Epiphysiodesis

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Epiphysiodesis_table_infobox_0

EpiphysiodesisEpiphysiodesis_header_cell_0_0_0
ICD-9-CMEpiphysiodesis_header_cell_0_1_0 Epiphysiodesis_cell_0_1_1

Epiphysiodesis is a pediatric orthopedic surgery procedure that aims at altering or stopping the bone growth naturally occurring through the growth plate also known as the physeal plate. Epiphysiodesis_sentence_0

There two types of epiphysiodesis: temporary hemiepiphysiodesis and permanent epiphysiodesis. Epiphysiodesis_sentence_1

Temporary hemiepiphysiodesis is also known as guided growth surgery or growth modulation surgery. Epiphysiodesis_sentence_2

Temporary hemiepiphysiodesis is reversible i.e. the metal implants used to achieve epiphysiodesis can be removed after the desired correction is achieved and the growth plate can thus resume its normal growth and function. Epiphysiodesis_sentence_3

In contrast, permanent epiphysiodesis is irreversible and the growth plate function cannot be restored after surgery. Epiphysiodesis_sentence_4

Both temporary hemiepiphysiodesis and permanent epiphysiodesis are used to treat a diverse array of pediatric orthopedic disorders but the exact indications for each procedure are different. Epiphysiodesis_sentence_5

Guided growth temporary hemiepiphysiodesis Epiphysiodesis_section_0

Temporary hemiepiphysiodesis is widely used to treat angular or coronal plane deformities around the knee in children i.e. deformities occurring in the medial/lateral plane as genu varum/ genu valgum. Epiphysiodesis_sentence_6

Additionally, it has been used to treat sagittal plane deformities i.e. deformities arising the anterior/posterior plane. Epiphysiodesis_sentence_7

Temporary hemiepiphysiodesis has also been used to treat deformities around the hips and ankles and in the upper extremity growth plates such as the distal radius growth plate. Epiphysiodesis_sentence_8

Temporary hemiepiphysiodesis works through arresting or inhibiting the physeal growth at one hemi-side of the growth plate. Epiphysiodesis_sentence_9

In consequence the other hemi-side is allowed to grow normally and unhindered. Epiphysiodesis_sentence_10

This process occurs gradually and steadily and eventually leads to correction of the angular deformity in most cases. Epiphysiodesis_sentence_11

Temporary hemiepiphysiodesis or guided growth surgery has been used to treat angular deformities in children suffering from diverse bone and joint disorders such as rickets, Blount's disease, osteochondrodysplasias, arthrogryposis multiplex congenita, idiopathic, trauma, and renal osteodystrophy among others. Epiphysiodesis_sentence_12

Temporary hemiepiphysiodesis is increasingly been viewed as more simple and efficient alternative to the classic time-honored osteotomy or bone cutting practice. Epiphysiodesis_sentence_13

Bone osteotomy achieve deformity correction immediately while temporary hemiepiphysiodesis does so gradually. Epiphysiodesis_sentence_14

A variety of metal implants have been used to perform temporary hemiepiphysiodesis or guided growth surgery as a two-hole plate and screws and staples. Epiphysiodesis_sentence_15

Figure 1 Any metal implant originally used to achieve temporary hemiepiphysiodesis should be removed once the intended deformity correction is reached. Epiphysiodesis_sentence_16

Otherwise the child will go into the reverse deformity, a phenomenon known as overcorrection. Epiphysiodesis_sentence_17

For example, failure to remove the metal implant in due time for a child that was being treated for a genu varum can result in overcorrection to a genu valgum deformity and vice versa. Epiphysiodesis_sentence_18

Outcome and complications Epiphysiodesis_section_1

Generally, the results of temporary hemiepiphysiodesis or guided growth surgery are satisfactory. Epiphysiodesis_sentence_19

In contrast to osteotomy or external fixation correction, it is considered as a less traumatic and safe surgical method. Epiphysiodesis_sentence_20

The complications are of low profile in terms of severity and frequency generally. Epiphysiodesis_sentence_21

Yet, there are concerns about the use of temporary hemiepiphysiodesis in certain diseases as Blount's disease and osteochondrodysplasias. Epiphysiodesis_sentence_22

Mechanical failure of the metal implant as plate and screws and failure to achieve full correction of the deformity has been closely associated with the Blount's disease. Epiphysiodesis_sentence_23

Additionally, recurrence of bone deformity or rebound phenomenon and subsequent repeated surgeries has been closely linked to bone deformities arising from osteochondrodysplasias. Epiphysiodesis_sentence_24

Generally, children should be followed up for deformity recurrence or rebound after removal of the metal implant used to achieve deformity correction. Epiphysiodesis_sentence_25

Permanent epiphysiodesis Epiphysiodesis_section_2

Outcome and complications Epiphysiodesis_section_3

The procedure must be performed for an appropriate duration during the patient's adolescent growth phase so that the limbs are near-equal in length by the end of skeletal growth. Epiphysiodesis_sentence_26

Poor timing can lead to a length mismatch, resulting in poor outcomes and significant patient morbidity. Epiphysiodesis_sentence_27


Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Epiphysiodesis.