Partial hardware removal in guided growth surgery: A convenient strategy?

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Skeletal growth modulation

Background:

• Tension band plates (TBPs) are common in guided growth (CG) surgeries.
• Removing only the metaphyseal screw to halt growth modulation is a newer, less understood strategy.
• This study evaluates the risks associated with this partial hardware removal technique.

Purpose of the Study:

• To report the clinical experience of three institutions using partial hardware removal in CG surgery.
• To analyze the indications, outcomes, and complications of removing only the metaphyseal screw.
• To assess the safety and efficacy of this modified CG approach.

Main Methods:

• A retrospective review of patients undergoing CG with TBPs between 2014-2019.
• Identification of cases where only the metaphyseal screw was removed.
• Analysis of demographic data, procedural characteristics, complications, and subsequent interventions.

Main Results:

• 28 partial hardware removals were performed in 10 male patients.
• Indications included angular deformity (6) and leg-length discrepancy (4).
• 22% of limbs experienced deformity recurrence requiring screw re-insertion; 2 patients had complications (soft tissue irritation, angular deformity) necessitating further surgery.

Conclusions:

• Partial hardware removal in CG surgery may increase the likelihood of complications.
• The potential advantages of this technique should be carefully weighed against the risks of adverse events.
• Further research is needed to fully understand the implications of this surgical modification.