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Combined Hemiepiphysiodesis Using Tension Band Plate and Osteotomy for Severe Coronal Plane Deformities Around Knee Joint in Children with Skeletal Dysplasia – An Innovative Technique

Volume 8 | Issue 2 | May-August 2022 | Page: 20-23 | Anil Agarwal, Ankit Jain, Ravi Jethwa, Jatin Raj Sareen DOI- https://doi.org/10.13107/ijpo.2022.v08i02.139 Authors: Anil Agarwal MS Ortho [1], Ankit Jain D Ortho [1], Ravi Jethwa MS Ortho [1], Jatin Raj Sareen MS Ortho [1] [1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India. […]

Concomitant Tibia Shaft And Triplane Fracture in Adolescents: A Case Series with Comprehensive Review of Literature

Volume 8 | Issue 2 | May-August 2022 | Page: 11-15 | K Venkatadass, V Durga Prasad, Deepak Jain, S Rajasekaran DOI- https://doi.org/10.13107/ijpo.2022.v08i02.138 Authors: K Venkatadass MS Orth [1], V Durga Prasad D Orth [1], Deepak Jain MS Orth [1], S Rajasekaran MS Orth [1] [1] Department of Orthopaedics & Spine Surgery, Ganga Hospital, Coimbatore, […]

Combined Hemiepiphysiodesis Using Tension Band Plate and Osteotomy for Severe Coronal Plane Deformities Around Knee Joint in Children with Skeletal Dysplasia – An Innovative Technique

Concomitant Tibia Shaft And Triplane Fracture in Adolescents: A Case Series with Comprehensive Review of Literature

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Combined Hemiepiphysiodesis Using Tension Band Plate and Osteotomy for Severe Coronal Plane Deformities Around Knee Joint in Children with Skeletal Dysplasia – An Innovative Technique

Volume 8 | Issue 2 | May-August 2022 | Page: 20-23 | Anil Agarwal, Ankit Jain, Ravi Jethwa, Jatin Raj Sareen

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.139

Authors: Anil Agarwal MS Ortho [1], Ankit Jain D Ortho [1], Ravi Jethwa MS Ortho [1], Jatin Raj Sareen MS Ortho [1]

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.

Address of Correspondence

Dr. Anil Agarwal
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
E-mail: rachna_anila@yahoo.co.in

Abstract

Skeletal dysplasia in children is sometimes associated with severe coronal plane angulations around the knee. The associated ligament laxity adds to the complexity of surgical correction. Osteotomies require precise surgical planning and execution. Hemiepiphyseodesis is usually employed only in mild and moderate deformity. Distraction osteogenesis method is labour intensive, costly and requires a prolonged treatment course. We describe an innovative surgical technique which combines hemiepiphysiodesis using tension-band plates and a metaphyseal osteotomy. The technique utilises acute bony correction by osteotomy followed by residual correction, if any and soft tissue fine tuning through growth modulation. Growth modulation also addresses recurrence to some extent. The surgical technique is described along with illustrative case examples.
Keywords: Skeletal dysplasia, Osteotomy, Hemiepiphyseodesis

