Session 16: Pediatrics
Fredag d. 26. oktober
11:00-12:00
Lokale: Sweden
Chairmen: Line Kjeldgaard Petersen og Niels Wisbech Petersen
Anders Mätzke Rasmussen, Søren Overgaard, Lars Kjaersgaard Hansen, Ulrike Dunkhase-Heinl, Yanko Petkov, Vilhelm Engell, Niels Wisbech Pedersen, Anders Holsgaard-Larsen
The Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; H.C. Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark; Department of Paediatrics, Lillebaelt Hospital, Kolding, Denmark; Department of Paediatrics, Hospital of Western Jutland, Esbjerg, Denmark; The Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Background: The Cerebral Palsy follow-Up Program (CPUP) is used to ensure consistent examinations of children with cerebral palsy (CP). However, gait function by 3D gait analysis is not evaluated within CPUP.
Purpose / Aim of Study: To test the hypothesis that improvements in gait and function following interdisciplinary interventions using 3D gait analysis in the decision-making are superior to those following ‘care as usual’ without gait analysis in young children with CP.
Materials and Methods: A pragmatic, single blind, randomised (1:1) controlled trial. Primary outcome was gait function at 52 weeks follow-up evaluated by Gait Deviation Index (GDI) and secondary outcomes were: patient reported outcomes of function, disability and quality of life. Using a minimum clinically important difference of 7.9 (SD 12) GDI points, alpha = 0.05, and 80% power, a total of 60 children were included.
Findings / Results: Between-groups change scores were evaluated by a multiple regression model. The statistical analysis plan was registered at ClinicalTrails.gov (NCT02160457) and a protocol paper was published ahead. Sixty children (median age 6y11m) with CP at Gross Motor Function Classification System levels I (n = 42) and II (n = 18), were randomised to interventions with or without gait analysis. The categories of interventions were dominated by non-surgical interventions that were applied in 36 to 86% of the participants. No significant or clinically relevant between- group differences in change scores of the primary or secondary outcomes were found.
Conclusions: Interdisciplinary interventions using gait analysis did not improve gait or function in the present sample of relatively young and well-functioning children with CP. However, 3D gait analysis may still be relevant in children with higher levels of disability or if a functional diagnosis is needed.
The Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; H.C. Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark; Department of Paediatrics, Lillebaelt Hospital, Kolding, Denmark; Department of Paediatrics, Hospital of Western Jutland, Esbjerg, Denmark; The Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Background: The Cerebral Palsy follow-Up Program (CPUP) is used to ensure consistent examinations of children with cerebral palsy (CP). However, gait function by 3D gait analysis is not evaluated within CPUP.
Purpose / Aim of Study: To test the hypothesis that improvements in gait and function following interdisciplinary interventions using 3D gait analysis in the decision-making are superior to those following ‘care as usual’ without gait analysis in young children with CP.
Materials and Methods: A pragmatic, single blind, randomised (1:1) controlled trial. Primary outcome was gait function at 52 weeks follow-up evaluated by Gait Deviation Index (GDI) and secondary outcomes were: patient reported outcomes of function, disability and quality of life. Using a minimum clinically important difference of 7.9 (SD 12) GDI points, alpha = 0.05, and 80% power, a total of 60 children were included.
Findings / Results: Between-groups change scores were evaluated by a multiple regression model. The statistical analysis plan was registered at ClinicalTrails.gov (NCT02160457) and a protocol paper was published ahead. Sixty children (median age 6y11m) with CP at Gross Motor Function Classification System levels I (n = 42) and II (n = 18), were randomised to interventions with or without gait analysis. The categories of interventions were dominated by non-surgical interventions that were applied in 36 to 86% of the participants. No significant or clinically relevant between- group differences in change scores of the primary or secondary outcomes were found.
Conclusions: Interdisciplinary interventions using gait analysis did not improve gait or function in the present sample of relatively young and well-functioning children with CP. However, 3D gait analysis may still be relevant in children with higher levels of disability or if a functional diagnosis is needed.
