Pediatrics
Marina R. Makarov, MD; Connor M. Smith, MD; Taylor J. Jackson, MD; Chan Hee Jo, Ph.D; John G JBirch, MD, FRCS(C)
Abstract
Introduction: Pediatric patients with Blount disease frequently demonstrate secondary adaptive deformities in the adjacent distal femur. This study evaluates adaptation of longitudinal and angular proportions of the ipsilateral healthy femur to progressive leg length discrepancy in unilateral cases.Methods: ...
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Introduction: Pediatric patients with Blount disease frequently demonstrate secondary adaptive deformities in the adjacent distal femur. This study evaluates adaptation of longitudinal and angular proportions of the ipsilateral healthy femur to progressive leg length discrepancy in unilateral cases.Methods: The study included 55 children with unilateral Blount disease. Preoperative radiographs were analyzed to characterize the condition as infantile or adolescent and measure femoral/tibial lengths and mechanical lateral distal femoral angles (mLDFA). Results: There were 26 patients with infantile and 29 with adolescent Blount disease. Adolescent patients were significantly older (14.4 ± 2.0 vs. 9.2 ±2.4; p<0.01). Black race was prevalent in both groups (69-79%). The adolescent group was predominantly male (25/29; 86%), while the infantile group was predominantly female (15/26; 58%, p<0.01). Leg length inequality in adolescent patients was significantly greater than in the infantile group (2.8 ± 2.0 vs.1.5 ± 1.1cm; p<0.01) with ipsilateral femoral shortening (1.8 ± 1.8 cm) accentuating tibial shortening (1.0 ± 1.1cm). Patients with infantile Blount disease had more pronounced tibial discrepancy (2.0 ± 1.1 cm; p<0.01) but modest overgrowth of the ipsilateral femur (0.5 ± 0.7; p<0.01) partially compensating ipsilateral tibial shortening. There was a significant difference in tibial:femoral ratios between the groups (p<0.01). The infantile group had on average normal mLDFA (88°), most adolescent patients had accentuating distal femoral varus deformity (96° ± 5°; p<0.01).Conclusions: Patients with unilateral infantile and adolescent Blount disease demonstrated distinctly different adaptation of the ipsilateral femur. Concomitant ipsilateral femoral changes aggravate angular deformity and leg length discrepancy in adolescent Blount disease.
Kshitij Manchanda, M.D; Jennifer Rodgers,M A; Yassine Kanaan, M.D.; Chan Chan-Hee Jo, Ph.D; David A Podeszwa, M.D; John G Birch, M.D., FRCS(C)
Abstract
PURPOSE: We sought to determine the incidence, extent, and prognostic factors for physeal growth resumption after partial physeal bar resection.
METHODS: We performed a retrospective chart review of all patients treated between 1981-2017 by lower extremity physeal bar resection. All radiographic images ...
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PURPOSE: We sought to determine the incidence, extent, and prognostic factors for physeal growth resumption after partial physeal bar resection.
METHODS: We performed a retrospective chart review of all patients treated between 1981-2017 by lower extremity physeal bar resection. All radiographic images were reviewed from preoperatively until cessation of affected physeal growth, subsequent surgery, or skeletal maturity.
RESULTS: Eighty-nine patients met inclusion criteria (26 distal femora, 49 proximal tibiae (including 40 infantile Blount patients), 14 distal tibiae). Thirty-seven (42%) had at least two years’ normal growth (defined as “successful”), 13 (15%) showed less than two years’ growth (“partial”), and 39 (44%) had no growth (“failure”) after resection surgery. 56% of the “successful” and “partial” groups required subsequent surgery compared to 100% of the “failure” group. The use of methylmethacrylate (CranioplasticTM) as interpositional material was superior to autologous fat (p <0.01). Anatomic type of bar (peripheral, central, linear), physis affected, patient age, and etiology were not prognostic.
CONCLUSIONS: Approximately 40% of patients demonstrated useful resumption of growth after partial physeal bar resection. With the exception of interpositional material, other demographic variables were not prognostic. These results should be considered when determining whether physeal bar resection surgery is warranted in individual patients.
Advanced 3-D imaging reconstruction preoperatively, imaging confirmation of complete bar resection, markers to detect and monitor growth, and periodic radiographic follow up until cessation of growth or maturity should be incorporated in a standardized treatment regimen. LEVEL OF EVIDENCE: Level 3
KEY WORDS: Physeal Arrest, Physeal Bar, Bony Bridge, Physiolysis, Epiphysiolysis