References

1. Bassett GS. Orthopaedic aspects of skeletal dysplasias. Instr Course Lect. 1990;39:381-387.
2. Rosskopf AB, Buck FM, Pfirrmann CW, Ramseier LE. Femoral and tibial torsion measurements in children and adolescents: comparison of MRI and 3D models based on low-dose biplanar radiographs. Skeletal Radiol. 2017;46:469-476.
3. Thacker MM, Davis ED, Ditro CP, Mackenzie W. Limb lengthening and deformity correction in patients with skeletal dysplasias. In: Sabharwal S (eds.). Pediatric Lower Limb Deformities. Springer, Cham; 2016. doi: 10.1007/978-3-319-17097-8_19
4. Bell DF, Boyer MI, Armstrong PF. The use of the Ilizarov technique in the correction of limb deformities associated with skeletal dysplasia. J Pediatr Orthop. 1992;12:283-290. doi: 10.1097/01241398-199205000-00003
5. Pinkowski JL, Weiner DS. Complications in proximal tibial osteotomies in children with presentation of technique. J Pediatr Orthop. 1995;15:307-312.
6. Yilmaz G, Oto M, Thabet AM, Rogers KJ, Anticevic D, Thacker MM, Mackenzie WG. Correction of lower extremity angular deformities in skeletal dysplasia with hemiepiphysiodesis: a preliminary report. J Pediatr Orthop. 2014;34:336-345. doi: 10.1097/BPO.0000000000000089
7. Cho TJ, Choi IH, Chung CY, Yoo WJ, Park MS, Lee DY. Hemiepiphyseal stapling for angular deformity correction around the knee joint in children with multiple epiphyseal dysplasia. J Pediatr Orthop. 2009;29:52-56.
8. Shabtai L, Herzenberg JE. Limits of growth modulation using tension band plates in the lower extremities. J Am Acad Orthop Surg. 2016;24):691-701. doi: 10.5435/JAAOS-D-14-00234
9. 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;6:658-668. doi: 10.1302/2058-5241.6.200098
10. Bell DF, Boyer MI, Armstrong PF. The use of the Ilizarov technique in the correction of limb deformities associated with skeletal dysplasia. J Pediatr Orthop. 1992;12:283-290.
11. Myers GJ, Bache CE, Bradish CF. Use of distraction osteogenesis techniques in skeletal dysplasias. J Pediatr Orthop. 2003;23:41-45.

How to Cite this Article: K Agarwal A, Jain A, Jethwa R, Sareen JR | Combined Hemiepiphysiodesis Using Tension Band Plate and Osteotomy for Severe Coronal Plane Deformities Around Knee Joint in Children with Skeletal Dysplasia – An Innovative Technique | International Journal of Paediatric Orthopaedics | May- August 2022; 8(2): 20-23.
https://doi.org/10.13107/ijpo.2022.v08i02.139

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Concomitant Tibia Shaft And Triplane Fracture in Adolescents: A Case Series with Comprehensive Review of Literature

Volume 8 | Issue 2 | May-August 2022 | Page: 11-15 | K Venkatadass, V Durga Prasad, Deepak Jain, S Rajasekaran

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.138

Authors: K Venkatadass MS Orth [1], V Durga Prasad D Orth [1], Deepak Jain MS Orth [1], S Rajasekaran MS Orth [1]

[1] Department of Orthopaedics & Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.

Address of Correspondence
Dr. K Venkatadass,
Consultant & Head of Paediatric Orthopaedics, Department of Orthopaedics & Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
E-mail: venkatpedortho@gmail.com

Abstract

Concomitant tibia shaft and ipsilateral triplane fracture in the paediatric population is a known but uncommon presentation. After the first report in 2001, approximately 27 cases have been reported to date. We aimed to do a comprehensive literature review and to present our experience with these rare fractures. We report three such cases of distal-third spiral tibial fractures with three-part triplane fracture. The average age was 15.3 years. The average Body mass index was 31.3 kg/m2. Two patients underwent rigid intramedullary locking nail for shaft fractures, and one patient underwent Ender’s nailing. All triplane fractures were fixed with percutaneous screws. There were no intraoperative or postoperative complications. The average union time was 10.6 weeks. We highlight the patient and injury characteristics in these fractures. A high index of suspicion of an associated ankle fracture is needed in obese adolescents presenting with distal-third tibia fractures. Tibia fractures demand rigid internal fixation whenever possible due to associated obesity.
Keywords: Concomitant, Ipsilateral, Triplane, Tibia, Shaft, Ankle Fracture, Obesity

