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Incomplete Follow-up After Growth Modulation Surgery: Incidence and Associated Complications.

John W Kemppainen1, Kenneth A Hood, Joanna H Roocroft

  • 1*Department of Orthopaedic Surgery, Helen DeVos Children's Hospital, Grand Rapids, MI †Department of Orthopedic Surgery, Children's Hospital Orange County, Orange ‡Department of Orthopedic Surgery, Rady Children's Hospital and Health Center §Department of Orthopedic Surgery, University of California San Diego, San Diego, CA.

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Summary

A significant number of children (12%) undergoing angular deformity correction with extraperiosteal tension plates experienced incomplete follow-up, with some requiring further surgery due to retained implants.

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Area of Science:

  • Pediatric Orthopedics
  • Skeletal Deformity Correction
  • Growth Modulation Surgery

Background:

  • Extraperiosteal tension plates are a common method for correcting angular deformities in children.
  • Some surgeons remove implants after correction, especially in younger patients.
  • This study investigates issues related to incomplete follow-up and retained implants.

Purpose of the Study:

  • To determine the incidence of incomplete follow-up in children treated with extraperiosteal tension plates.
  • To assess the outcomes of children lost to follow-up with retained implants.

Main Methods:

  • A quality initiative survey was conducted at two institutions.
  • Children treated with knee extraperiosteal tension plates were reviewed.
  • Follow-up compliance was assessed, and outcomes for patients with retained implants and open physes were analyzed.

Main Results:

  • 200 children were treated; 12% (23 patients) had incomplete follow-up with retained implants.
  • Of those who returned, 3 had no complications, but 4 developed overcorrection requiring osteotomy.
  • Most patients with retained implants and incomplete follow-up were unreachable or failed to return.

Conclusions:

  • Incomplete follow-up is a significant quality of care issue in growth modulation surgery.
  • Nearly one-third of patients with incomplete follow-up required additional surgery.
  • An EMR system is now in place to actively monitor children post-growth modulation surgery.