Eight Plate Hemiepiphysiodesis In Genu Valgum: A Retrospective Study
Background: Angular deformities of distal femur can be treated with corrective osteotomies and skeletal fixation. In children, this major intervention can be avoided with temporary hemiepiphysiodesis. Recently, a new implant called the eight-Plate, consisting of a two-hole plate and two screws, is popular as an alternative to the Blount staple to perform temporary hemiepiphysiodesis in children.
Materials & Methods: Fifteen patients (16 physes, 16 limbs) were identified retrospectively in between November 2012 to September 2017 who underwent eight plate surgical growth modulation with average follow-up after plate insertion of 2 years 2 months (range, 1 year 6 months to 2 years 6 months).
Results: Average age at eight-Plate implantation was eleven years three months (age range, 9 years 8 months to 13 years 6 months). Eight-plates were inserted for an average 14.0 months (range, 11.0–20.4 months). No growth disturbance was observed. Mechanical lateral distal femoral angle changed an average 10.00 degrees (range, 7–18 degrees) or 0.4 degrees/month.
Conclusions: The eight-Plate effectively treats angular deformities in growing children and is less likely to extrude spontaneously than the Blount staple. We have not observed growth disturbance or other complications related to this device.
2. Brooks WC, Gross RH. Genu varum in children: diagnosis and treatment. J Am Acad Orthop Surg. 1995;3(6):326–335.
3. Fabry G, MacEwen GD, Shands AR. Torsion of the femur. A follow-up study in normal and abnormal conditions. J Bone Joint Surg Am. 1973;55(8):1726–1738.
4. Kulkarni GS. Angular deformities in lower limb in children. In: Kulkarni GS, editor. Text Book of Orthopedics and Trauma. 2nd ed. New Delhi: Jaypee Publishers; 2008. p. 3650-7.
5. Mycoskie P. Complication of osteotomies about the knee in children. Orthopedics 1981;4:1005-15. 7. Steel HH, Sandrow RE, Sullivan PD.
6. Complications of tibial osteotomy in children for genu varum or valgum. Evidence that neurological changes are due to ischemia. J Bone Joint Surg Am 1971;53:1629-35.
7. Blount WP, Clarke GR. Control of bone growth by epiphyseal stapling: a preliminary report. J Bone Joint Surg Am 1949;31: 464–78.
8. Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop 2007;27:253–9.
9. Zuege RC, Kempken TG, Blount WP. Epiphyseal stapling for angular deformity at the knee. J Bone Joint Surg Am 1979;61:320-9.
10. Bylski-Austrow DI, Wall EJ, Rupert MP, Roy DR, Crawford AH. Growth plate forces in the adolescent human knee: A radiographic and mechanical study of epiphyseal staples. J Pediatr Orthop 2001;21:817-23.
11. Frantz CH. Epiphyseal stapling: A comprehensive review. Clin Orthop Relat Res 1971;77:149-57.
12. Bowen JR, Leahey JL, Zhang ZH, MacEwen GD. Partial epiphysiodesis at the knee to correct angular deformity. Clin Orthop Relat Res. 1985;198:184–90.
13. Paley D. Frontal plane mechanical and anatomic axis planning. In: Paley D. Principles of deformity correction. 1st ed, corrected 3rd printing. Berlin Tokyo Heidelberg New York: Springer-Verlag; 2005:61–97.
14. Kulkarni RM, Ilyas Rushnaiwala FM, Kulkarni GS, Negandhi R, Kulkarni MG, Kulkarni SG. Correction of coronal plane deformities around the knee using a tension band plate in children younger than 10 years. Indian J Orthop 2015;49:208-18.
15. Wiemann JM 4th, Tryon C, Szalay EA. Physeal stapling versus 8-plate hemiepiphysiodesis for guided correction of angular deformity about the knee. J Pediatr Orthop 2009;29:481-5.
16. Ballal MS, Bruce CE, Nayagam S. Correcting genu varum and genu valgum in children by guided growth: Temporary hemiepiphysiodesis using tension band plates. J Bone Joint Surg Br 2010;92:273-6.
17. Schroerlucke S, Bertrand S, Clapp J, Bundy J, Gregg FO. Failure of Orthofix eight-Plate for the treatment of Blount disease. J Pediatr Orthop 2009;29:57-60.
18. Burghardt RD, Herzenberg JE. Temporary hemiepiphysiodesis with the eight-Plate for angular deformities: Midterm results. J Orthop Sci 2010;15:699-704.