Berry P, Urquhart DM. Does knee malalignment increase the risk of development and progression of knee osteoarthritis. A systematic review. Arthritis Rheum. 2009;61:459–467.
    1. Goldman V, Green DW. Advances in growth plate modulation for lower extremity malalignment (knock knees and bow legs) Curr Opin Pediatr. 2010;22:47–53.
    1. Phemister DB. Operative Arrestment of longitudinal growth of bones in the treatment of deformities. JBJS. 1933;15:1–15.
    1. Stevens PM. Guided growth: 1933 to the present. Strategies Trauma Limb Reconstr. 2006;1:29–35.
    1. Mielke CH, Stevens PM. Hemiepiphyseal stapling for knee deformities in children younger than 10 years: a preliminary report. J Pediatr Orthop. 1996;16:423–429.
    1. Raab P, Wild A, Seller K, Krauspe R. Correction of length discrepancies and angular deformities of the leg by Blount's epiphyseal stapling. Eur J Pediatr. 2001;160:668–674.
    1. Métaizeau JP, Wong-Chung J, Bertrand H, Pasquier P. Percutaneous epiphysiodesis using transphyseal screws (PETS) J Pediatr Orthop. 1998;18:363–369.
    1. Shin SJ, Cho TJ, Park MS, Bae JY, Yoo WJ, Chung CY, et al. Angular deformity correction by asymmetrical physeal suppression in growing children: stapling versus percutaneous transphyseal screw. J Pediatr Orthop. 2010;30:588–593.
    1. Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop. 2007;27:253–259.
    1. El-Sobky TA, Samir S, Baraka MM, Fayyad TA, Mahran MA, Aly AS, et al. Growth Modulation for Knee Coronal Plane Deformities in Children With Nutritional Rickets: A Prospective Series With Treatment Algorithm. e19J Am Acad Orthop Surg Glob Res Rev. 2020;4
    1. Atik OŞ. Is there something new and interesting in my article. Eklem Hastalik Cerrahisi. 2019;30:69–69.
    1. Atik OŞ. What are the expectations of an editor from a scientific article. Jt Dis Relat Surg. 2020;31:597–598.
    1. Mycoskie PJ. Complications of osteotomies about the knee in children. Orthopedics. 1981;4:1005–1015.
    1. Burghardt RD, Herzenberg JE. Temporary hemiepiphysiodesis with the eight-Plate for angular deformities: mid-term results. J Orthop Sci. 2010;15:699–704.
    1. Zajonz D, Schumann E, Wojan M, Kübler FB, Josten C, Bühligen U, et al. Treatment of genu valgum in children by means of temporary hemiepiphysiodesis using eight- plates: short-term findings. BMC Musculoskelet Disord. 2017;18:456–456.
    1. Danino B, Rödl R, Herzenberg JE, Shabtai L, Grill F, Narayanan U, et al. Guided growth: preliminary results of a multinational study of 967 physes in 537 patients. J Child Orthop. 2018;12:91–96.
    1. Guzman H, Yaszay B, Scott VP, Bastrom TP, Mubarak SJ. Early experience with medial femoral tension band plating in idiopathic genu valgum. J Child Orthop. 2011;5:11–17.
    1. Zampogna B, Vasta S, Amendola A, Uribe-Echevarria Marbach B, Gao Y, Papalia R, et al. Assessing lower limb alignment: comparison of standard knee X ray vs long leg view. Iowa Orthop J. 2015;35:49–54.
    1. Blount WP, Clarke GR. Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Joint Surg [Am] 1949;31:464–478.
    1. Kumar A, Gaba S, Sud A, Mandlecha P, Goel L, Nayak M. Comparative study between staples and eight plate in the management of coronal plane deformities of the knee in skeletally immature children. J Child Orthop. 2016;10:429–437.
    1. Burghardt RD, Specht SC, Herzenberg JE. Mechanical failures of eight-plateguided growth system for temporary hemiepiphysiodesis. J Pediatr Orthop. 2010;30:594–597.

Source: PubMed

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