Study Guide

Hemiepiphysiodesis Technique

Key Points:

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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References:

Blount WP, Clarke GR. Control of bone growth by epiphyseal stapling: a preliminary report. J Bone Joint Surg Am. 1949;31:464–478.
Burghardt RD, Herzenberg JE. Temporary hemiepiphysiodesis with the eight-plate for angular deformities: mid-term results. J Orthop Sci. 2010;15:699–704.
Burghardt RD, Specht SC, Herzenberg JE. Mechanical failures of eight-plateguided growth system for temporary hemiepiphysiodesis. J Pediatr Orthop. 2010;30(6):594-597.
Davids JR, McBrayer D, Blackhurst DW. Juvenile hallux valgus deformity: surgical management by lateral hemiepiphyseodesis of the great toe metatarsal. J Pediatr Orthop. 2007;27:826-30.
Funk SS, Mignemi ME, Schoenecker JG, Lovejoy SA, Mencio GA, Martus JE. Hemiepiphysiodesis
Implants for Late Onset Tibia Vara: A Comparison of Cost, Surgical Success, and Implant Failure.
J Pediatr Orthop. 2016;36(1):29-35.
Greulich W, Pyle S. Radiographic atlas of the skeletal development of the hand and wrist, Stanford, CA: Stanford University Press; 1959.
Masquijo JJ, Lanfranchi L, Torres-Gomez A, Allende V. Guided Growth With the Tension Band Plate Construct: A Prospective Comparison of 2 Methods of Implant Placement. J Pediatr Orthop. 2015;35:e20-5.
Mignemi ME, Martus JE. Mechanical Failure of the OrthoPediatrics PediPlate in Late-Onset Tibia
Vara with Moderate Deformity. A Report of Three Cases. 2013;3(2):e48.
Schoenleber SJ, Iobst CA, Baitner A, Standard SC. The biomechanics of guided growth: does screw size, plate size, or screw configuration matter? J Pediatr Orthop B. 2014;23:122–125.
Schroerlucke S, Bertrand S, Clapp J, Bundy J, Gregg FO. Failure of Orthofix eight-Plate for the treatment of Blount disease. J Pediatr Orthop. 2009;29(1):57-60.
Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop. 2007;27:253–259.

Top Contributors:

James C. Kyriakedes, M.D.
Raymond W. Liu, M.D.

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