CORONAL PLANE GROWTH MODULATION FOR GENU VALGUM IN SKELETAL DYSPLASIA

To investigate the efficiency and rates of correction by hemiepiphysiodesis using 8-plate to manage genu valgum deformity in children with skeletal dysplasia.

Methods:

Eleven children with skeletal dysplasia (three female, eight male; mean age = 10.5 years; age range = 7-13) who underwent temporary hemiepiphysiodesis using 8-plates for genu valgum deformity were retrospectively reviewed. There were nine bilateral cases and two unilateral cases. The mean follow-up time from the index surgery to the final follow-up was 45 (ranging from 24 to 72) months. Radiographical assessment including preoperative and final follow-up measurements of joint orientation angles and mechanical axis deviation (MAD) were conducted.

Results:

Deformities were completely corrected in nine lower extremities (45%) and partially corrected in seven extremities (35%). In four extremities of two children with Morquio syndrome, MAD worsened. The correction rate of MAD was 1.25 ± 1.62 mm/mo.

Conclusion:

Though hemiepiphysiodesis using 8-plate requires a longer treatment period, it seems to be an effective treatment for correction of genu valgum in children with skeletal dysplasia. Level of Evidence IV, Case Series.

Keywords:
Bone Dysplasia; Genu Valgum; Growth Plate; Epiphyses; Retrospective Studies

Inclusion criteria	Exclusion criteria
• A diagnosis of skeletal dysplasia;
• Radiologically-confirmed genu valgum deformity;	• Lost to follow-up;
• Treated for HES using 8-plates;	• A history of lower limb correction surgery;
• A minimum of 12 months of follow-up after the index surgery;	• Unwillingness to participate in the study.
• Willingness to participate in the study.

Type of Skeletal Dysplasia	Patient No.	Type of Skeletal Dysplasia	Age at Treatment Onset (years)	Site of Plate Insertion: Femur/Tibia	Duration of 8-plate Treatment (months)	Removal of implants (+/-)	Follow-up period (months)	Side	Joint Orientation Angle (˚)	Mechanical Axis Deviation*** (mm)
									Angle Initial Final	Initial Final
									Angle Δ	MAD Δ
Achondroplasia	1 - U*	Achondroplasia	7	Both	R = 24	+	24	R	MPTA 100 88 12	62 - 10 72
									aLDFA 73 76 3
									mLDFA 82 90 8
									LDTA 84 93 9
	2 - B**	Achondroplasia	10	Both		+	48	R	MPTA 95 92 3	35 22 13
									aLDFA 83 81 2
									mLDFA 90 84 6
					R = 36				LDTA. 89 97 8
					L = 36			L	MPTA 94 80 14	42 - 21 63
									aLDFA. 83 87 4
									mLDFA 87 90 3
									LDTA 82 97 15
	3 - B	Achondroplasia	9	Both		+	72	R	MPTA 94 88 6	21 - 44 65
									aLDFA 79 107 28
									mLDFA 86 113 27
					R = 60				LDTA 94 95 1
					L = 60			L	MPTA 92 83 9	12 - 60 72
									aLDFA 85 108 23
									mLDFA 92 111 19
									LDTA 92 87 5
X-linked Hypophosphatemic Rickets	4 - U	X-linked Hypophosphatemic Rickets	4.5	Femur	R = 24	+	60	R	MPTA 89 90 1	22 8 14
									aLDFA 75 88 13
									mLDFA 87 94 7
									LDTA 103 79 22
	5 - B	X-linked Hypophosphatemic Rickets	12	Both		+	72	R	MPTA 96 90 6	14 10 4
									aLDFA 85 86 1
									mLDFA 90 86 4
					R = 60				LDTA 92 76 16
					L = 60			L	MPTA 88 90 2	19 10 9
									aLDFA 77 79 2
									mLDFA 84 85 1
									LDTA 91 89 2
	6 - B	X-linked Hypophosphatemic Rickets	9	Both		-	24	R	MPTA 97 81 16	49 - 19 68
									aLDFA 67 84 17
									mLDFA 78 89 11
					R = 24				LDTA 81 84 3
					L = 24			L	MPTA 100 83 17	54 - 9 63
									aLDFA 62 83 21
									mLDFA 70 84 14
									LDTA 87 75 12
Ellis-Van Creveld syndrome	7 - B	Ellis-Van Creveld syndrome	10	Both		+	48	R	MPTA 100 95 5	47 21 26
									aLDFA 59 58 1
									mLDFA 76 72 4
					R = 12				LDTA 92 90 2
					L = 12			L	MPTA 92 91 1	5 4 1
									aLDFA 79 87 8
									mLDFA 92 94 2
									LDTA 98 97 1
Mucopolysaccharidosis type IVA (Morquio syndrome)	8 - B	Mucopolysaccharidosis type IVA (Morquio syndrome)	10	Both		-	36	R	MPTA 98 104 6	60 91 - 31
									aLDFA 78 59 19
									mLDFA 83 63 20
					R = 36				LDTA 92 80 12
					L = 36			L	MPTA 102 106 4	29 85 - 56
									aLDFA 66 56 10
									mLDFA 71 63 8
									LDTA 86 78 8
	9 - B	Mucopolysaccharidosis type IVA (Morquio syndrome)	12	Both		-	48	R	MPTA 106 110 4	49 37 12
									aLDFA 81 80 1
									mLDFA 94 86 8
					R = 48				LDTA 74 70 4
					L = 48			L	MPTA 88 89 1	16 - 11 28
									aLDFA 80 90 10
									mLDFA 77 94 17
									LDTA 91 90 1
	10 - B	Mucopolysaccharidosis type IVA (Morquio syndrome)	13	Both		-	24	R	MPTA 87 88 1	22 - 16 38
									aLDFA 79 88 9
									mLDFA 75 91 16
					R = 24				LDTA 89 89 0
					L = 24			L	MPTA 100 103 3	26 40 - 14
									aLDFA 75 76 1
									mLDFA 83 80 3
									LDTA 60 70 10
	11 - B	Mucopolysaccharidosis type IVA (Morquio syndrome)	8	Both		+	36	R	MPTA 102 94 8	27 - 10 37
									aLDFA 84 85 1
									mLDFA 91 93 2
					R = 24				LDTA 65 64 1
					L = 24			L	MPTA 92 106 14	11 32 - 21
									aLDFA 85 70 15
									mLDFA 87 78 9
									LDTA 98 74 14

