3+4+Supplementum/2012 - Společnost pro pojivové tkáně

Recently, a new device called the
eight-Plate guided Growth System, was
presented as an alternative to the widely
used Blount staple to perform temporary
hemiepiphysiodesis in children. The eight-
Plate Guided Growth System (Orthofix,
McKinney, TX, USA) is attached to the bone
with two screws, making it more stable.
The main advantage of the eight-Plates is
temporary slower and safe correction of
deformities in comparison with the Blount
staple (4). Anthropological assessment of
residual growth in patients with skeletal
dysplasias and genetic syndromes is usually
not precise and that is why the eight-Plate
System shapes up as a method of choice in
these cases (3).
There is a further method of epiphysiodesis
using drilling of epiphysis that was
introduced by Macnicol and Pattinson at
the Princess Margaret Rose Orthopaedic
Hospital, Edinburgh in 1992 (11). This epiphysiodesis
using a cannulated tubesaw has
been developed to combine the precision of
the original Phemister method with newer
percutaneous methods. Epiphysiodesis is
carried out by boring of a part of a growth
plate using an X-ray intensifier for its identification.
The approach is unilateral, and
requires minimal access and a fairly prolonged
exposure to irradiation. Reinsertion
of the removed core of bone reduces haemorrhage
from the defect and augments
arrest of the growth plate
We have not our own experience with
a stapling method of reversible (temporary)
epiphysiodesis. Almost twenty years
we use modified Macnicol´s technique of
epiphysiodesis (11) and we present our
results. At present, we are introducing the
new eight-Plate System in Ambulant Centre
for Locomotor Defects
340 14 th Prague-Sydney-Lublin
Methods and Patients
The drilling epiphysiodesis by modified
Macnicol´s technique must be carefully
planned with regard to timing which
is one of the most important. Bone age
(Greulich Pyle and Tanner Whitehouse
Method 3 (13) was evaluated before surgery.
Remaining growth was predicted
according to Anderson, Green and Messner
(1) method. In our population the remaining
growth data by Anderson, Green and
Messner are more precise for prediction
of the remaining growth and timing of
surgery (21). Resulting lower limb axis or
lengs of lower limb was compared with
the prediction and remaining growth after
epiphysiodesis.
Valgosity or varosity of knee joints
were assessed by tibiofemoral angle
(anthropometric measurement according
to Culik and Marik (6), special photographic
method (7), and intermalleolar or intercondylar
distances, resp. flexion knee
deformities were assessed by a protractor
and verified by photographs.
Partial permanent epiphysiodesis
was carried out by boring of a part of
a growth plate using an X-ray intensifier for
its identification (11).
Total or partial boring (permanent)
epiphysiodesis was made in a cohort of 96
patients (107 epiphysiodesis), age 10.4 –
16.52 years. The cohort includes deformities
and uneven leg length at idiopathic,
metabolic, neuromuscular, genetic, traumatic
and developmental diseases. In several
cases the same surgical technique was
used for growth arrest and/or correction
at distal epiphysis of tibia, radius and
fibula. These indications are rare due to
a lack of growth references dates.