Temporary epiphyseodesis for limb-length discrepancy. 8- to 15-year follow-up of 34 children

TY - JOUR

T1 - Temporary epiphyseodesis for limb-length discrepancy. 8- to 15-year follow-up of 34 children

AU - Siedhoff, Markus

AU - Ridderbusch, Karsten

AU - Breyer, Sandra

AU - Stücker, Ralf

AU - Rupprecht, Martin

N1 - Zuordnung UKE-Affiliation unklar (Siedhoff, Ridderbusch, Rupprecht). Alles andere ok.

PY - 2014/12/1

Y1 - 2014/12/1

N2 - BACKGROUND AND PURPOSE: For the treatment of leg-length discrepancies (LLDs) of between 2 and 5 cm in adolescent patients, several epiphyseodesis options exist and various complications have been reported. We reviewed the 8- to 15-year outcome after temporary epiphyseodesis in patients with LLD.PATIENTS AND METHODS: 34 children with LLD of up to 5 cm were included in the study. Mean age at epiphyseodesis was 12.8 (10-16) years. Temporary epiphyseodesis was performed with Blount staples or 8-plates. The LLD was reviewed preoperatively, at the time of implant removal, and at follow-up. Every child had reached skeletal maturity at follow-up. Long-standing anteroposterior radiographs were analyzed with respect to the mechanical axis and remaining LLD at the time of follow-up. Possible complications were noted.RESULTS: The mean LLD changed from 2.3 (0.9-4.5) cm to 0.8 (-1.0 to 2.6) cm at follow-up (p<0.001). 21 patients had a final LLD of <1 cm, and 10 had LLD of <0.5 cm. At the time of follow-up, in 32 patients the mechanical axis crossed within Steven's zone 1. No deep infections or neurovascular lesions were seen. 4 implant failures occurred, which were managed by revision.INTERPRETATION: Temporary epiphyseodesis is an effective and safe option for the treatment of LLD. The timing of the procedure has to be chosen according to the remaining growth, facilitating a full correction of the LLD. If inaccurate placement of staples is avoided, substantial differences between the mechanical axes of both legs at skeletal maturity are rare.

AB - BACKGROUND AND PURPOSE: For the treatment of leg-length discrepancies (LLDs) of between 2 and 5 cm in adolescent patients, several epiphyseodesis options exist and various complications have been reported. We reviewed the 8- to 15-year outcome after temporary epiphyseodesis in patients with LLD.PATIENTS AND METHODS: 34 children with LLD of up to 5 cm were included in the study. Mean age at epiphyseodesis was 12.8 (10-16) years. Temporary epiphyseodesis was performed with Blount staples or 8-plates. The LLD was reviewed preoperatively, at the time of implant removal, and at follow-up. Every child had reached skeletal maturity at follow-up. Long-standing anteroposterior radiographs were analyzed with respect to the mechanical axis and remaining LLD at the time of follow-up. Possible complications were noted.RESULTS: The mean LLD changed from 2.3 (0.9-4.5) cm to 0.8 (-1.0 to 2.6) cm at follow-up (p<0.001). 21 patients had a final LLD of <1 cm, and 10 had LLD of <0.5 cm. At the time of follow-up, in 32 patients the mechanical axis crossed within Steven's zone 1. No deep infections or neurovascular lesions were seen. 4 implant failures occurred, which were managed by revision.INTERPRETATION: Temporary epiphyseodesis is an effective and safe option for the treatment of LLD. The timing of the procedure has to be chosen according to the remaining growth, facilitating a full correction of the LLD. If inaccurate placement of staples is avoided, substantial differences between the mechanical axes of both legs at skeletal maturity are rare.

KW - Adolescent

KW - Arthrodesis

KW - Bone Lengthening

KW - Child

KW - Device Removal

KW - Epiphyses

KW - Female

KW - Femur

KW - Follow-Up Studies

KW - Humans

KW - Leg Length Inequality

KW - Male

KW - Prosthesis Failure

KW - Sutures

KW - Tibia

KW - Treatment Outcome

U2 - 10.3109/17453674.2014.960646

DO - 10.3109/17453674.2014.960646

M3 - SCORING: Journal article

C2 - 25191935

VL - 85

SP - 626

EP - 632

JO - ACTA ORTHOP

JF - ACTA ORTHOP

SN - 1745-3674

IS - 6

ER -