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10.02.2025 | Beindeformitäten | CME

Wachstumslenkung bei kindlichen Achs- und Torsionsfehlern

verfasst von: Dr. med. Andrea Laufer, PD Dr. med. Adrien Frommer, Prof. Dr. med. Robert Rödl, Dr. med. Henning Tretow, PD Dr. med. Gregor Toporowski, Prof. Dr. med. Björn Vogt

Erschienen in: Knie Journal | Ausgabe 1/2025

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Zusammenfassung

Die Beurteilung von Achs- und Torsionsverhältnissen der unteren Extremitäten ist in der Kinderorthopädie essenziell, um zwischen physiologischen Entwicklungsprozessen und pathologischen Deformitäten zu unterscheiden. Frontale Achsabweichungen zeigen meist einen günstigen Spontanverlauf, können jedoch bei persistierenden oder stark ausgeprägten Fehlstellungen biomechanische Konsequenzen und Beschwerden verursachen. Zur Korrektur hat sich die Wachstumslenkung mittels temporärer Hemiepiphysiodese als Goldstandard etabliert. Torsionsfehlstellungen der unteren Gliedmaße erfordern eine differenzierte Diagnostik und werden bei Therapiebedürftigkeit bislang primär durch Korrekturosteotomien behandelt. Zwar gibt es erste Ansätze für wachstumsmodulierende Verfahren zur Torsionskorrektur, welche jedoch klinisch noch nicht regelhaft zum Einsatz kommen. Regelmäßige Nachkontrollen und die korrekte Terminierung der wachstumslenkenden Eingriffe sind für den Behandlungserfolg entscheidend.
Literatur
1.
Zurück zum Zitat Salenius P, Vankka E (1975) The development of the tibiofemoral angle in children. J Bone Joint Surg Am 57:259–261CrossRefPubMed Salenius P, Vankka E (1975) The development of the tibiofemoral angle in children. J Bone Joint Surg Am 57:259–261CrossRefPubMed
2.
Zurück zum Zitat Oest O (1978) The significance of axial misalignment as a pre-osteoarthrotic deformity, and its radiological assessment. Unfallheilkunde 81:629–633PubMed Oest O (1978) The significance of axial misalignment as a pre-osteoarthrotic deformity, and its radiological assessment. Unfallheilkunde 81:629–633PubMed
3.
Zurück zum Zitat Stevens PM (2007) Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop 27:253–259CrossRefPubMed Stevens PM (2007) Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop 27:253–259CrossRefPubMed
4.
Zurück zum Zitat Stevens PM, Maguire M, Dales MD et al (1999) Physeal stapling for idiopathic genu valgum. J Pediatr Orthop 19:645–649CrossRefPubMed Stevens PM, Maguire M, Dales MD et al (1999) Physeal stapling for idiopathic genu valgum. J Pediatr Orthop 19:645–649CrossRefPubMed
5.
Zurück zum Zitat Ghanem I, Karam JA, Widmann RF (2011) Surgical epiphysiodesis indications and techniques: update. Curr Opin Pediatr 23:53–59CrossRefPubMed Ghanem I, Karam JA, Widmann RF (2011) Surgical epiphysiodesis indications and techniques: update. Curr Opin Pediatr 23:53–59CrossRefPubMed
6.
Zurück zum Zitat Vogt B, Toporowski G, Gosheger G et al (2023) Guided growth: angular deformity correction through temporary hemiepiphysiodesis with a novel flexible staple (FlexTack). Bone Joint J 105–B:331–340CrossRefPubMed Vogt B, Toporowski G, Gosheger G et al (2023) Guided growth: angular deformity correction through temporary hemiepiphysiodesis with a novel flexible staple (FlexTack). Bone Joint J 105–B:331–340CrossRefPubMed
7.
Zurück zum Zitat Westhoff B, Jager M, Krauspe R (2007) Axes of the legs in childhood. What is pathologic? Orthopade 36:485–498CrossRefPubMed Westhoff B, Jager M, Krauspe R (2007) Axes of the legs in childhood. What is pathologic? Orthopade 36:485–498CrossRefPubMed
8.
