Related Experiment Video
Updated: Dec 26, 2025
A Rat Tibial Growth Plate Injury Model to Characterize Repair Mechanisms and Evaluate Growth Plate Regeneration Strategies
Published on: July 4, 2017
Growth Modulation for Knee Coronal Plane Deformities in Children With Nutritional Rickets: A Prospective Series With
Tamer A El-Sobky1, Shady Samir1, Mostafa M Baraka1
1Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
Insights
Guided growth surgery effectively corrected knee deformities in children with nutritional rickets, showing significant improvement in leg alignment and function. Tibial torsion also responded well to this treatment.
Area of Science:
- Pediatric Orthopedics
- Skeletal Dysplasias
- Nutritional Deficiencies
Background:
- Nutritional rickets can cause significant coronal plane deformities around the knee in young children.
- Guided growth surgery offers a potential solution for correcting these deformities during skeletal development.
Purpose of the Study:
- To prospectively evaluate the radioclinical outcomes of guided growth surgery for knee coronal plane deformities in children with nutritional rickets.
- To assess the effectiveness of guided growth in addressing tibial torsional deformities.
- To propose a treatment algorithm for managing these conditions.
Main Methods:
- Fifty children with nutritional rickets and knee coronal plane deformities underwent temporary hemiepiphysiodesis using 8-plates.
- Radiographic parameters (mechanical axis deviation, tibiofemoral angle) and tibial torsion were measured before and after surgery.
- Follow-up included clinical assessment and serial radiographs.
Main Results:
- Statistically significant improvements were observed in all measured radiologic parameters (P ≤ 0.001).
- Radiographic improvements correlated with clinical outcomes.
- Internal tibial torsion demonstrated a strong response to the correction of coronal plane deformities.
Conclusions:
- Guided growth surgery provides rewarding radioclinical outcomes for knee deformities in nutritional rickets with a tolerable complication profile.
- Derotation osteotomies are rarely necessary as tibial torsion is responsive to guided growth.
- A proposed treatment algorithm can guide efficient growth modulation.
Abstract:
To report prospectively the radioclinical outcome of guided growth surgery for coronal plane deformities around the knee in young children with nutritional rickets on the intermediate term, to assess the responsiveness of torsional deformities of the tibias to guided growth regarding function and objective clinical parameters, and to propose a treatment algorithm.
Methods:
Fifty children (male:female, 27:23) with knee coronal plane deformities (knees:physes, 86:99), (varum:valgum, 51:35) secondary to nutritional rickets were subjected to femoral and/or tibial temporary hemiepiphysiodesis using a two-hole 8-plate. The mean age at implantation was 3.8 ± 1.5 years (range 2.5 to 5). The mean follow-up was 2.8 years (range 2 to 4). All children received a standing full-length AP radiographs of both lower limbs in neutral rotation to measure the mechanical axis deviation, tibiofemoral angle, and joint orientation angles. Tibial torsion was objectively assessed by measuring the bimalleolar axis.
Results:
The radiologic measurements, tibiofemoral angle, mechanical axis deviation, mechanical lateral distal femoral angle, medial proximal tibial angle, and Hilgenreiner-epiphyseal angle, showed a highly statistically significant improvement (P ≤ 0.001). Radiographic outcomes correlated with their clinical counterparts. The mean duration of correction of the mechanical axis was 10.8 ± 2.4 months (7 to 21). The mean follow-up for rebound of the deformity was 1.5 years (range 1 to 3).
Conclusion:
The radioclinical outcome is rewarding with a tolerable complication profile. The mechanical complications were mostly related to lengthy implant retainment encountered in severe deformities. Internal tibial torsion seems profoundly responsive to correction of coronal plane deformity. And, derotation osteotomies are rarely justified. Our proposed algorithm may be used as a decision-taking guide for achieving the desired growth modulation in a more efficient manner.
Related Concept Videos
01:27Growth of Cartilage and Bone Tissue
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...