gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Potential and distribution of growth arrest by temporary epiphysiodesis – Comparison of modern RigidTacks TM and traditional Blount Staples in a porcine animal model

Meeting Abstract

  • presenting/speaker Hauke Hillebrand - Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Kinderorthopädie, Deformitätenrekonstruktion u. Fußchirurgie, Münster, Germany
  • Julia Sattelberger - Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Kinderorthopädie, Deformitätenrekonstruktion u. Fußchirurgie, Münster, Germany
  • Georg Gosheger - Universitätsklinikum Münster, Klinik und Poliklinik für Allgemeine und Tumororthopädie, Münster, Germany
  • Robert Rödl - Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Kinderorthopädie, Deformitätenrekonstruktion u. Fußchirurgie, Münster, Germany
  • Ahmed Abdul-Hussein Abood - Paediatric Orthopaedic Research Institute, Dept. of Children's Orthopaedics, University Hospital Aarhus, Aarhus, Denmark
  • Martin Gottliebsen - Paediatric Orthopaedic Research Institute, Dept. of Children's Orthopaedics, University Hospital Aarhus, Aarhus, Denmark
  • Bjarne Moeller-Madsen - Paediatric Orthopaedic Research Institute, Dept. of Children's Orthopaedics, University Hospital Aarhus, Aarhus, Denmark
  • Björn Vogt - Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Kinderorthopädie, Deformitätenrekonstruktion u. Fußchirurgie, Münster, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocPO12-1232

doi: 10.3205/17dkou616, urn:nbn:de:0183-17dkou6160

Veröffentlicht: 23. Oktober 2017

© 2017 Hillebrand et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: For decades 2-3 inflexible Blount Staples(BS) per arrested site have been used for temporary epiphysiodesis(TED) in moderate leg length discrepancies(LLD). However, high rates of implant associated complications were reported. Therefore, the indication of the precisely implantable eight-PlatesTM with their flexible tension band effect recently was extended to LLD. However, this biomechanical behaviour is appropriate for angular deformity(AD) correction, but can lead to central knee joint deformations in LLD correction. Additionally, iatrogenic coronal and sagittal AD resulting from unevenly distributed growth arrests(GA) are major complications of these implants. The new RigidTacksTM(RT) consist of anatomically preformed, cannulated staples with rigid crossbars. Only 1 device per site is recommended. This study compares the potential and distribution of GA either using BS or RT in a porcine animal model.

Methods: A paired randomised design was used. 12 immature pigs were divided into 2 equally sized groups treated by TED either using 2 BS or 1 centrally placed RT per arrested site (Figure 1 [Fig. 1]). The right proximal tibia was randomly allocated to TED or no treatment. The left side received the opposite treatment. All devices were removed after 14 weeks of GA. 3 Tesla MR scans of both tibiae were performed before treatment and after removal. The interphyseal distance(ID) was measured in different tibial zones (Figure 2 [Fig. 2], Figure 3 [Fig. 3]) to generally compare the potential of GA between the devices and to evaluate the distribution of GA within each tibia. Statistics was conducted using Wilcoxon test.

Results and Conclusion: The ID before treatment was not significantly different between the groups (p>0.05). TED with BS and RT, each led to significantly shorter ID in all treated tibiae compared to the control legs (Table 1 [Tab. 1]). The GA potentials were similar despite implantation of only 1 RT compared to 2 BS per arrested side (p>0.05). In both groups no significant differences were found comparing the GA potential of the examined tibial zones, although the greatest numeric ID difference was reached in the central zone using RT and in the anterior and posterior zone using BS (Table 2 [Tab. 2], Table 3 [Tab. 3]).

Only 1 centrally placed RT per side produced the same extent of GA as 2 BS. Additionally, the GA potential comparing the examined tibial zones was not significantly different within both groups. Concluding, no secondary coronal or sagittal AD and central joint deformations developed either using 1 central RT or 2 BS per site. However, as slight numeric differences were measured, the extent of GA resulting from 14 weeks of TED might be too short to reach statistical significance. RT are a reasonable alternative to BS for LLD correction by TED.