Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling: a randomized clinical trial on guided growth for idiopathic genu valgum

Martin Gottliebsen, Ole Rahbek, Ivan Hvid, Michael Davidsen, Michel Bach Hellfritzsch, Bjarne Møller-Madsen, Martin Gottliebsen, Ole Rahbek, Ivan Hvid, Michael Davidsen, Michel Bach Hellfritzsch, Bjarne Møller-Madsen

Abstract

Background: In children with angulating deformities of the lower limbs, hemiepiphysiodesis can be used to guide growth to achieve better alignment at skeletal maturity. Traditionally, this has been performed with staples. The tension-band plating technique is new and it has been advocated because it is believed to reduce the risk of premature closure of the growth plate compared to stapling. The benefit of the tension-band plating technique has not yet been proven in experimental or randomized clinical studies.

Methods: We performed a randomized clinical trial in which 26 children with idiopathic genu valgum were allocated to stapling or tension-band plating hemiepiphysiodesis. Time to correction of the deformity was recorded and changes in angles on long standing radiographs were measured. Pain score using visual analog scale (VAS) was recorded for the first 72 h postoperatively. Analgesics taken were recorded by the parents.

Results: Mean treatment times for stapling hemiepiphysiodesis (n = 10) and for tension-band plating hemiepiphysiodesis (n = 10) were similar. Postoperative VAS scores and consumption of analgesics were also similar in both groups. No hardware failure or wound-related infection was observed.

Interpretation: Treatment time for the 2 treatment modalities was not significantly different in this randomized clinical trial. Tension-band plating and stapling appeared to have a similar effect regarding correction of genu valgum. We cannot rule out type-II error and the possibility that our study was underpowered. ClinicalTrials.gov Identifier: NCT01641354.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3639343/bin/ORT-84-202-g001.jpg
A. Genu valgum prior to medial stapling of the distal femoral physes. B. Before removal of implants. C. Genu valgum prior to medial hemiepiphysiodesis of the distal femoral physes using the tension-band plating technique. D. Correction of genu valgum before removal of implants.

References

    1. Aykut US, Yazici M, Kandemir U, Gedikoglu G, Aksoy MC, Cil A, Surat A. The effect of temporary hemiepiphyseal stapling on the growth plate: a radiologic and immunohistochemical study in rabbits. J Pediatr Orthop. 2005;25(3):336–41.
    1. Ballal MS, Bruce CE, Nayagam S. Correcting genu varum and genu valgum in children by guided growth: Temporary hemiepiphysiodesis using tension band plates. J Bone Joint Surg (Br) 2010;92(2):273–6.
    1. Blount WP, Clarke GR. Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Joint Surg (Am) 1949;31(3):464–78.
    1. Burghardt RD, Herzenberg JE. Temporary hemiepiphysiodesis with the eight-Plate for angular deformities: mid-term results. J Orthop Sci. 2010;15(5):699–704.
    1. Burghardt RD, Herzenberg JE, Standard SC, Paley D. Temporary hemiepiphyseal arrest using a screw and plate device to treat knee and ankle deformities in children: a preliminary report. J Child Orthop. 2008;(2):187–97.
    1. Burghardt RD, Specht SC, Herzenberg JE. Mechanical Failures of eight-Plate Guided Growth System for Temporary Hemiepiphysiodesis. J Pediatr Orthop. 2010;30(6):594–7.
    1. Burghardt RD, Kanellopoulos AD, Herzenberg JE. Hemiepiphyseal arrest in a porcine model. J Pediatr Orthop. 2011;31(4):e25–e29.
    1. Courvoisier A, Eid A, Merloz P. Epiphyseal stapling of the proximal tibia for idiopathic genu valgum. J Child Orthop. 2009;3(3):217–21.
    1. Frantz CH. Epiphyseal stapling: a comprehensive review. Clin Orthop. 1971;77:149–57.
    1. Fraser RK, Dickens DR, Cole WG. Medial physeal stapling for primary and secondary genu valgum in late childhood and adolescence. J Bone Joint Surg (Br) 1995;77(5):733–5.
    1. Goyeneche RA, Primomo CE, Lambert N, Miscione H. Correction of bone angular deformities: experimental analysis of staples versus 8-plate. J Pediatr Orthop. 2009;29(7):736–40.
    1. Jelinek EM, Bittersohl B, Martiny F, Scharfstadt A, Krauspe R, Westhoff B. The 8-plate versus physeal stapling for temporary hemiepiphyseodesis correcting genu valgum and genu varum: a retrospective analysis of thirty five patients. Int Orthop. 2012;36(3):599–605.
    1. Kanellopoulos AD, Mavrogenis AF, Dovris D, Vlasis K, Burghart R, Soucacos PN, Papagelopoulos PJ, Herzenberg JE. Temporary hemiepiphysiodesis with blount staples and eight-plates in pigs. Orthopedics. 2011;34(4)
    1. Mast N, Brown NA, Brown C, Stevens PM. Validation of a genu valgum model in a rabbit hind limb. J Pediatr Orthop. 2008;28(3):375–80.
    1. McNeely JK, Trentadue NC. Comparison of patient-controlled analgesia with and without nighttime morphine infusion following lower extremity surgery in children. J Pain Symptom Manage. 1997;13(5):268–73.
    1. Mielke CH, Stevens PM. Hemiepiphyseal stapling for knee deformities in children younger than 10 years: a preliminary report. J Pediatr Orthop. 1996;16(4):423–9.
    1. Niethard M, Deja M, Rogalski M. Correction of angular deformity of the knee in growing children by temporary hemiepiphyseodesis using the eight-plate. Z Orthop Unfall. 2010;148(2):215–21.
    1. Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop. 1992;(280):48–64.
    1. Schroerlucke S, Bertrand S, Clapp J, Bundy J, Gregg FO. Failure of Orthofix eight-Plate for the Treatment of Blount Disease. J Pediatr Orthop. 2009;29(1):57–60.
    1. Stevens P. Guided growth. 1933 the present. Strategies in Trauma and Limb Reconstruction. 2006;1(1):29–35.
    1. Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop. 2007;27(3):253–9.
    1. Stevens PM, Maguire M, Dales MD, Robins AJ. Physeal stapling for idiopathic genu valgum. J Pediatr Orthop. 1999;19(5):645–9.
    1. Wiemann JM, Tryon C, Szalay EA. Physeal stapling versus 8-plate hemiepiphysiodesis for guided correction of angular deformity about the knee. J Pediatr Orthop. 2009;29(5):481–5.
    1. Zuege RC, Kempken TG, Blount WP. Epiphyseal stapling for angular deformity at the knee. J Bone Joint Surg (Am) 1979;61(3):320–9.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する