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Topic:

Cerebral Palsy

Issue:

Knee

Category:

Neuromuscular

Title:

Anterior Distal Femoral Hemiepiphysiodesis in Children With Fixed Knee Flexion Deformities: Does Screw Position Matter?

Author:

Seth, Akshay MD; Watkins, Colyn J. MD; Miller, Patricia E. MS; Shore, Benjamin J. MD, MPH

Journal:

Journal of Pediatric Orthopaedics

Date:

March 2024

Reference:

44(3): p e255-e259, DOI: 10.1097/BPO.0000000000002599

Level Of Evidence:

III

# of Patients:

36 patients (68 knees)

Study Type:

Retrospective case series

Location:

Single pediatric hospital

Summary:

This study evaluates the effect of screw position on the outcome of anterior distal femoral hemiepiphysiodesis (ADFH) in children with fixed knee flexion deformities. It investigates how the sagittal positioning of screws impacts the change in lateral distal femoral physeal angle.

Methods:

Participants: 36 patients who underwent ADFH between 2013 and 2020. Intervention: Two percutaneous screws were used for ADFH. The position of screws was classified into three groups: AA: Both screws in the anterior third of the physis. AM: One screw in the anterior third and the other in the middle third of the physis. MM: Both screws in the middle third of the physis. Outcome Measures: Radiographs were evaluated for the sagittal screw position and the change in lateral distal femoral physeal angle at 12 and 24 months.

Exclusions:

Not specified

Results:

Preoperative and Follow-up Data: Mean physeal angle at surgery: 93° (SD 4.0). At 12 months: 102.4° (SD 5.7), showing a change of 9.4° (P<0.001). At 24 months: 104.6° (SD 6.3), showing a further change of 2.9° (P<0.001). Screw Position Effects: AA Screws: Continued to increase by 3.5° at 24 months (P<0.05). AM Screws: Minimal change (1.47°, P>0.05). MM Screws: A reversal of physeal angle by −7.1° at 24 months (P<0.05).

Conclusions:

ADFH increases the lateral distal femoral physeal angle, with the most significant correction occurring in the first 12 months. Screw positioning affects the degree of correction, with AA screws showing continued improvement. Close monitoring is essential, especially for patients with limited growth remaining (less than 2 years).

Relevance:

Limitations:

Perspective:

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