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Anders Wensaas - One of the best experts on this subject based on the ideXlab platform.
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ORIGINAL CLINICAL ARTICLE Long-term outcome of slipped capital femoral epiphysis: a 38-year follow-up of 66 patients
2013Co-Authors: Anders Wensaas, Svein Svenningsen, Terje Terjesen, A. WensaasAbstract:Ó The Author(s) 2010. This article is published with open access at Springerlink.com Purpose The purpose of this retrospective study was to evaluate the long-term outcome of different methods of treatment in slipped capital femoral epiphysis (SCFE), to find risk factors for poor outcome, and to assess whether prophylactic fixation is indicated. Methods Sixty-six patients (76 hips) treated for SCFE with a mean follow-up of 38 years (range 21–57 years) were evaluated. All except seven patients had chronic SCFE. Ten patients (15%) had bilateral affection. Three methods of treatment had been used: screw fixation (35 hips), bone-peg Epiphysiodesis (30 hips), and bone-peg Epiphysiodesis combined with corrective femoral osteotomy (11 hips). The long-term clinical outcome was classified as good when the patient had not undergone total hip replacement (THR), when the Harris hip score (HHS) was 85 points or above, or the patient had no pain. Good radiographic outcome was defined as no THR or osteoarthritis (OA). Results In 51 patients with chronic slip (mean slip angle 32°) treated with in situ fixation, the clinical outcome was good in 35 patients (69%) and there was no significant difference between screw fixation and bone-peg Epiphysiodesis. Eight patients with large chronic slip (mean sli
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Percutaneous Epiphysiodesis in the proximal tibia by a single-portal approach: evaluation by radiostereometric analysis
Journal of children's orthopaedics, 2013Co-Authors: Joachim Horn, Ragnhild Gunderson, Anders Wensaas, Harald SteenAbstract:Purpose We modified the method for tibial Epiphysiodesis by solely using a lateral approach to the physis. From this small-incision approach, the lateral as well as the medial part of the tibial physis were ablated. The aim of our study was to see if this operative technique might be as effective as a bilateral approach, and reduce the operation time and usage time of the image intensifier. The epiphysiodeses were monitored by radiostereometric analysis (RSA), which is a well-established method for the analysis of micro movements and has been used to monitor percutaneous Epiphysiodesis with the bilateral approach. There are no reports in the literature comparing single- with double-portal approaches for percutaneous Epiphysiodesis evaluated by RSA. Methods Twenty children were treated by percutaneous Epiphysiodesis for leg length discrepancies ranging from 15 to 70 mm, comprising 14 boys and 6 girls with a mean age of 13 (11‐15) years. The timing of Epiphysiodesis was determined by using Moseley’s straight-line graph and Paley’s multiplier method. For the tibial Epiphysiodesis, ten patients were operated with a single surgical approach from the lateral side (Group I) and ten patients were operated with a surgical approach from both the medial and the lateral sides (Group II). The percutaneous Epiphysiodesis was monitored by RSA, a method which allows analysis of the three-dimensional dynamics of the epiphysis relative to the metaphysics. RSA examinations were performed postoperatively and after 6 weeks, 12 weeks,
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Long-term outcome of slipped capital femoral epiphysis: a 38-year follow-up of 66 patients
Journal of Children's Orthopaedics, 2011Co-Authors: Anders Wensaas, Svein Svenningsen, Terje TerjesenAbstract:Purpose The purpose of this retrospective study was to evaluate the long-term outcome of different methods of treatment in slipped capital femoral epiphysis (SCFE), to find risk factors for poor outcome, and to assess whether prophylactic fixation is indicated. Methods Sixty-six patients (76 hips) treated for SCFE with a mean follow-up of 38 years (range 21–57 years) were evaluated. All except seven patients had chronic SCFE. Ten patients (15%) had bilateral affection. Three methods of treatment had been used: screw fixation (35 hips), bone-peg Epiphysiodesis (30 hips), and bone-peg Epiphysiodesis combined with corrective femoral osteotomy (11 hips). The long-term clinical outcome was classified as good when the patient had not undergone total hip replacement (THR), when the Harris hip score (HHS) was 85 points or above, or the patient had no pain. Good radiographic outcome was defined as no THR or osteoarthritis (OA). Results In 51 patients with chronic slip (mean slip angle 32°) treated with in situ fixation, the clinical outcome was good in 35 patients (69%) and there was no significant difference between screw fixation and bone-peg Epiphysiodesis. Eight patients with large chronic slip (mean slip angle 53°) were treated with bone-peg Epiphysiodesis and corrective femoral osteotomy, and the clinical outcome was poor in six patients. Seven patients with acute slip had larger mean slip angle (57°) and more complications than those with chronic slip, and the long-term outcome was poor in all. Two hips out of 42 (5%) had OA in the contralateral hip at follow-up. Conclusion In situ fixation of chronic SCFE gave satisfactory long-term outcome irrespective of the treatment method. Corrective femoral osteotomy did not improve the outcome in hips with large slip angles. Acute SCFE had poor outcome. Prophylactic fixation of the contralateral hip is barely necessary.
