Overcorrection as Complication of Growth Modulation with Eight-Plate for Coronal Plane Deformities of Knee and its Management
Volume 8 | Issue 2 | May-August 2022 | Page: 06-10 | Sandeep Patwardhan, Arkesh Madegowda, Sujith Omkaram, Pavan Patil, Ashok Shyam, Parag Sancheti
DOI- https://doi.org/10.13107/ijpo.2022.v08i02.137
Authors: Sandeep Patwardhan MS Ortho [1], Arkesh Madegowda MS Ortho [1], Sujith Omkaram MS Ortho [1], Pavan Patil MS Ortho [1], Ashok Shyam MS Ortho [1], Parag Sancheti MS Ortho [1]
[1] Department of Paediatric Orthopaedics Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Address of Correspondence
Dr. Arkesh Madegowda,
Clinical Fellow, Department of Paediatric Orthopaedics Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
E-mail: dr.arkesh@gmail.com
Abstract
Objectives: To report the incidence of overcorrection as complication following eight-plate application for genu varum/valgum deformities and its management.
Methods: This was a retrospective review of children who underwent growth modulation for genu varum/valgum between 2012-2019. Data of patients who had presented with overcorrection of their primary deformity, the reasons for such complication and its management were collected and analysed.
Results: 110 children had undergone growth modulation during the study period. 75 children (68%) had achieved deformity correction in mean time of 14.4 months and had their implant removed on time when intercondylar (ICD)/intermalleolar (IMD) distance was ≤ 5 centimeters (cms) and/or Hip Knee Ankle (HKA) angle was < ±6⁰. 29 children (26%) were lost to follow up. 6 children (5.4%) had presented with overcorrection of moderate to severe grade with mean ICD/IMD of 13.3 cms (range 11-18) and mean HKA angle of 14.3⁰ (range 11-21⁰). Mean age of initial surgery was 6.1 years (range 5-8). Mean time gap of presentation with overcorrection was 33.6 months (range 24-45). Lack of awareness, long distance of hospital, medical expenses were some of the notable reasons for irregular follow-up. All 6 had an open physes with growth remaining when they presented with overcorrection. These children managed with repeat growth modulation. Final correction was achieved at mean time of 15.3 months and underwent implant removal. At the latest follow up of 4.4 years, limb alignment within physiologic limits was maintained.
Conclusion: Children undergoing growth modulation should be carefully monitored with regular follow-up to avoid complication of overcorrection. Overcorrection beyond physiologic limits can be managed with repeat growth modulation in younger children with open physes.
Keywords: Growth modulation, Genu valgum, Genu varum, Irregular follow up, Complication, Overcorrection.
References
1. Saran N, Rathjen KE. Guided growth for the correction of pediatric lower limb angular deformity. J Am Acad Orthop Surg. 2010 Sep;18(9):528-36.
2. Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop. 2007 Apr-May;27(3):253-9.
3. Danino B, Rödl R, Herzenberg JE, Shabtai L, Grill F, Narayanan U, Segev E, Wientroub S. Guided growth: preliminary results of a multinational study of 967 physes in 537 patients. J Child Orthop. 2018 Feb 1;12(1):91-96. doi: 10.1302/1863-2548.12.170050.
4. Radtke K, Goede F, Schweidtmann K, Schwamberger T, Calliess T, Fregien B, Stukenborg-Colsman C, Ettinger M. Temporary hemiepiphysiodesis for correcting idiopathic and pathologic deformities of the knee: A retrospective analysis of 355 cases. Knee. 2020 Jun;27(3):723-730.
5. Kumar S, Sonanis SV. Growth modulation for coronal deformity correction by using Eight Plates-Systematic review. J Orthop. 2018 Feb 2;15(1):168-172
6. Kemppainen JW, Hood KA, Roocroft JH, Schlechter JA, Edmonds EW. Incomplete Follow-up After Growth Modulation Surgery: Incidence and Associated Complications. J Pediatr Orthop. 2016 Jul-Aug;36(5):516-20.
7. Zajonz D, Schumann E, Wojan M, Kübler FB, Josten C, Bühligen U, Heyde CE. Treatment of genu valgum in children by means of temporary hemiepiphysiodesis using eight-plates: short-term findings. BMC Musculoskelet Disord. 2017 Nov 15;18(1):456.
8. Lawing C, Margalit A, Ukwuani G, Sponseller PD. Predicting Late Follow-up and Understanding Its Consequences in Growth Modulation for Pediatric Lower Limb Deformities. J Pediatr Orthop. 2019 Jul;39(6):295-301.
9. Gupta P, Gupta V, Patil B, Verma V. Angular deformities of lower limb in children: Correction for whom, when and how? J Clin Orthop Trauma. 2020 Mar-Apr;11(2):196-201.
10. De Brauwer V, Moens P. Temporary hemiepiphysiodesis for idiopathic genua valga in adolescents: percutaneous transphyseal screws (PETS) versus stapling. J Pediatr Orthop. 2008 Jul-Aug;28(5):549-54.
11. Degreef I, Moens P, Fabry G. Temporary epiphysiodesis with Blount stapling for treatment of idiopathic genua valga in children. Acta Orthop Belg. 2003;69(5):426Y432.
12. Heath CH, Staheli LT. Normal limits of knee angle in white children–genu varum and genu valgum. J Pediatr Orthop. Mar-Apr 1993.
13. Saini UC, Bali K, Sheth B, Gahlot N, Gahlot A. Normal development of the knee angle in healthy Indian children: a clinical study of 215 children. J Child Orthop. 2010 Dec;4(6):579-86.
14. Masquijo JJ, Artigas C, de Pablos J. Growth modulation with tension-band plates for the correction of paediatric lower limb angular deformity: current concepts and indications for a rational use. EFORT Open Rev. 2021 Aug 10;6(8):658-668.
15. Chang FM, Ma J, Pan Z, Hoversten L, Novais EN. Rate of correction and recurrence of ankle valgus in children using a Transphyseal medial malleolar screw. J Pediatr Orthop. 2015;35:589–592.
16. Vaishya R, Shah M, Agarwal AK, Vijay V. Growth modulation by hemi epiphysiodesis using eight-plate in Genu valgum in Paediatric population. J Clin Orthop Trauma. 2018 Oct-Dec;9(4):327-333.
| How to Cite this Article: Patwardhan S, Madegowda A, Omkaram S, Patil P, Shyam A, Sancheti P | Overcorrection as Complication of Growth Modulation with Eight-Plate for Coronal Plane Deformities of Knee and its Management | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 06-10. https://doi.org/10.13107/ijpo.2022.v08i02.137 |