Preoperative Final follow-up Δ P
aTFA˚	27.4 ± 10	12.6 ± 20	14.8 ± 17.7	0.005*
MPTA˚	95.6 ± 5.39	92.5 ± 9.10	- 3.5 ± 8.23	0.140
aLDFA˚	76.8 ± 7.76	81.4 ± 13.6	4.65 ± 12	0.076
mLDFA˚	83.8 ± 7.18	87 ± 12.6	3.45 ± 11.4	0.35
LDTA˚	87 ± 10.6	83.7 ± 10.1	- 2.7 ± 9.39	0.177
MAD (mm)	30.5 ± 16.5	8.95 ± 37	22.1 ± 38.1	0.024*

ATHA EDITORA Rua: Machado Bittencourt, 190, 4º andar - Vila Mariana - São Paulo Capital - CEP 04044-000, Telefone: 55-11-5087-9502 - São Paulo - SP - Brazil
E-mail: actaortopedicabrasileira@uol.com.br

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[1] Correspondence: Mehmet Demirel. Istanbul Faculty of Medicine, Fatih, Istanbul, Turkey, 34080. dr88.mehmet.demirel@gmail.com

Number of patients (extremities)	11 (20)
Bilateral involvement	9
Unilateral involvement	2
Gender	8M, 3F
Types of skeletal dysplasia	Achondroplasia→3
	X-linked hypophosphatemic rickets→3
	Ellis-Van Creveld syndrome→1
	Morquio syndrome→4
Mean age at surgery (year)	10.5 (ranging 7-13)
Treatment period (month)	35 (ranging 12-60)
Implant removal	+ => 11 limbs of 6 children
Implant removal	- => 9 limbs of 5 children
Follow-up duration (month)	45 (ranging 24-72)