Background: Lower extremity angular deformities are common
in children with skeletal dysplasia and can be treated with various
surgical options. Both acute correction by osteotomy with
internal fixation and gradual correction by external fixation
have been used with acceptable results. Recently, the Guided
Growth concept using temporary hemiepiphysiodesis for correction
of angular deformities in the growing child has been
proposed. This study presents the results of temporary hemiepiphysiodesis
using eight-Plates and medial malleolus transphyseal
screws in children with skeletal dysplasia with lower
extremity angular deformities.
Methods: Twenty-nine patients (50 lower extremities) with
skeletal dysplasia of different types were treated for varus or
valgus deformities at 2 centers. The mean age at the time of
hemiepiphysiodesis was 10±2.9 years. A total of 66 eight-
Plates and 12 medial malleolus screws were used. The average
follow-up time between the index surgery and the latest followup
with the eight-Plate in was 25±13.4 months. Erect longstanding
anteroposterior and lateral view radiographs were
obtained for deformity planning before the procedure. Angular
deformities on radiograph were evaluated by mechanical axis
deviation, mechanical lateral distal femoral angle, medial
proximal tibial angle, and lateral distal tibial angle. Mechanical
axis deviation was also expressed as a percentage to one half of
the width of the tibial plateau, and the magnitude of the deformity
was classified by determining the zones through which
the mechanical axis of the lower extremity passed. Four zones
were determined on both the medial and lateral side of the knee
and the zones were labeled 1, 2, 3, and 4, corresponding to the
severity of the deformity. A positive value was assigned for
valgus alignment and a negative for varus alignment.
Results: Patients were analyzed in valgus and varus groups.
There was correction in 34 of 38 valgus legs and 7 of 12 varus
legs. In the valgus group, the mean preoperative and postoperative
mechanical lateral distal femoral angles were
82.1±3.7 and 91.1±4.9 degrees, respectively (P |
