Skip to main content
main-content
Erschienen in: Journal of Children's Orthopaedics 3/2011

01.06.2011 | Original Clinical Article

Use of the eight-Plate for angular correction of knee deformities due to idiopathic and pathologic physis: initiating treatment according to etiology

verfasst von: Silvio Boero, Maria Beatrice Michelis, Simone Riganti

Erschienen in: Journal of Children's Orthopaedics | Ausgabe 3/2011

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Angular deformities of the knee resulting from idiopathic, congenital, or acquired causes are commonly encountered in pediatric orthopedics. Whereas physiological deformities should be treated expectantly, the remaining often progress enough to warrant operative treatment, despite attempted bracing. Historical methods of surgical treatment (e.g., epiphysiodesis and stapling) have yielded to the increasingly popular method of reversible guided growth using the eight-Plate.

Methods

We studied 58 patients with knee angular deformities managed with eight-Plate guided growth. All etiologies except physiological deformities and those with very slow growth rate were included. Each patient was under appropriate medical management during the entire duration of treatment and after plate removal.

Results

In the dysplasia/syndrome group, we noted complete correction in 22 patients (78.5%), partial correction in 5 (17.9%), and no correction in 1 patient (3.6%). All cases of idiopathic deformities resolved. Patients with osteochondral dysplasias and genetic syndromes underwent earlier intervention and slower correction than those with idiopathic genu varum or valgum. The time difference in reaching a neutral mechanical axis between the two groups (11 months in idiopathic versus 18 months in pathological physis) could be explained by a significant difference in growth speeds (P = 0.003).

