title: Poor Efficiency of Eight-Plates in the Treatment of Lower Limb Discrepancy.
abstract: BACKGROUND
  Among the numerous existing epiphysiodesis procedures, the eight-plate-guided growth technique, initially described for angular deformities correction, has progressively gained popularity among pediatric orthopaedic surgeons to treat lower limb discrepancy (LLD). The goal of this study was to assess the efficacy of eight-plates in LLD.
  
  
  METHODS
  All children treated for LLD with eight-plates were prospectively included and followed until skeletal maturity. Efficacy of the epiphysiodesis was calculated 6 and 18 months postoperatively and at latest follow-up, according to a method previously validated for percutaneous epiphysiodesis using transphyseal screws (PETS). Radiologic measurements were performed using 3-dimensional low-dose stereoradiography. Intraoperative and postoperative complications were reported.
  
  
  RESULTS
  Thirty-two patients were included (average age at surgery, 12.5 y). For femoral epiphysiodesis, efficacy was only 23% at 6 months and 68% at latest follow-up. The procedure was even less efficient on the proximal tibia, with only 42% of the expected growth arrest at latest examination. Eight patients (20%) experienced plate-related pain during follow-up, and 5 physes (12.5%) required unplanned revision surgery.
  
  
  CONCLUSIONS
  Results of the current series show that the eight-plate technique procedure was associated with few perioperative complications, but the growth arrest observed at follow-up was unpredictable and lower than that achieved with PETS in previous reports. Eight-plate procedures cannot be considered as an efficient epiphysiodesis technique in comparison with standard technique.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Pediatric Orthopaedics, Robert Debré Hospital, Paris Diderot University, Paris, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Gaumétou
authors.forename: Cindy
authors.initials: C
authors.lastname: Mallet
authors.forename: Philippe
authors.initials: P
authors.lastname: Souchet
authors.forename: Keyvan
authors.initials: K
authors.lastname: Mazda
authors.forename: Brice
authors.initials: B
authors.lastname: Ilharreborde
mesh_terms: D000293:Adolescent; D001852:Bone Lengthening / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D001860:Bone Plates; D002648:Child; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000254:growth & development; D006132:Growth Plate / Q000601:surgery; D006801:Humans; D007870:Leg Length Inequality / Q000175:diagnosis / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000145:classification / Q000601:surgery; D011859:Radiography / Q000379:methods; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D013977:Tibia / Q000000981:diagnostic imaging / Q000254:growth & development; D016896:Treatment Outcome