Tag Archive for: Growth modulation

Basics of Paediatric Limb Reconstruction Surgeries

Volume 10 | Issue 2 | May-August 2024 | Page: 2-11 | Prateek Rastogi, Nitish Arora, Yogesh Patel 

DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.182

Submitted: 18/05/2024; Reviewed: 14/06/2024; Accepted: 19/07/2024; Published: 10/08/2024

Authors: Prateek Rastogi MS Ortho [1], Nitish Arora MS Ortho [2], Yogesh Patel MS Ortho [3]

[1] Department of Orthopaedics, Sharda Hospital, Greater Noida, Uttar Pradesh, India.
[2] Department of Orthopaedics, Medicover Hospital, Khargar, Navi Mumbai, Maharashtra, India.
[3] Department of Orthopaedics, Sagar Multispeciality Hospital, Bhopal, Madhya Pradesh, India.

Address of Correspondence

Dr. Prateek Rastogi,
Paediatric Orthopaedics and Limb Reconstruction Surgeon, Department of Orthopaedics, Sharda Hospital, Greater Noida, Uttar Pradesh, India.
E-mail: prateek.rastogi12@gmail.com

Abstract

Paediatric limb reconstruction surgeries play a pivotal role in managing congenital and acquired deformities, limb length discrepancies, and complex musculoskeletal disorders in children. These procedures aim to restore alignment, function, and length while preserving growth potential and minimizing long-term disability. Unlike adult cases, paediatric reconstructions demand unique considerations due to ongoing skeletal development, necessitating precise planning to avoid growth plate damage. This review outlines the evolving indications for reconstruction—including congenital conditions like various hemimelia and bony deficiency, as well as acquired deformities from trauma, infection, and tumors. Foundational principles such as anatomical and mechanical axes and their deviation, CORA (Center of Rotation of Angulation), and ACA (Angulation Correction Axis) are discussed alongside osteotomy planning and execution. Techniques of gradual deformity correction such as growth modulation, and distraction osteogenesis are examined in depth, highlighting the roles of devices like Ilizarov fixators, hexapods, and intramedullary lengthening nails. Recent advancements in imaging, surgical planning, and implant design have significantly improved outcomes, although complications such as joint stiffness, infection, and secondary deformities persist. With increasing precision and a growing array of tools, paediatric limb reconstruction continues to evolve, offering promising outcomes and functional restoration to affected children.
Keywords: Paediatric limb reconstruction, Deformity Correction, Limb Lengthening, Growth Modulation, Distraction Osteogenesis, Osteotomy Techniques

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How to Cite this Article:  Rastogi P, Arora N, Patel Y| Basics of Paediatric Limb Reconstruction Surgeries| International Journal of Paediatric Orthopaedics | May-August 2024; 10(2): 02-11. https://doi.org/10.13107/ijpo.2024.v10.i02.182

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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

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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

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Temporary Transphyseal Medial Malleolar Screw Hemiepiphysiodesis for Acquired Ankle Valgus Following Fibular Graft Harvest in Children: A Series of 15 Patients

Volume 7 | Issue 3 | September-December 2021 | Page: 17-22 | Ankit Jain, Anil Agarwal, Nitish Bikram Deo, Ankur, Jatin Raj Sareen

DOI-10.13107/ijpo.2021.v07i03.117

Authors: Ankit Jain D. Ortho. [1], Anil Agarwal MS Ortho. [1], Nitish Bikram Deo MS Ortho. [1], Ankur 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
Specialist, Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
E-mail: anilrachna@gmail.com

Abstract

Purpose: To assess the role of temporary transphyseal medial malleolar screw hemiepiphysiodesis in cases of acquired ankle valgus following non-vascularized fibular harvest.
Methods: This retrospective chart review included 15 children (18 ankles). Exclusion criteria were inadequate records or additional procedures besides screw hemiepiphysiodesis. Radiological evaluations included lateral distal tibial angle (LDTA) and fibular station (Malhotra grade).
Results : The average patient age was 8.6 years at surgery. The overall duration of treatment was 18.2 months and post removal follow-up (5 ankles) was 16.6 months. The average correction rate was 0.48 degrees/ month. LDTA changed significantly following hemiepiphysiodesis (Pre-op 077.3 degrees/ in situ follow-up 85.9 degrees). The Malhotra grade did not change significantly during the same period. The average recurrence rate [noted in 4/5 patients] was 0.52 degrees per month. However, LDTA and Malhotra grade did not change significantly post removal.
Conclusions : We report the results of temporary transphyseal medial malleolar screw hemiepiphysiodesis for post fibular harvest acquired ankle valgus in children. Temporary hemiepiphysiodesis is a viable option for the correction of acquired ankle valgus in children. The fibular station is however not restored following the procedure. Recurrence of deformity following screw removal remains a worrying complication in some patients.
Keywords: Hemiepiphysiodesis, Ankle valgus, Growth modulation, Fibula, Harvest

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How to Cite this Article:  Jain A, Agarwal A, Deo NB, Ankur, Sareen JR | Temporary Transphyseal Medial Malleolar Screw Hemiepiphysiodesis for Acquired Ankle Valgus following Fibular Graft Harvest in Children: A Series of 15 Patients | International Journal of Paediatric Orthopaedics | September-December 2021; 7(3): 17-22.

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