References

1. Kempegowda H, Maniar HH, Richard R, et al. (2016) Posterior Malleolar Fractures Associated with Tibial Shaft Fractures and Sequence of Fixation. J Orthop Trauma, 30(10):568-571.
2. Jarvis JG, Miyanji F. (2001) The Complex Triplane Fracture: Ipsilateral Tibial Shaft and Distal Triplane Fracture: The Journal of Trauma: Injury, Infection, and Critical Care, 51(4):714-716.
3. Holland TS, Prior CP, Walton RD. (2018) Distal tibial triplane fracture with ipsilateral tibial shaft fracture: A case series. Surgeon, 16(6):333-338.
4. Kasture S, Azurza K. (2017) Triplane Ankle Fracture with Concomitant Ipsilateral Shaft of Tibia Fracture: Case Report and Review of Literature. Journal of Orthopaedic Case Reports, 7(3):4.
5. Sprenger De Rover WB, Alazzawi S, Hallam PJ, Walton NP. (2011) Ipsilateral tibial shaft fracture and distal tibial triplane fracture with an intact fibula: a case report. J Orthop Surg (Hong Kong), 19(3):364-6.
6. Sferopoulos NK. (2018) Concomitant tibia shaft and triplane fractures. International Journal of Radiology, 5(1):197-201.
7. Sheffer BW, Villarreal ED, Iii MGO, Sawyer JR, Spence DD, Kelly DM. (2019) Concurrent Ipsilateral Tibial Shaft and Distal Tibial Fractures in Pediatric Patients: Risk Factors, Frequency, and Risk of Missed Diagnosis. J Pediatr Orthop., 40(1):5.
8. Durga Prasad V, Sangeet G, Venkatadass K, Rajasekaran S. (2021) Ender’s nailing of displaced tibia shaft fractures in children – A nine-year experience. Injury, 52(4):837-843.
9. Rogers GP, Tan HB, Foster P, Harwood P. (2019) Complex Tibial Shaft Fractures in Children Involving the Distal Physis Managed with the Ilizarov Method. Strategies Trauma Limb Reconstr., 14(1):20-24.
10. Rico-Pecero J, Dwyer A. (2009) Triplane fracture of the ankle associated with homolateral tibial fracture in a teenager. A case report. Revista Española de Cirugía Ortopédica y Traumatología (English Edition), 53(4):254-256.
11. Stuermer EK, Stuermer KM. (2008) Tibial shaft fracture and ankle joint injury. J Orthop Trauma, 22(2):107-112.
12. Ertl JP, Barrack RL, Alexander AH, Van Buecken K. Triplane fracture of the distal tibial epiphysis. Long-term follow-up. J Bone Joint Surg Am. 1988 Aug;70(7):967-76. PMID: 3403587.
13. Lurie, B., Van Rysselberghe, N., Pennock, A. T., & Upasani, V. V. (2020). Functional outcomes of tillaux and triplane fractures with 2 to 5 millimetres of intra-articular gap. Journal of Bone and Joint Surgery, 102(8), 679–686.
14. El-Karef E, Sadek HI, Nairn DS, Aldam CH, Allen PW. Triplane fracture of the distal tibia. Injury. 2000 Nov;31(9):729-36. Doi: 10.1016/s0020-1383(00)00086-3. PMID: 11084162.

How to Cite this Article: K Venkatadass, V Durga Prasad, Jain D, S Rajasekaran | Concomitant Tibia Shaft And Triplane Fracture in Adolescents: A Case Series With Comprehensive Review Of Literature | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 11-15.
https://doi.org/10.13107/ijpo.2022.v08i02.138

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Combined Hemiepiphysiodesis Using Tension Band Plate and Osteotomy for Severe Coronal Plane Deformities Around Knee Joint in Children with Skeletal Dysplasia – An Innovative Technique

Concomitant Tibia Shaft And Triplane Fracture in Adolescents: A Case Series with Comprehensive Review of Literature

Combined Hemiepiphysiodesis Using Tension Band Plate and Osteotomy for Severe Coronal Plane Deformities Around Knee Joint in Children with Skeletal Dysplasia – An Innovative Technique

Concomitant Tibia Shaft And Triplane Fracture in Adolescents: A Case Series with Comprehensive Review of Literature

Full Sized Blog Element (Big Preview Pic)

Combined Hemiepiphysiodesis Using Tension Band Plate and Osteotomy for Severe Coronal Plane Deformities Around Knee Joint in Children with Skeletal Dysplasia – An Innovative Technique

Authors: Anil Agarwal MS Ortho [1], Ankit Jain D Ortho [1], Ravi Jethwa MS Ortho [1], Jatin Raj Sareen MS Ortho [1]

Abstract

(Article Text HTML) (Full Text PDF)

Concomitant Tibia Shaft And Triplane Fracture in Adolescents: A Case Series with Comprehensive Review of Literature

Authors: K Venkatadass MS Orth [1], V Durga Prasad D Orth [1], Deepak Jain MS Orth [1], S Rajasekaran MS Orth [1]

Abstract

(Article Text HTML) (Full Text PDF)

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