Article
Proximal fibular epiphysiodesis – is it necessary when performing proximal tibial growth arrest for leg length correction?
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Authors
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Adrien Frommer
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Uniklinik Münster, Münster, Germany
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Maike Niemann
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Uniklinik Münster, Münster, Germany
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Georg Gosheger
- Klinik für Allgemeine Orthopädie und Tumororthopädie, Münster, Germany
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Niklas Bröking
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Uniklinik Münster, Münster, Germany
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Anna Rachbauer
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Uniklinik Münster, Münster, Germany
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Gregor Toporowski
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Uniklinik Münster, Münster, Germany
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Robert Rödl
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Uniklinik Münster, Münster, Germany
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Björn Vogt
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Uniklinik Münster, Münster, Germany
| Published: | October 22, 2019 |
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Outline
Text
Objectives: Proximal tibial epiphysiodesis (PTE) is a common procedure for leg length discrepancy (LLD) and tall stature (TS) in children and adolescents. To prevent possible fibular overgrowth, proximal fibular epiphysiodesis (PFE) is frequently performed concomitantly to PTE.
Figure 1 [Fig. 1]
There is controversy in literature whether performing PFE should be performed to prevent instability of the lateral collateral ligament (LCL) or not in order minimize the risk potential peroneal nerve injury. Our study evaluates the relevance of additional PFE in tibial growth arrest.
Methods: Calibrated long standing radiographs of all patients who underwent temporary PTE with or without PFE for LLD or TS at our institution between 2009 and 2018 were retrospectively analysed. PTE was performed either with tension band plates or rigid staples. Cannulated screws (Ø4.0 or 4.5mm) were used for PFE. Measurements were performed right before implantation and directly before implant removal. The distance from the proximal tibial physis to the fibular head (dPTFH), normal range -3mm, +/-3mm) was measured as a radiographic reference parameter. Potential complications such as knee instability due to laxity of the LCL and discomfort caused by overgrowth were clinically assessed.
Results and conclusion: Temporary PTE was performed on 68 legs in 58 patients at a mean age of 11.96 years (y) (female: n=20, 11.15y; male: n= 38, 12.42y). 21/68 patients (group1) received additional PFE, while in 37/68 patients (group2) no PFE was performed. Mean follow up was 23.6 months. Average LLD was 3.2cm before treatment and 1.3cm just before hardware removal. Preoperative measurements of dPTFH resulted in -5.14mm in group1 and -3.45mm in group2. Right before implant removal the mean dPTFH measured -6.43mm in group1 and + 0,01mm in group2. In group1 no implantation associated complications i.e. injury of the peroneal nerve were observed. Patients of group2 did not suffer from knee instability or discomfort caused by potential fibular overgrowth. Since we did not observe a relevant proximal fibular overgrowth in the patients treated without PFE we believe that concomitant PFE is not necessary when treating LLD or TS with PTE in children and adolescents from 10-16 years. Based on our results and since PFE bears the potential risk of peroneal nerve injury, we stopped performing concomitant PFE in combination with PTE in length corrections. Further standardised and reliably reproducible clinical investigations are needed to assess potential discomfort or functional complications caused by fibular overgrowth and shortening.