Zurück zum Zitat Vogt B, Schiedel F, Rodl R (2014) Guided growth in children and adolescents. Correction of leg length discrepancies and leg axis deformities. Orthopade 43:267–284CrossRefPubMed Vogt B, Schiedel F, Rodl R (2014) Guided growth in children and adolescents. Correction of leg length discrepancies and leg axis deformities. Orthopade 43:267–284CrossRefPubMed
9.
Zurück zum Zitat Paley D (2002) Malalignment and Malorientation in the Frontal Plane. In: Paley D (Hrsg) Principles of Deformity Correction. Springer, Berlin, Heidelberg, S 19–30CrossRef Paley D (2002) Malalignment and Malorientation in the Frontal Plane. In: Paley D (Hrsg) Principles of Deformity Correction. Springer, Berlin, Heidelberg, S 19–30CrossRef
10.
Zurück zum Zitat Vogt B, Frommer A, Gosheger G et al (2021) Growth modulation through hemiepiphysiodesis : Novel surgical techniques: risks and progress. Orthopade 50:538–547CrossRefPubMed Vogt B, Frommer A, Gosheger G et al (2021) Growth modulation through hemiepiphysiodesis : Novel surgical techniques: risks and progress. Orthopade 50:538–547CrossRefPubMed
11.
Zurück zum Zitat Frommer A, Laufer AM, Toporowski G et al (2024) Angular and torsional malalignments of the paediatric knee joint. Orthopädie 53:631–645CrossRefPubMed Frommer A, Laufer AM, Toporowski G et al (2024) Angular and torsional malalignments of the paediatric knee joint. Orthopädie 53:631–645CrossRefPubMed
12.
Zurück zum Zitat Bowen JR, Johnson WJ (1984) Percutaneous epiphysiodesis. Clin Orthop Relat Res: 170–173 Bowen JR, Johnson WJ (1984) Percutaneous epiphysiodesis. Clin Orthop Relat Res: 170–173
13.
Zurück zum Zitat Canale ST, Christian CA (1990) Techniques for epiphysiodesis about the knee. Clin Orthop Relat Res: 81–85 Canale ST, Christian CA (1990) Techniques for epiphysiodesis about the knee. Clin Orthop Relat Res: 81–85
14.
Zurück zum Zitat Blount WP, Clarke GR (1949) Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Joint Surg Am 31A:464–478CrossRefPubMed Blount WP, Clarke GR (1949) Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Joint Surg Am 31A:464–478CrossRefPubMed
15.
Zurück zum Zitat Metaizeau JP, Wong-Chung J, Bertrand H et al (1998) Percutaneous epiphysiodesis using transphyseal screws (PETS). J Pediatr Orthop 18:363–369CrossRefPubMed Metaizeau JP, Wong-Chung J, Bertrand H et al (1998) Percutaneous epiphysiodesis using transphyseal screws (PETS). J Pediatr Orthop 18:363–369CrossRefPubMed
16.
Zurück zum Zitat Phemister DB (1933) Operative arrestment of longitudinal growth of bones in the treatment of deformities. JBJS 15:1–15 Phemister DB (1933) Operative arrestment of longitudinal growth of bones in the treatment of deformities. JBJS 15:1–15
17.
Zurück zum Zitat Ramseier LE, Sukthankar A, Exner GU (2009) Minimal invasive epiphysiodesis using a modified “Canale”-technique for correction of angular deformities and limb leg length discrepancies. J Child Orthop 3:33–37CrossRefPubMedCentralPubMed Ramseier LE, Sukthankar A, Exner GU (2009) Minimal invasive epiphysiodesis using a modified “Canale”-technique for correction of angular deformities and limb leg length discrepancies. J Child Orthop 3:33–37CrossRefPubMedCentralPubMed
18.