Conclusion

Results indicate that early intervention is advisable for patients with osteochondral dysplasias/syndromes as subsequent correction takes longer. If rebound growth causing recurrent deformity occurs, guided growth can be safely repeated. Additionally, complications reported with other techniques such as hardware failure, physeal violation by the implant, premature physeal closure, and overcorrection were not reported while using the eight-Plate.
Literatur
1.
Zurück zum Zitat Stevens P (2006) Guided growth: 1933 to the present. Strategies Trauma Limb Reconstr 1(1):29–35 CrossRef Stevens P (2006) Guided growth: 1933 to the present. Strategies Trauma Limb Reconstr 1(1):29–35 CrossRef
2.
Zurück zum Zitat Brooks WC, Gross RH (1995) Genu varum in children: diagnosis and treatment. J Am Acad Orthop Surg 3(6):326–335 Brooks WC, Gross RH (1995) Genu varum in children: diagnosis and treatment. J Am Acad Orthop Surg 3(6):326–335
3.
Zurück zum Zitat Fabry G, MacEwen GD, Shands AR Jr (1973) Torsion of the femur. A follow-up study in normal and abnormal conditions. J Bone Joint Surg Am 55(8):1726–1738 Fabry G, MacEwen GD, Shands AR Jr (1973) Torsion of the femur. A follow-up study in normal and abnormal conditions. J Bone Joint Surg Am 55(8):1726–1738
4.
Zurück zum Zitat Stevens PM, Klatt JB (2008) Guided growth for pathological physes: radiographic improvement during realignment. J Pediatr Orthop 28(6):632–639 CrossRef Stevens PM, Klatt JB (2008) Guided growth for pathological physes: radiographic improvement during realignment. J Pediatr Orthop 28(6):632–639 CrossRef
5.
Zurück zum Zitat Mycoskie P (1981) Complication of osteotomies about the knee in children. Orthopedics 4:1005–1015 Mycoskie P (1981) Complication of osteotomies about the knee in children. Orthopedics 4:1005–1015
6.
Zurück zum Zitat Steel HH, Sandrow RE, Sullivan PD (1971) Complications of tibial osteotomy in children for genu varum or valgum. Evidence that neurological changes are due to ischemia. J Bone Joint Surg Am 53(8):1629–1635 Steel HH, Sandrow RE, Sullivan PD (1971) Complications of tibial osteotomy in children for genu varum or valgum. Evidence that neurological changes are due to ischemia. J Bone Joint Surg Am 53(8):1629–1635
7.
Zurück zum Zitat Blount WP, Clarke GR (1949) Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Joint Surg Am 31A(3):464–478 Blount WP, Clarke GR (1949) Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Joint Surg Am 31A(3):464–478
8.
Zurück zum Zitat Bylski-Austrow DI, Wall EJ, Rupert MP, Roy DR, Crawford AH (2001) Growth plate forces in the adolescent human knee: a radiographic and mechanical study of epiphyseal staples. J Pediatr Orthop 21(6):817–823 Bylski-Austrow DI, Wall EJ, Rupert MP, Roy DR, Crawford AH (2001) Growth plate forces in the adolescent human knee: a radiographic and mechanical study of epiphyseal staples. J Pediatr Orthop 21(6):817–823
9.
Zurück zum Zitat Frantz CH (1971) Epiphyseal stapling: a comprehensive review. Clin Orthop Relat Res 77:149–157 Frantz CH (1971) Epiphyseal stapling: a comprehensive review. Clin Orthop Relat Res 77:149–157
10.
Zurück zum Zitat Zuege RC, Kempken TG, Blount WP (1979) Epiphyseal stapling for angular deformity at the knee. J Bone Joint Surg Am 61(3):320–329 Zuege RC, Kempken TG, Blount WP (1979) Epiphyseal stapling for angular deformity at the knee. J Bone Joint Surg Am 61(3):320–329
11.
Zurück zum Zitat Brockway A, Craig WA, Cockreli BR Jr (1954) End-result study of sixty-two stapling operations. J Bone Joint Surg Am 36(5):1063–1070 Brockway A, Craig WA, Cockreli BR Jr (1954) End-result study of sixty-two stapling operations. J Bone Joint Surg Am 36(5):1063–1070
12.
Zurück zum Zitat Mielke CH, Stevens PM (1996) Hemiepiphyseal stapling for knee deformities in children younger than 10 years: a preliminary report. J Pediatr Orthop 16(4):423–429 CrossRef Mielke CH, Stevens PM (1996) Hemiepiphyseal stapling for knee deformities in children younger than 10 years: a preliminary report. J Pediatr Orthop 16(4):423–429 CrossRef
13.
Zurück zum Zitat Stevens PM, Maguire M, Dales MD, Robins AJ (1999) Physeal stapling for idiopathic genu valgum. J Pediatr Orthop 19(5):645–649 Stevens PM, Maguire M, Dales MD, Robins AJ (1999) Physeal stapling for idiopathic genu valgum. J Pediatr Orthop 19(5):645–649
14.
