- Hemiepiphysiodesis, also known as guided growth, is a surgical technique used to gradually correct angular limb deformity in skeletally immature patients.
- This surgical option is an alternative to corrective osteotomies that is associated with less pain, shorter immobilization, decreased cost, and less surgical risk.
- Temporary hemiepiphysiodesis, by plating or stapling, can be complicated by premature physeal closure, a rebound period of accelerated growth or hardware migration; complications appear to be lower using the extraperiosteal, 2-hole plate method.
- Although controversial in the literature, 2-hole plates with parallel screw configuration appear to be more efficient in slowing growth than divergent screw configuration. Screw size and plate size have not been shown to affect rate of angular correction.
Description:Pathological angular deformities of the lower extremities cause children and adolescents activity-related pain, altered gait mechanics, and joint instability, and these are exacerbated by periods of growth. Angular deformities can be corrected gradually with growth by performing permanent hemiepiphysiodesis with physeal ablation or temporary hemiepiphysiodesis using Blount staple(s) (Blount, 1945) or a tension band plate (Stevens, 2007) across one side of the physis. Through guided growth, the patient can often obtain the end-result of equal limb lengths, neutral mechanical axes, and horizontal knees by skeletal maturity without destruction of any part of the physis or major surgery. As opposed to ablation of the physis, temporary hemiepiphysiodesis allows the entire physis to resume growth after hardware removal. Precise timing and surgical technique is required in order to avoid undercorrection or overcorrection.
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Top Contributors:James C. Kyriakedes, M.D.
Raymond W. Liu, M.D.