Zurück zum Zitat Burghardt RD, Herzenberg JE, Standard SC et al (2008) Temporary hemiepiphyseal arrest using a screw and plate device to treat knee and ankle deformities in children: a preliminary report. J Child Orthop 2:187–197CrossRefPubMedCentralPubMed Burghardt RD, Herzenberg JE, Standard SC et al (2008) Temporary hemiepiphyseal arrest using a screw and plate device to treat knee and ankle deformities in children: a preliminary report. J Child Orthop 2:187–197CrossRefPubMedCentralPubMed
19.
Zurück zum Zitat Degreef I, Moens P, Fabry G (2003) Temporary epiphysiodesis with Blount stapling for treatment of idiopathic genua valga in children. Acta Orthop Belg 69:426–432PubMed Degreef I, Moens P, Fabry G (2003) Temporary epiphysiodesis with Blount stapling for treatment of idiopathic genua valga in children. Acta Orthop Belg 69:426–432PubMed
20.
Zurück zum Zitat Raab P, Wild A, Seller K et al (2001) Correction of length discrepancies and angular deformities of the leg by Blount’s epiphyseal stapling. Eur J Pediatr 160:668–674CrossRefPubMed Raab P, Wild A, Seller K et al (2001) Correction of length discrepancies and angular deformities of the leg by Blount’s epiphyseal stapling. Eur J Pediatr 160:668–674CrossRefPubMed
21.
Zurück zum Zitat Park SS, Kang S, Kim JY (2016) Prediction of rebound phenomenon after removal of hemiepiphyseal staples in patients with idiopathic genu valgum deformity. Bone Joint J 98-B:1270–1275CrossRefPubMed Park SS, Kang S, Kim JY (2016) Prediction of rebound phenomenon after removal of hemiepiphyseal staples in patients with idiopathic genu valgum deformity. Bone Joint J 98-B:1270–1275CrossRefPubMed
22.
Zurück zum Zitat Bakircioglu S, Kolac UC, Yigit YA et al (2023) Does the Sleeper Plate Application for Temporary Epiphysiodesis Make Life Easier or Complicated? Increased Risk of Tethering. J Pediatr Orthop 43:572–577CrossRefPubMed Bakircioglu S, Kolac UC, Yigit YA et al (2023) Does the Sleeper Plate Application for Temporary Epiphysiodesis Make Life Easier or Complicated? Increased Risk of Tethering. J Pediatr Orthop 43:572–577CrossRefPubMed
23.
Zurück zum Zitat Keshet D, Katzman A, Zaidman M et al (2019) Removal of Metaphyseal Screw Only After Hemiepiphysiodesis Correction of Coronal Plane Deformities Around the Knee Joint: Is This a Safe and Advisable Strategy? J Pediatr Orthop 39:e236–e239CrossRefPubMed Keshet D, Katzman A, Zaidman M et al (2019) Removal of Metaphyseal Screw Only After Hemiepiphysiodesis Correction of Coronal Plane Deformities Around the Knee Joint: Is This a Safe and Advisable Strategy? J Pediatr Orthop 39:e236–e239CrossRefPubMed
24.
Zurück zum Zitat Jani L, Schwarzenbach U, Afifi K et al (1979) Progression of idiopathic coxa antetorta. a) Spontaneous progression of idiopathic coxa antetorta (controlled clinical study of 148 patients at the end of adolescence). Orthopade 8:5–11PubMed Jani L, Schwarzenbach U, Afifi K et al (1979) Progression of idiopathic coxa antetorta. a) Spontaneous progression of idiopathic coxa antetorta (controlled clinical study of 148 patients at the end of adolescence). Orthopade 8:5–11PubMed
25.
Zurück zum Zitat Grisch D, Dreher T (2019) Torsion and torsional development of the lower extremities. Orthopade 48:523–530CrossRefPubMed Grisch D, Dreher T (2019) Torsion and torsional development of the lower extremities. Orthopade 48:523–530CrossRefPubMed
26.