Ahmed Abdul-Hussein Abood Abood, Ole Rahbek, Morten Lykke Olesen, Bjørn Borsøe Christensen, Bjarne Møller-Madsen, Søren Kold
Children's Orthopedics and Reconstruction, Aalborg University Hospital; Children's Orthopedics, Aarhus University Hospital; Orthopedic Research Lab, Aarhus University Hospital; Orthopedic Research Lab, Aarhus University Hospital; Children's Orthopedics, Aarhus University Hospital; Children's Orthopedics and Reconstruction, Aalborg University Hospital
Background: The use of retrograde femoral intramedullary nails in children for deformity correction is controversial. It is unknown if the injury to the central part of the growth plate results in premature bony union, leading to limb deformities or discrepancies.
Purpose / Aim of Study: The aim of this study is to asses physeal healing and bone growth after insertion of a retrograde femoral nail in a skeletally immature experimental porcine model.
Materials and Methods: Eleven immature pigs were included in the study. One leg was randomised for operation with a retrograde femoral nail (diameter 10 mm), whilst the non-operated contralateral remained as control. All nails were inserted centrally in coronal and sagittal plane under fluorescence, and the nails spanned the physis. The nails were removed at 8 weeks. Both femora in all animals underwent MRI at baseline (pre- operatively), 8 weeks (after nail removal) and 16 weeks (before euthanasia). Femoral bone length was measured at 5 sites (anterior, posterior, central, lateral and medial) using 3d T1-weighted MRI. Growth was calculated after 8 weeks (growth with nail) and 16 weeks (growth without nail). Corresponding 95% confidence intervals were calculated. Operated side was compared to non-operated. One animal died at 8 weeks and was only subject to 8 week- analysis.
Findings / Results: No differences in axial growth were observed between operated and non- operated sides. Mean growth difference was 0,61 mm [-0,78;2,01] whilst the nail was inserted into the bone and 0,72 mm [-1,04;1,65]; after nail removal. Furthermore, no signs of angular bone deformities were found when comparing operated side to non-operated side. No premature bony healing at the physis occurred.
Conclusions: The insertion of a retrograde femoral nail through the centre of an open physis might be a safe procedure with no growth arrest.
Children's Orthopedics and Reconstruction, Aalborg University Hospital; Children's Orthopedics, Aarhus University Hospital; Orthopedic Research Lab, Aarhus University Hospital; Orthopedic Research Lab, Aarhus University Hospital; Children's Orthopedics, Aarhus University Hospital; Children's Orthopedics and Reconstruction, Aalborg University Hospital
Background: The use of retrograde femoral intramedullary nails in children for deformity correction is controversial. It is unknown if the injury to the central part of the growth plate results in premature bony union, leading to limb deformities or discrepancies.
Purpose / Aim of Study: The aim of this study is to asses physeal healing and bone growth after insertion of a retrograde femoral nail in a skeletally immature experimental porcine model.
Materials and Methods: Eleven immature pigs were included in the study. One leg was randomised for operation with a retrograde femoral nail (diameter 10 mm), whilst the non-operated contralateral remained as control. All nails were inserted centrally in coronal and sagittal plane under fluorescence, and the nails spanned the physis. The nails were removed at 8 weeks. Both femora in all animals underwent MRI at baseline (pre- operatively), 8 weeks (after nail removal) and 16 weeks (before euthanasia). Femoral bone length was measured at 5 sites (anterior, posterior, central, lateral and medial) using 3d T1-weighted MRI. Growth was calculated after 8 weeks (growth with nail) and 16 weeks (growth without nail). Corresponding 95% confidence intervals were calculated. Operated side was compared to non-operated. One animal died at 8 weeks and was only subject to 8 week- analysis.
Findings / Results: No differences in axial growth were observed between operated and non- operated sides. Mean growth difference was 0,61 mm [-0,78;2,01] whilst the nail was inserted into the bone and 0,72 mm [-1,04;1,65]; after nail removal. Furthermore, no signs of angular bone deformities were found when comparing operated side to non-operated side. No premature bony healing at the physis occurred.
Conclusions: The insertion of a retrograde femoral nail through the centre of an open physis might be a safe procedure with no growth arrest.
Andreas Vestergaard Larsen, Esben Mundbjerg, Jens Martin Lauritsen, Christian Færgemann
Dept of Orthopedics and Traumatology, OUH; Dept of Orthopedics and Traumatology, OUH; Dept of Orthopedics and Traumatology, OUH; Dept of Orthopedics and Traumatology, OUH
Background: Previous Scandinavian studies have shown an increase in the incidence of paediatric fractures over the past 60 years. So far no Danish study has aimed to describe the development of incidence rates of paediatric fractures.
