Angular Deformity Correction by Asymmetrical Physeal Supression in Children

Woo Young Jang; Yun Seong Choi; Won Joon Yoo

doi:10.4055/jkoa.2016.51.2.101

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Jang, Choi, and Yoo: Angular Deformity Correction by Asymmetrical Physeal Supression in Children

Symposium

Common Problems in Skeletally Immature Patients

Journal of the Korean Orthopaedic Association 2016; 51(2): 101-108.

Published online: 22 April 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.2.101

Angular Deformity Correction by Asymmetrical Physeal Supression in Children

Woo Young Jang, M.D., Yun Seong Choi, M.D.^*, Won Joon Yoo, M.D.

Division of Pediatric Orthopaedic Surgery, Seoul National University Children Hospital, Seoul, Korea.

^*Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea.

Correspondence to: Won Joon Yoo, M.D. Division of Pediatric Orthopaedic Surgery, Seoul National University Children Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. TEL: +82-2-2072-1966, FAX: +82-2-745-3367, yoowj@snu.ac.kr

Received 30 April 2015 Revised 18 September 2015 Accepted 3 February 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Angular deformity of extremities in children and adolescents with residual growth is not a rare condition in orthopaedics. Asymmetrical physeal suppression or guided growth method, one of the surgical techniques for correction of angular deformity, is a method of inducing plastic deformation by application of constant external force to a growing bone. Internal fixation devices used for asymmetrical physeal suppression include staples, transphyseal screws, and tension band plates, most representatively the 8-plate. Temporary hemiepiphysiodesis using staples is reported to show a success rate of 60% to 80%. Epiphysiodesis using transphyseal screws has several advantages over staples or 8-plates; smaller skin incision, shorter operation time, no postoperative splint or cast, faster return to daily life. Advantages of 8-plates over staples or transphyseal plates include a longer moment arm, which enables better correction of angular deformity and less suppression of the growth of the nearby normal growth plate. Asymmetrical physeal suppression is a simple and effective surgical method in correcting angular deformity of extremities of children and adolescents. Each of three internal fixation devices discussed in the current article has strengths and weaknesses and superiority in terms of angular correction power and complication rate, however further study is needed. Therefore, the most appropriate device should be selected according to the condition of each patient.

Keywords: lower extremity, asymmetrical physeal suppression, staple, transphyseal screw, tension band plate

Figures and Tables

Figure 1

A 15-year-old boy with Ehlers-Danlos syndrome. He developed genu valgum of the left knee (A) which was over corrected using staples in consideration of expected rebound overgrowth (B).

Figure 2

After temporary hemiepiphysiodesis with a staple, extrusion of the staple from the metaphysis occurred.

Figure 3

(A) An 11-year-old boy with cerebral palsy showed leg length discrepancy and right side genu valgum. Percutaneous epiphysiodesis using a transphyseal screw was performed for physeal growth suppression. (B) Correction of the leg length discrepancy and angular deformity was observed.

Figure 4

(A) Idiopathic bilateral genu valgum was observed in a 10-year-old girl. A tension band plate was used for asymmetrical physeal growth suppression. (B) Correction of the lower leg angular deformity was observed.

Figure 5

The correction angle moment arm of the staple (A) and percutaneous epiphysiodesis using a transphyseal screw (B) is shorter compared to usage of the tension band plate. (C) The fulcrum of the tension band plate is placed at the margin of the growth plate.

Table 1

Kinds of Tension Band Plate

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose

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