Zurück zum Zitat Weinberg DS, Park PJ, Morris WZ et al (2017) Femoral Version and Tibial Torsion are Not Associated With Hip or Knee Arthritis in a Large Osteological Collection. J Pediatr Orthop 37:e120–e128CrossRefPubMed Weinberg DS, Park PJ, Morris WZ et al (2017) Femoral Version and Tibial Torsion are Not Associated With Hip or Knee Arthritis in a Large Osteological Collection. J Pediatr Orthop 37:e120–e128CrossRefPubMed
27.
Zurück zum Zitat Paley D, Shannon C (2022) Rotational Guided Growth: A Preliminary Study of Its Use in Children. Children 10: Paley D, Shannon C (2022) Rotational Guided Growth: A Preliminary Study of Its Use in Children. Children 10:
28.
Zurück zum Zitat Abood AA, Hellfritzsch MB, Møller-Madsen B et al (2022) Controlled rotation of long bones by guided growth: A proof of concept study of a novel plate in cadavers. J Orthop Res 40:1075–1082CrossRefPubMed Abood AA, Hellfritzsch MB, Møller-Madsen B et al (2022) Controlled rotation of long bones by guided growth: A proof of concept study of a novel plate in cadavers. J Orthop Res 40:1075–1082CrossRefPubMed
29.
Zurück zum Zitat Abood AA, Rolfing JD, Halloum A et al (2024) An Innovative Plate Concept for Rotational Guided Growth: A Porcine Pilot Study. Cureus 16:e58169PubMedCentralPubMed Abood AA, Rolfing JD, Halloum A et al (2024) An Innovative Plate Concept for Rotational Guided Growth: A Porcine Pilot Study. Cureus 16:e58169PubMedCentralPubMed
30.
Zurück zum Zitat Cobanoglu M, Cullu E, Kilimci FS et al (2016) Rotational deformities of the long bones can be corrected with rotationally guided growth during the growth phase. Acta Orthop 87:301–305CrossRefPubMedCentralPubMed Cobanoglu M, Cullu E, Kilimci FS et al (2016) Rotational deformities of the long bones can be corrected with rotationally guided growth during the growth phase. Acta Orthop 87:301–305CrossRefPubMedCentralPubMed
31.
Zurück zum Zitat Martel GA, Holmes L, Sobrado G et al (2018) Rotational-Guided Growth. J Limb Lengthening Reconstr 4:97–105CrossRef Martel GA, Holmes L, Sobrado G et al (2018) Rotational-Guided Growth. J Limb Lengthening Reconstr 4:97–105CrossRef
32.
Zurück zum Zitat Metaizeau JD, Denis D, Louis D (2019) New femoral derotation technique based on guided growth in children. Orthop Traumatol Surg Res 105:1175–1179CrossRefPubMed Metaizeau JD, Denis D, Louis D (2019) New femoral derotation technique based on guided growth in children. Orthop Traumatol Surg Res 105:1175–1179CrossRefPubMed
33.
Zurück zum Zitat Halloum A, Kold S, Rolfing JD et al (2024) Correction of rotational deformities in long bones using guided growth: a scoping review. Efort Open Rev 9:119–128CrossRefPubMedCentralPubMed Halloum A, Kold S, Rolfing JD et al (2024) Correction of rotational deformities in long bones using guided growth: a scoping review. Efort Open Rev 9:119–128CrossRefPubMedCentralPubMed
Metadaten
Titel
Wachstumslenkung bei kindlichen Achs- und Torsionsfehlern
verfasst von
Dr. med. Andrea Laufer
PD Dr. med. Adrien Frommer
Prof. Dr. med. Robert Rödl
Dr. med. Henning Tretow
PD Dr. med. Gregor Toporowski
Prof. Dr. med. Björn Vogt
Publikationsdatum
10.02.2025
Verlag
Springer Medizin
Erschienen in
Knie Journal / Ausgabe 1/2025
Print ISSN: 2662-4028
Elektronische ISSN: 2662-4036
DOI
https://doi.org/10.1007/s43205-025-00310-0