Guided growth for angular correction: a preliminary series using a tension band plate

The classic treatment of pathological angular deformities of the extremities is corrective osteotomy; however, osteotomies require hospitalization, pain management, immobilization, and delayed weight bearing. The associated risks, inconvenience, and cost of osteotomy make hemiepiphysiodesis or guided growth an attractive option. Although stapling has a long and proven track record, reported drawbacks related to implant failure, including migration or breakage of staples, have led some to abandon this technique. This report describes a prospective series of 34 consecutive patients who presented with a total of 65 deformities (femur and/or tibia) due to a variety of pathological conditions and who underwent guided growth using a nonlocking extraperiosteal 2-hole plate and screws. This technique relies upon the tension band principle rather than physeal compression. With follow-up ranging from 14 to 26 months (from implantation) in this series, 32 of 34 patients (63 deformity levels) have corrected to neutral at a mean of 11 months and the hardware has been removed. The observed rate of correction was approximately 30% more rapid than noted with stapling, and there have been no permanent growth arrests. Four patients with bilateral idiopathic genu valgum experienced rebound deformity and have since undergone repeat guided growth using the same technique. Only 2 patients with adolescent Blount disease have experienced insufficient correction; each may need a corrective osteotomy of the tibia. Having prevented 63 (97%) of 65 osteotomies in this series of patients, it is evident that guided growth holds promise for postponing if not preventing more invasive surgery.These patients will be observed up to maturity to support my conclusion that the concept of osteotomy as a first resort and criterion standard has become outdated.