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Distal Femur Growth Modification Surgery Is Associated With Higher Surgical Wound Complication Rate
Chen-Heng Hsu1, Wei-Chung Lee, Hsuan-Kai Kao
1Department of Paediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Insights
Pediatric growth modification surgeries, like guided growth, show higher wound complication rates than osteotomies. Plates or staples at the distal femur increase risks, suggesting transphyseal screws for better outcomes.
Area of Science:
- Orthopaedic surgery
- Pediatric orthopaedics
- Surgical complications
Background:
- Wound complications are common in extensive orthopaedic surgeries.
- Minor pediatric growth modification surgeries (guided growth, epiphysiodesis) also present wound complications.
- This study investigates complication rates and risk factors in pediatric growth modification.
Purpose of the Study:
- To determine the complication rate of pediatric growth modification surgeries.
- To identify risk factors associated with these surgical wound complications.
- To compare complication rates between growth modification and osteotomy procedures.
Main Methods:
- Retrospective review of 622 pediatric orthopaedic patients (2007-2019).
- Compared wound complications (modified Clavien-Dindo-Sink system) in growth modification vs. osteotomy groups.
- Analyzed risk factors using logistic regression.
Main Results:
- Growth modification group had higher complication rates (6.9% patient, 3.6% site) than osteotomy group (P=0.001).
- Complications linked to surgical location (distal femur) and implant type (plates/staples) in growth modification.
- Transphyseal screws showed lower complication rates (0.5%) compared to plates/staples (4.3-10.5%).
Conclusions:
- Surgical wound complications are associated with growth modification using plates/staples at the distal femur.
- Orthopaedic surgeons should be aware of these unneglectable complications.
- Transphyseal screws are recommended for distal femur procedures in older children due to lower risks.
Background:
Orthopaedic wound complications are often associated with extensive surgeries and patient medical conditions. However, we noticed wound complications in minor growth modification surgeries in children, including guided growth and epiphysiodesis. Herein, we report the complication rate and risk factors associated with pediatric growth modification surgeries.
Methods:
This retrospective study reviewed surgical wound complications in 622 pediatric orthopaedic patients who underwent growth modification surgeries (418 children) or osteotomies (204 children) in the lower extremities in a single center between 2007 and 2019. The grades II and III complications assessed using the modified Clavien-Dindo-Sink complication classification system were compared between growth modification and osteotomy. Risk factors for complications, including the type of surgery, age, body mass index, neuromuscular disease, operation time, surgical sites per patient, surgical location, and implant types, were analyzed using the logistic regression.
Results:
The complication rate was 6.9% per patient and 3.6% per surgical site (29 sites in 29 patients comprising 21 grade II and 8 grade III) in the growth modification group, which was >1.0% per patient and 0.6% per site in the osteotomy group (2 sites in 2 patients comprising 2 grade III infections; P =0.001). Among 418 patients with 797 surgical sites in the growth modification group, wound complications were associated with surgical location (5.2% at distal femur vs. 1.0% at proximal tibia, P =0.002) and implant type (0.5% using transphyseal screw vs. 4.3-10.5% using plates or staples, P =0.011).
Conclusion:
Surgical wound complication was associated with growth modification surgeries using plates or staples at the distal femur. Our results alert orthopaedic surgeons to this minor but unneglectable problem. Transphyseal screws may be the implant of choice for guided growth and epiphysiodesis at the distal femur in older children, considering the lower risks of wound complication.
Level Of Evidence:
Level III, retrospective comparative study.
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