Purpose / Aim of Study: To describe the long-time development in the incidence rates of paediatric fractures and to describe the frequency of the most common fractures.
Materials and Methods: A retrospective register study of all paediatric bone fractures 0-15 years inhabited in the Odense Municipality and treated at Odense University Hospital 1980-2014. Data was extracted from the patient registration system and stratified by gender and age groups.
Findings / Results: The study included 32,927 children aged 0-15 with fractures. Overall 58 % were boys and the median age was 11 years for both boys and girls. The peak age in males was 13 years throughout the study period, whereas a tendency of declining peak age was found in girls from 11 years of age in 1980 to 10 years of age in 2014. The incidence rate was 330 (95% CI: 304-358) per 100,000 patient-years for boys and 258 (95% CI:226-274) per 100,000 patient-years for girls. The highest incidence rate was found in the age group 12-15 years and the lowest in the age group 0-1 years in both boys and girls. The incidence rate increased steadily until the age of 13 years for boys and 11 years for girls. Hereafter the incidence rate decreased rapidly. The overall incidence rate declined 23.4 % in in the study period as boys and girls contributed equally to the decline. The most common fracture was that of the distal radius/forearm with 28.5 %.
Conclusions: The present study does support the findings in previous studies. Our study showed a significant decline in the incidence rate of pediatric fractures in a 35 years period 1980-2014. Boys and girls contributed equally to the decline.
Dept of Orthopedics and Traumatology, OUH; Dept of Orthopedics and Traumatology, OUH; Dept of Orthopedics and Traumatology, OUH; Dept of Orthopedics and Traumatology, OUH
Background: Previous Scandinavian studies have shown an increase in the incidence of paediatric fractures over the past 60 years. So far no Danish study has aimed to describe the development of incidence rates of paediatric fractures.
Purpose / Aim of Study: To describe the long-time development in the incidence rates of paediatric fractures and to describe the frequency of the most common fractures.
Materials and Methods: A retrospective register study of all paediatric bone fractures 0-15 years inhabited in the Odense Municipality and treated at Odense University Hospital 1980-2014. Data was extracted from the patient registration system and stratified by gender and age groups.
Findings / Results: The study included 32,927 children aged 0-15 with fractures. Overall 58 % were boys and the median age was 11 years for both boys and girls. The peak age in males was 13 years throughout the study period, whereas a tendency of declining peak age was found in girls from 11 years of age in 1980 to 10 years of age in 2014. The incidence rate was 330 (95% CI: 304-358) per 100,000 patient-years for boys and 258 (95% CI:226-274) per 100,000 patient-years for girls. The highest incidence rate was found in the age group 12-15 years and the lowest in the age group 0-1 years in both boys and girls. The incidence rate increased steadily until the age of 13 years for boys and 11 years for girls. Hereafter the incidence rate decreased rapidly. The overall incidence rate declined 23.4 % in in the study period as boys and girls contributed equally to the decline. The most common fracture was that of the distal radius/forearm with 28.5 %.
Conclusions: The present study does support the findings in previous studies. Our study showed a significant decline in the incidence rate of pediatric fractures in a 35 years period 1980-2014. Boys and girls contributed equally to the decline.
Vilhelm Engell, Mathias Bünger, Ole Rahbek, Søren Ege
Ortopaedic department, Aarhus University Hospital; Ortopaedic department, Aarhus University Hospital; Ortopaedic department, Aarhus University Hospital; Rehabilitation, Aarhus University Hospital
Background: The Ponseti method (PM) is the gold standard in the treatment of Congenital Clubfoot. We report our results and experience with accelerated Ponseti method(APM) in a consecutive prospective series of clubfeet.
