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Physeal stapling versus 8-plate hemiepiphysiodesis for guided correction of angular deformity about the knee
John M Wiemann1, Connor Tryon, Elizabeth A Szalay
1Department of Orthopaedics, University of New Mexico, Albuquerque, NM 87131, USA. jwiemann@salud.unm.edu
Background:
Angular deformity in the lower extremities results in cosmetic deformity, gait disturbance, pain, and early joint degeneration. Corrective osteotomy is the gold standard for angular deformity, but is a major surgical intervention with significant incidence of complication. For these reasons, hemiepiphysiodesis is an attractive alternative in the growing child to allow "guided growth" to correct the angular deformity. Physeal stapling has proven success, but hardware prominence or failure has been problematic. Recently, the tension band plate construct ("8-plate") has been promoted for hemiepiphysiodesis, citing ease of surgical technique and more rapid rate of correction. We sought to test the claim that the 8-plate effected a more rapid correction of angular deformity with a lower complication rate.
Methods:
Hemiepiphysiodesis for angular deformity in 63 lower extremities from 2000 to 2007 were retrospectively reviewed. Thirty-nine limbs received staple hemiepiphysiodesis and 24 received 8-plate hemiepiphysiodesis. Angular measurements were compared preoperatively, during the first year postoperatively, and at the time of hardware removal or skeletal maturity. Complications requiring additional surgery for the correction of angular deformity were noted in each group.
Results:
There was no difference between the 2 groups in the rate of correction (approximately 10 degrees/y, P=0.48). Complication rates were similar (12.8% vs. 12.5%, P=1.0). Patients with abnormal physes (eg, Blount disease, skeletal dysplasias) had a higher complication rate (27.8% vs. 6.7% for patients with normal physes, P=0.04) with no difference between the 8-plate and staple groups (P=1.0). The patients in the 8-plate group were significantly younger than those in the staple group (P=0.04).
Conclusions:
The 8-plate is as effective as staple hemiepiphysiodesis for guided correction of angular deformity with respect to rate of correction and complications, even in somewhat younger patients. Higher complication rates are observed in patients with pathologic physes.
