Growth Modulation for Knee Coronal Plane Deformities in Children With Nutritional Rickets: A Prospective Series With Treatment Algorithm
| Autor: | John Amen, Mostafa M Baraka, Mahmoud A. Mahran, Shady Mahmoud, Shady Samir, Ahmad Saeed Aly, Tamer A. El-Sobky, Tamer A. Fayyad |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Knee Joint Radiography Nutritional Rickets Genu Varum Deformity Humans Medicine Orthopedic Procedures Orthopedics and Sports Medicine Femur Prospective Studies Child Mechanical axis Tibia business.industry Genu Valgum Internal tibial torsion Joint Deformities Acquired Child Preschool Coronal plane Female Surgery Implant medicine.symptom business Complication Bone Plates Epiphyses Algorithm Algorithms Rickets Research Article |
| Zdroj: | JAAOS Global Research & Reviews |
| ISSN: | 2474-7661 |
| DOI: | 10.5435/jaaosglobal-d-19-00009 |
| Popis: | Purpose: To report prospectively the radioclinical outcome of guided growth surgery for coronal plane deformities around the knee in young children with nutritional rickets on the intermediate term, to assess the responsiveness of torsional deformities of the tibias to guided growth regarding function and objective clinical parameters, and to propose a treatment algorithm. Methods: Fifty children (male:female, 27:23) with knee coronal plane deformities (knees:physes, 86:99), (varum:valgum, 51:35) secondary to nutritional rickets were subjected to femoral and/or tibial temporary hemiepiphysiodesis using a two-hole 8-plate. The mean age at implantation was 3.8 ± 1.5 years (range 2.5 to 5). The mean follow-up was 2.8 years (range 2 to 4). All children received a standing full-length AP radiographs of both lower limbs in neutral rotation to measure the mechanical axis deviation, tibiofemoral angle, and joint orientation angles. Tibial torsion was objectively assessed by measuring the bimalleolar axis. Results: The radiologic measurements, tibiofemoral angle, mechanical axis deviation, mechanical lateral distal femoral angle, medial proximal tibial angle, and Hilgenreiner-epiphyseal angle, showed a highly statistically significant improvement (P ≤ 0.001). Radiographic outcomes correlated with their clinical counterparts. The mean duration of correction of the mechanical axis was 10.8 ± 2.4 months (7 to 21). The mean follow-up for rebound of the deformity was 1.5 years (range 1 to 3). Conclusion: The radioclinical outcome is rewarding with a tolerable complication profile. The mechanical complications were mostly related to lengthy implant retainment encountered in severe deformities. Internal tibial torsion seems profoundly responsive to correction of coronal plane deformity. And, derotation osteotomies are rarely justified. Our proposed algorithm may be used as a decision-taking guide for achieving the desired growth modulation in a more efficient manner. |
| Databáze: | OpenAIRE |
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