Purpose / Aim of Study: In APM the rate of manipulation and casting is twice or three times a week thus reducing the time to correction
Materials and Methods: In this consecutive prospective series we included all clubfeet treated with APM at the department in 2016. Controls were clubfeet treated with PM in 2015 and Follow-up was at 1 year
Findings / Results: APM reduced the manipulation and casting time by 40 % from 32 to 19 days (P=0,0002).Tendo Achilles Lenghtening (TAL) was performed in 28 clubfeet (97 %) in APM and 25 clubfeet (89 %) in PM (P=0,3525).No skin problems in any of the groups During follow-up we had two patients (10%) relapse with tightness of the dorsiflexion in both groups (P=1). All were treated with (re)casting and a second TAL
Conclusions: All feet were corrected with the APM. The rate of relapse with the APM is not higher than in clubfeet treated with the PM. This is preliminary results, with a short follow-up. We note the reduction in time to correction is significant and consider APM safe.
Ortopaedic department, Aarhus University Hospital; Ortopaedic department, Aarhus University Hospital; Ortopaedic department, Aarhus University Hospital; Rehabilitation, Aarhus University Hospital
Background: The Ponseti method (PM) is the gold standard in the treatment of Congenital Clubfoot. We report our results and experience with accelerated Ponseti method(APM) in a consecutive prospective series of clubfeet.
Purpose / Aim of Study: In APM the rate of manipulation and casting is twice or three times a week thus reducing the time to correction
Materials and Methods: In this consecutive prospective series we included all clubfeet treated with APM at the department in 2016. Controls were clubfeet treated with PM in 2015 and Follow-up was at 1 year
Findings / Results: APM reduced the manipulation and casting time by 40 % from 32 to 19 days (P=0,0002).Tendo Achilles Lenghtening (TAL) was performed in 28 clubfeet (97 %) in APM and 25 clubfeet (89 %) in PM (P=0,3525).No skin problems in any of the groups During follow-up we had two patients (10%) relapse with tightness of the dorsiflexion in both groups (P=1). All were treated with (re)casting and a second TAL
Conclusions: All feet were corrected with the APM. The rate of relapse with the APM is not higher than in clubfeet treated with the PM. This is preliminary results, with a short follow-up. We note the reduction in time to correction is significant and consider APM safe.
Gottliebsen Martin, Mathias Bünger, Ahmed Abdul-Hussein Abood, Vilhelm Engell, Ole Rahbek
Ortopædkirurgisk Afdeling E, Århus Universitetshospital; Ortopædkirurgisk Afdeling E, Århus Universitetshospital; Ortopædkirurgisk Afdeling , Aalborg Universitetshospital; Ortopædkirurgisk Afdeling E, Århus Universitetshospital; Ortopædkirurgisk Afdeling E, Århus Universitetshospital
Background: Open reduction surgery of severe cases of slipped capital femoral epiphysis (SCFE) guided by an intracranial pressure (ICP) monitoring probe inserted in the femoral head is a promising new technique. It has also been proposed to do closed reduction (CR) of acute SCFE (the condition that carries the highest risk of avascular necrosis) aided by monitoring pulse in the femoral head using ICP probes inserted through cannulated screws. However, little is known about the actual relationship between different approaches to monitor pulsatile flow in the femoral head.
Purpose / Aim of Study: To compare direct and indirect techniques for monitoring pulse in the femoral head in an experimental animal model.
Materials and Methods: Animal model using anesthetized pigs with an immature femoral head. Perfusion of the femoral head was confirmed by a preoperative gadolinium MRI scan. The following measurements were performed using the Codman ICP probe on 9 hip joints; direct measurement using 1.5 mm drill hole and indirect measurements through joint aspiration cannula, 4.5 mm cannulated screw and 6.5 mm cannulated screw. Direct measurements were performed through a drill hole in the adjacent metaphysis.
Findings / Results: Pulsatile flow was observed on all measurements. Groups were tested using ANOVA. Pressure was significantly higher using the direct approach (31.6 mmHg) to the femoral head compared to indirect techniques (6.7 - 13.7 mmHg). We were unable to find any difference between the different indirect techniques.
Conclusions: Indirect monitoring through cannulated screws may have a limited role for CR of acute SCFE. Because of the more reliable direct monitoring technique we advocate that CR is only undertaken in a setting where conversion to surgical dislocation and direct monitoring of pulse in the femoral head can performed.
Ortopædkirurgisk Afdeling E, Århus Universitetshospital; Ortopædkirurgisk Afdeling E, Århus Universitetshospital; Ortopædkirurgisk Afdeling , Aalborg Universitetshospital; Ortopædkirurgisk Afdeling E, Århus Universitetshospital; Ortopædkirurgisk Afdeling E, Århus Universitetshospital
Background: Open reduction surgery of severe cases of slipped capital femoral epiphysis (SCFE) guided by an intracranial pressure (ICP) monitoring probe inserted in the femoral head is a promising new technique. It has also been proposed to do closed reduction (CR) of acute SCFE (the condition that carries the highest risk of avascular necrosis) aided by monitoring pulse in the femoral head using ICP probes inserted through cannulated screws. However, little is known about the actual relationship between different approaches to monitor pulsatile flow in the femoral head.
Purpose / Aim of Study: To compare direct and indirect techniques for monitoring pulse in the femoral head in an experimental animal model.
Materials and Methods: Animal model using anesthetized pigs with an immature femoral head. Perfusion of the femoral head was confirmed by a preoperative gadolinium MRI scan. The following measurements were performed using the Codman ICP probe on 9 hip joints; direct measurement using 1.5 mm drill hole and indirect measurements through joint aspiration cannula, 4.5 mm cannulated screw and 6.5 mm cannulated screw. Direct measurements were performed through a drill hole in the adjacent metaphysis.
Findings / Results: Pulsatile flow was observed on all measurements. Groups were tested using ANOVA. Pressure was significantly higher using the direct approach (31.6 mmHg) to the femoral head compared to indirect techniques (6.7 - 13.7 mmHg). We were unable to find any difference between the different indirect techniques.
Conclusions: Indirect monitoring through cannulated screws may have a limited role for CR of acute SCFE. Because of the more reliable direct monitoring technique we advocate that CR is only undertaken in a setting where conversion to surgical dislocation and direct monitoring of pulse in the femoral head can performed.
christian wong, Johanna Hall, Kasper Gosvig
Dept of Orthopedics, hvidovre hospital; Dept of Radiology, hvidovre hospital; Dept of Radiology, h
Background: Vertebral rotation in straight spines or in spines with small scoliosis may potentially affect measurement of radiological parameters in both the frontal and sagittal plane. This is important, since it could lead to potential misdiagnosis of scoliosis and other clinical consequences, and until now, this has not been examined.
Purpose / Aim of Study: To examine the effect of axial vertebral rotation of the spine on measurement of common radiological parameters.
Materials and Methods: Reconstructions from computed tomography scans of 40 consecutive included and anonymized patients with straight spines or small scoliosis. Fourteen sagittal and coronal reconstructions covering the whole pelvis and spine were executed. Radiographic parameters in both the frontal and sagittal plane were measured blinded and separately by three doctors. These parameters were evaluated for inter-rater reliability using intra-class correlation coefficient and mixed model analysis for the effects of rotation. The parameters were also analyzed sub- stratified according to ‘Lenke’s classification’ and 15 sub-categories of thoracic and lumbar Cobb’s angle.
Findings / Results: Vertebral rotation in general does not have any significant effects in both the frontal and sagittal plane. However, there are significant effects on lumbar and spinopelvic radiologic parameters in moderate to extreme rotation or for larger scoliosis. Interrater reliability was very good to good.
Conclusions: In conclusion, axial spinal rotation does not influence common radiological parameters in the frontal and sagittal plane, except in cases of extreme rotation or large scoliosis for selected parameters, thus this does not lead to potential misinterpretation in scoliosis diagnosis, treatment or research.
Dept of Orthopedics, hvidovre hospital; Dept of Radiology, hvidovre hospital; Dept of Radiology, h
Background: Vertebral rotation in straight spines or in spines with small scoliosis may potentially affect measurement of radiological parameters in both the frontal and sagittal plane. This is important, since it could lead to potential misdiagnosis of scoliosis and other clinical consequences, and until now, this has not been examined.
Purpose / Aim of Study: To examine the effect of axial vertebral rotation of the spine on measurement of common radiological parameters.
Materials and Methods: Reconstructions from computed tomography scans of 40 consecutive included and anonymized patients with straight spines or small scoliosis. Fourteen sagittal and coronal reconstructions covering the whole pelvis and spine were executed. Radiographic parameters in both the frontal and sagittal plane were measured blinded and separately by three doctors. These parameters were evaluated for inter-rater reliability using intra-class correlation coefficient and mixed model analysis for the effects of rotation. The parameters were also analyzed sub- stratified according to ‘Lenke’s classification’ and 15 sub-categories of thoracic and lumbar Cobb’s angle.
