Angular deformity correction by asymmetrical physeal suppression in growing children: stapling versus percutaneous transphyseal screw.
OBJECTIVE
The aim of this study was to compare the outcomes of angular deformity correction by hemiepiphyseal stapling versus percutaneous hemiepiphysiodesis using transphyseal screw in growing children.


METHODS
Forty-three physes in 19 patients underwent hemiepiphyseal stapling, and 37 physes in 23 patients underwent percutaneous transphyseal screw placement. All cases were followed up to skeletal maturity or for more than 1 year after hardware removal. Amounts and rates of angular deformity correction, physeal behaviors after hardware removal, and postoperative courses were compared between the 2 groups.


RESULTS
The goal of angular correction was achieved in all except 2 patients, who reached skeletal maturity precociously. The mean rates of angular correction were not significantly different between the 2 groups, in both distal femur and proximal tibia. Hardware was removed before skeletal maturity from 56 physes. Angular change remained within 3 degrees for 43 physes (76.8%) at more than 1 year postoperatively, and the rebound phenomenon was observed in 12 (21.4%). No significant difference was observed between the 2 groups in terms of physeal behavior after hardware removal. Patients in the screw group were administered less postoperative pain medication, had shorter hospital stays, and smaller operation scars. In the stapling group, 1 case was complicated due to an extruded staple, and another case experienced premature physeal arrest at 1.5 years postoperatively. One case in the screw group experienced correction failure, probably because of a technical error during screw placement.


CONCLUSIONS
Hemiepiphysiodesis using percutaneous transphyseal screw is as effective as hemiepiphyseal stapling in terms of angular deformity correction. Furthermore, hemiepiphysiodesis using transphyseal screw has the advantage of being a minimally invasive procedure, and in this series, did not cause permanent physeal arrest.


METHODS
Level III.
Shin
Sung Jin
SJ
Department of Orthopedic Surgery, Seoul National University Children's Hospital, Seoul, Korea.
Cho
Tae-Joon
TJ
Park
Moon Seok
MS
Bae
Jung Yun
JY
Yoo
Won Joon
WJ
Chung
Chin Youb
CY
Choi
In Ho
IH
D001863:Bone Screws; D002648:Child; D002921:Cicatrix / Q000209:etiology; D020878:Device Removal; D004838:Epiphyses / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000002:abnormalities / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome