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Topic:

Limb Deformity

Issue:

Knee

Category:

​

Title:

Physeal Migration During Knee-guided Growth With Tension Band Plates: Influence of Implant Position

Author:

Galán-Olleros, María MD; Sánchez del Saz, Jaime MD; Miranda-Gorozarri, Carlos MD; Serrano, Jose Ignacio; Egea-Gámez, Rosa M. MD, PhD; Garríguez-Pérez, Daniel MD; Alonso-Hernández, Javier MD; Martínez-Caballero, Ignacio MD, PhD

Journal:

Journal of Pediatric Orthopaedics

Date:

February 2024

Reference:

44(2): p e174-e183, DOI: 10.1097/BPO.0000000000002583

Level Of Evidence:

III

# of Patients:

491

Study Type:

Retrospective study

Location:

Single institution

Summary:

The study aims to determine the impact of implant position on physeal migration during knee-guided growth using TBP. It investigates the association between implant placement and the risk of physeal migration and its clinical implications.

Methods:

This retrospective study included 491 patients, with a subgroup of 29 patients who experienced physeal migration during follow-up. Radiographic measurements were taken from immediate postoperative and follow-up radiographs, assessing various angles and distances related to screw positioning. Descriptive and case-control analyses were performed to evaluate the factors influencing physeal migration.

Exclusions:

Patients without adequate follow-up radiographs or those who did not undergo the intended procedure were excluded from the study.

Results:

Patient Demographics: The median age at intervention was 12.2 years, with 76% of patients being male. Radiographic Analysis: Statistically significant differences were found in several radiographic measures, such as the epiphyseal screw base–physis distance (3.7 vs 6.3; P = 0.029) and epiphyseal screw tip–physis distance (3.6 vs 7.85; P = 0.002). Physeal Migration: In 16, 17, and 12 cases, the physis was touched, occupied, or traversed, respectively. However, no physeal abnormalities were detected after plate removal.

Conclusions:

Physeal migration is a common occurrence in TBP-guided growth, but no physeal abnormalities were observed after plate removal. The study suggests avoiding the convergent placement of the epiphyseal screw close to the physis, as this positioning increases the risk of physeal migration.

Relevance:

Limitations:

Perspective:

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