Zurück zum Zitat Métaizeau J-P, Wong-Chung J, Bertrand H, Pasquier P (1998) Percutaneous epiphysiodesis using transphyseal screws (PETS). J Pediatr Orthop 18(3):363–369 Métaizeau J-P, Wong-Chung J, Bertrand H, Pasquier P (1998) Percutaneous epiphysiodesis using transphyseal screws (PETS). J Pediatr Orthop 18(3):363–369
15.
Zurück zum Zitat Burghardt R, Herzenberg J, Standard S, Paley D (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(3):187–197 CrossRef Burghardt R, Herzenberg J, Standard S, Paley D (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(3):187–197 CrossRef
16.
Zurück zum Zitat Stevens PM, Pease F (2006) Hemiepiphysiodesis for posttraumatic tibial valgus. J Pediatr Orthop 26(3):385–392 CrossRef Stevens PM, Pease F (2006) Hemiepiphysiodesis for posttraumatic tibial valgus. J Pediatr Orthop 26(3):385–392 CrossRef
17.
Zurück zum Zitat Nouth F, Kuo LA (2004) Percutaneous epiphysiodesis using transphyseal screws (PETS): prospective case study and review. J Pediatr Orthop 24(6):721–725 CrossRef Nouth F, Kuo LA (2004) Percutaneous epiphysiodesis using transphyseal screws (PETS): prospective case study and review. J Pediatr Orthop 24(6):721–725 CrossRef
18.
Zurück zum Zitat Novais E, Stevens PM (2006) Hypophosphatemic rickets: the role of hemiepiphysiodesis. J Pediatr Orthop 26(2):238–244 CrossRef Novais E, Stevens PM (2006) Hypophosphatemic rickets: the role of hemiepiphysiodesis. J Pediatr Orthop 26(2):238–244 CrossRef
19.
Zurück zum Zitat Ballal MS, Bruce CE, Nayagam S (2010) Correcting genu varum and genu valgum in children by guided growth: temporary hemiepiphysiodesis using tension band plates. J Bone Joint Surg Br 92(2):273–276 CrossRef Ballal MS, Bruce CE, Nayagam S (2010) Correcting genu varum and genu valgum in children by guided growth: temporary hemiepiphysiodesis using tension band plates. J Bone Joint Surg Br 92(2):273–276 CrossRef
20.
Zurück zum Zitat Stevens PM (2007) Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop 27(3):253–259 CrossRef Stevens PM (2007) Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop 27(3):253–259 CrossRef
21.
Zurück zum Zitat Schroerlucke S, Bertrand S, Clapp J, Bundy J, Gregg FO (2009) Failure of Orthofix eight-Plate for the treatment of Blount disease. J Pediatr Orthop 29(1):57–60 CrossRef Schroerlucke S, Bertrand S, Clapp J, Bundy J, Gregg FO (2009) Failure of Orthofix eight-Plate for the treatment of Blount disease. J Pediatr Orthop 29(1):57–60 CrossRef
22.
Zurück zum Zitat Salenius P, Vankka E (1975) The development of the tibiofemoral angle in children. J Bone Joint Surg Am 57(2):259–261 Salenius P, Vankka E (1975) The development of the tibiofemoral angle in children. J Bone Joint Surg Am 57(2):259–261
23.
Zurück zum Zitat Heath CH, Staheli LT (1993) Normal limits of knee angle in white children-genu varum and genu valgum. J Pediatr Orthop 13(2):259–262 Heath CH, Staheli LT (1993) Normal limits of knee angle in white children-genu varum and genu valgum. J Pediatr Orthop 13(2):259–262
24.
Zurück zum Zitat Kling TF Jr, Hensinger RN (1983) Angular and torsional deformities of the lower limbs in children. Clin Orthop Relat Res 176:136–147 Kling TF Jr, Hensinger RN (1983) Angular and torsional deformities of the lower limbs in children. Clin Orthop Relat Res 176:136–147
25.
Zurück zum Zitat Levine AM, Drennan JC (1982) Physiological bowing and tibia vara. The metaphyseal-diaphyseal angle in the measurement of bowleg deformities. J Bone Joint Surg Am 64(8):1158–1163 Levine AM, Drennan JC (1982) Physiological bowing and tibia vara. The metaphyseal-diaphyseal angle in the measurement of bowleg deformities. J Bone Joint Surg Am 64(8):1158–1163
Metadaten
Titel
Use of the eight-Plate for angular correction of knee deformities due to idiopathic and pathologic physis: initiating treatment according to etiology
verfasst von
Silvio Boero
Maria Beatrice Michelis
Simone Riganti
Publikationsdatum
01.06.2011
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Children's Orthopaedics / Ausgabe 3/2011
Print ISSN: 1863-2521
Elektronische ISSN: 1863-2548
DOI
https://doi.org/10.1007/s11832-011-0344-4

Weitere Artikel der Ausgabe 3/2011

Journal of Children's Orthopaedics 3/2011 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, DICOM-Daten, Videos und Abbildungen. » Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Orthopädie und Unfallchirurgie und bleiben Sie gut informiert – ganz bequem per eMail.

Der einfache Weg sich fortzubilden: Befundungskurs Radiologie

Strukturiertes Interpretieren und Analysieren von radiologischen Befunden