Document Detail

Mechanical axis following staple epiphysiodesis for limb-length inequality.
MedLine Citation:
PMID:  19797579     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Staple epiphysiodesis is an option for the treatment of limb-length discrepancies, but it is not without complications. The purpose of this study was to review the outcomes of staple epiphysiodesis, including changes in the mechanical axis. METHODS: The study included patients who underwent, between 1990 and 2005, staple epiphysiodesis of the femur or tibia, or both, to address limb-length discrepancy. We reviewed preoperative, postoperative, and final long standing anteroposterior radiographs of fifty-four patients to assess limb-length discrepancy, shifts in the mechanical axis, changes in the mechanical axis zone, and changes in the anatomic lateral distal femoral angle and the medial proximal tibial angle. Postoperative radiographs were also reviewed to assess the adequacy of staple placement. RESULTS: Three staple epiphysiodesis groups were identified: fifteen patients who underwent a distal femoral staple epiphysiodesis, eighteen who underwent a proximal tibial procedure, and twenty-one who underwent combined distal femoral and proximal tibial procedures. Fifty percent (twenty-seven) of the fifty-four patients showed a shift in the mechanical axis of > or =1 cm as compared with the preoperative measurement. Eighty-nine percent of these large shifts were varus in nature. The proximal tibial and combined epiphysiodeses resulted in significantly larger shifts in the mechanical axis (p = 0.002 and p = 0.006, respectively) and zone changes (p = 0.009 and p = 0.006, respectively) than did the distal femoral procedures. Six patients ultimately underwent a high tibial osteotomy to correct a post-stapling varus deformity. The proximal-lateral aspect of the tibia was by far the most common location for inadequate staple placement. CONCLUSIONS: Mechanical axis deviation is common following staple epiphysiodesis for the treatment of limb-length discrepancy. Proximal tibial and combined distal femoral and proximal tibial staple epiphysiodeses, even if done well technically, lead to clinically relevant shifts in the mechanical axis of the lower extremity more than half of the time. Distal femoral staple epiphysiodesis may still be a safe option for the treatment of limb-length discrepancy, but we advise caution when utilizing proximal tibial staple epiphysiodesis to treat limb-length inequality.
Troy M Gorman; Ryan Vanderwerff; Michael Pond; Bruce MacWilliams; Stephen D Santora
Related Documents :
19554329 - Opening wedge osteotomy of the first cuneiform for the treatment of hallux valgus.
17603449 - Periacetabular osteotomy in the treatment of developmental hip dysplasia in adolescents...
12382979 - Effect of pulsed electromagnetic fields (pemf) on late-phase osteotomy gap healing in a...
21866739 - Inferior turbinate hypertrophy radiofrequency management for children with cystic fibro...
17826549 - Distal radius osteotomy in the elderly patient using angular stable implants and norian...
9763269 - Arthroscopic evaluation of radial osteotomy for kienböck's disease.
21110509 - Intravitreal bevacizumab for myopic choroidal neovascularization: 1-year and 2-year res...
9069249 - Reduction of scrotalized skin improves the cosmetic appearance of feminising genitoplasty
6684879 - Fixed subaortic stenosis in the young: medical and surgical course in 83 patients.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of bone and joint surgery. American volume     Volume:  91     ISSN:  1535-1386     ISO Abbreviation:  J Bone Joint Surg Am     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-02     Completed Date:  2009-10-29     Revised Date:  2010-10-25    
Medline Journal Info:
Nlm Unique ID:  0014030     Medline TA:  J Bone Joint Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2430-9     Citation Subset:  AIM; IM    
Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Arthrodesis / adverse effects*
Epiphyses / surgery*
Femur / surgery
Leg Length Inequality / surgery*
Retrospective Studies
Surgical Stapling / adverse effects
Tibia / surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  The effect of postoperative passive motion on rotator cuff healing in a rat model.
Next Document:  The efficacy of the floor-reaction ankle-foot orthosis in children with cerebral palsy.