Findings / Results: Vertebral rotation in general does not have any significant effects in both the frontal and sagittal plane. However, there are significant effects on lumbar and spinopelvic radiologic parameters in moderate to extreme rotation or for larger scoliosis. Interrater reliability was very good to good.
Conclusions: In conclusion, axial spinal rotation does not influence common radiological parameters in the frontal and sagittal plane, except in cases of extreme rotation or large scoliosis for selected parameters, thus this does not lead to potential misinterpretation in scoliosis diagnosis, treatment or research.
Andreas Balslev-Clausen, Peter Buxbom, Christian Wong, Klaus Hindsø
Dept. of Orthopaedics, Hvidovre Hospital; Dept of Orthopaedics, Herlev Hospital; Dept. of Orthopaedics, Hvidovre Hospital; Dept. of Orthopaedics, Rigshospitalet
Background: Correction using osteotomies and plates or frames for angular and rotational deformities of the lower extremity are large surgical procedures with risk of complications, but they can be necessary for amending the subsequent gait disturbances, pain and decreased function caused by the deformity. Guided growth are used for correcting angular deformities in the growing pediatric patients, but the technique have not been used for rotational deformities in humans. So far only animal studies have been published.
Purpose / Aim of Study: To investigate, if derotation using guided growth is possible in the human pediatric population.
Materials and Methods: Five children (9 bone segments) with symptomatic rotational deformities were included after informed consent in a prospective and consecutive cohort. Using intraoperative fluoroscopy, Pediplates® were inserted across the growth plate in a 45 degree (dg.) angle on both sides of either the femoral and/or tibial physes of the knee. RSA beads were inserted systematically, and patients were followed up every three months with radiostereometric analysis.
Findings / Results: At 9.3 months follow up, there was an avg. of 5.5 dg. of derotation (range 0-12 deg) and a longitudinal growth of 8.4 mm (range 2.8-13). However, the first two patients (4 segments) showed minimal derotation and growth after 6 months, whereas the later three patients (5 segments) showed an average rotation of 9.3 dg. and 9.4 mm of growth. Also, a rebound effect of 2.49 dg. was demonstrated in two children 9.9 months after plate.
Conclusions: The principles of guided growth can be applied for rotational deformity in growing children. In principle, this can be utilized to correct rotational deformities with minimal morbidity and discomfort. Exact plate placement of plates is crucial and a rebound effect is to be expected.
Dept. of Orthopaedics, Hvidovre Hospital; Dept of Orthopaedics, Herlev Hospital; Dept. of Orthopaedics, Hvidovre Hospital; Dept. of Orthopaedics, Rigshospitalet
Background: Correction using osteotomies and plates or frames for angular and rotational deformities of the lower extremity are large surgical procedures with risk of complications, but they can be necessary for amending the subsequent gait disturbances, pain and decreased function caused by the deformity. Guided growth are used for correcting angular deformities in the growing pediatric patients, but the technique have not been used for rotational deformities in humans. So far only animal studies have been published.
Purpose / Aim of Study: To investigate, if derotation using guided growth is possible in the human pediatric population.
Materials and Methods: Five children (9 bone segments) with symptomatic rotational deformities were included after informed consent in a prospective and consecutive cohort. Using intraoperative fluoroscopy, Pediplates® were inserted across the growth plate in a 45 degree (dg.) angle on both sides of either the femoral and/or tibial physes of the knee. RSA beads were inserted systematically, and patients were followed up every three months with radiostereometric analysis.
Findings / Results: At 9.3 months follow up, there was an avg. of 5.5 dg. of derotation (range 0-12 deg) and a longitudinal growth of 8.4 mm (range 2.8-13). However, the first two patients (4 segments) showed minimal derotation and growth after 6 months, whereas the later three patients (5 segments) showed an average rotation of 9.3 dg. and 9.4 mm of growth. Also, a rebound effect of 2.49 dg. was demonstrated in two children 9.9 months after plate.
Conclusions: The principles of guided growth can be applied for rotational deformity in growing children. In principle, this can be utilized to correct rotational deformities with minimal morbidity and discomfort. Exact plate placement of plates is crucial and a rebound effect is to be expected.