ABSTRACT
PURPOSE: In skeletally immature patients, treatment of malalignment about the knee is possible by performing temporary hemi-epiphyseodesis. Following the well-established procedure of physeal stapling, the 8-plate was introduced as a new device. The purpose of this study was to compare physeal stapling with 8-plate hemi-epiphyseodesis. We focused on evaluating deformity correction, complication rate and duration of the procedures. METHODS: We retrospectively analysed 35 patients (61 extremities, age 2.9-16.0 years) who were treated by temporary hemi-epiphyseodesis about the knee for correction of genu varum or genu valgum by using Blount staples (32 extremities) or the 8-plate (29 extremities). Plain radiographs were analysed at the time of operation and at hardware removal that included measurement of mechanical axis deviation, mechanical lateral distal femoral angle and mechanical medial proximal tibial angle. Time until hardware removal, operation time and complications were recorded. RESULTS: A statistically significant improvement of all radiographic measurements could be achieved with comparable results in both groups. Complications were similar in both groups with no relevant differences in amount and severity. In the 8-plate group, however, the surgical time was significantly shorter by an average of ten minutes for implantation and 12 minutes for explantation. CONCLUSIONS: Both Blount stapling and the 8-plate technique are methods for correction of genu varum and valgum deformity in skeletally immature patients; however, a shorter operating time for implantation and explantation was noted for the 8-plate technique.
Subject(s)
Bone Plates , Genu Valgum/surgery , Genu Varum/surgery , Growth Plate/surgery , Knee Joint/surgery , Sutures , Adolescent , Bone Malalignment/surgery , Bone Plates/adverse effects , Child , Child, Preschool , Female , Genu Valgum/diagnostic imaging , Genu Varum/diagnostic imaging , Growth Plate/diagnostic imaging , Humans , Intraoperative Complications , Knee Joint/abnormalities , Knee Joint/diagnostic imaging , Male , Postoperative Complications , Radiography , Retrospective Studies , Sutures/adverse effects , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: The risk of developing avascular osteonecrosis (AVN) after chemotherapy is age related and, at up to 17% of all treated patients, relatively high. PATIENTS AND METHODS: In a prospective study, 8 patients (4 male, 4 female, 14.3+/-4.9 years old) were treated for symptomatic chemotherapy-associated AVN with intravenous infusion of iloprost. Association Research Circulation Osseus (ARCO) stages I-IV in 37 bones (25 joints) were treated. RESULTS: Follow-up was 20.8+/-17 months (range: 6-53 months). No serious adverse reactions due to the infusion with iloprost were recorded. Pain levels were lower and functional outcome measured as Harris Hip and Knee Society Scores improved by the latest follow up. CONCLUSION: Our current data confirm the findings of other investigators that healing of advanced stages of AVN is not possible, but that in early stages of AVN, pain relief and an improvement of joint function can be achieved by iloprost.