J. R. Bowen - One of the best experts on this subject based on the ideXlab platform.
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Experimental Epiphysiodesis: magnetic resonance imaging evaluation with histopathologic correlation.
International orthopaedics, 2001Co-Authors: Marek Synder, H T Harcke, K Conard, J. R. BowenAbstract:We performed an experimental Epiphysiodesis on the tibia in 16 immature New Zealand white rabbits. The purpose was to study the process of trauma-induced growth plate closure. The animals were killed at weekly intervals over 8 weeks. We correlated the histological findings with serial magnetic resonance images. The undamaged, central part of the growth plate became histologically abnormal within 1 week. Mature bone bridge formation in the area of the Epiphysiodesis was seen after 3 to 4 weeks. The study suggests that growth arrest starts before the bone bridge formation. Factors regulating cartilage growth may also play a role.
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Partial Epiphysiodesis to address genu varum or genu valgum.
Journal of pediatric orthopedics, 1992Co-Authors: J. R. Bowen, R. Ruiz Torres, E. ForlinAbstract:Two groups of children with excessive genu valgum or genu varum were treated with a partial Epiphysiodesis. In group I (16 extremities) a predictive chart was used to determine the appropriate bone age to perform the partial Epiphysiodesis, and in group II (15 extremities) the age for the procedure was estimated. The partial Epiphysiodesis was performed by either an open or a percutaneous technique. In group I the correction of the genu valgum and genu varum followed the predicted course, whereas group II resulted in a 9.1 degree error. Genu valgum and genu varum in children with adequate remaining growth can be corrected using a predictive growth chart to determine the appropriate bone age for the procedure.
Terje Terjesen - One of the best experts on this subject based on the ideXlab platform.
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ORIGINAL CLINICAL ARTICLE Long-term outcome of slipped capital femoral epiphysis: a 38-year follow-up of 66 patients
2013Co-Authors: Anders Wensaas, Svein Svenningsen, Terje Terjesen, A. WensaasAbstract:Ó The Author(s) 2010. This article is published with open access at Springerlink.com Purpose The purpose of this retrospective study was to evaluate the long-term outcome of different methods of treatment in slipped capital femoral epiphysis (SCFE), to find risk factors for poor outcome, and to assess whether prophylactic fixation is indicated. Methods Sixty-six patients (76 hips) treated for SCFE with a mean follow-up of 38 years (range 21–57 years) were evaluated. All except seven patients had chronic SCFE. Ten patients (15%) had bilateral affection. Three methods of treatment had been used: screw fixation (35 hips), bone-peg Epiphysiodesis (30 hips), and bone-peg Epiphysiodesis combined with corrective femoral osteotomy (11 hips). The long-term clinical outcome was classified as good when the patient had not undergone total hip replacement (THR), when the Harris hip score (HHS) was 85 points or above, or the patient had no pain. Good radiographic outcome was defined as no THR or osteoarthritis (OA). Results In 51 patients with chronic slip (mean slip angle 32°) treated with in situ fixation, the clinical outcome was good in 35 patients (69%) and there was no significant difference between screw fixation and bone-peg Epiphysiodesis. Eight patients with large chronic slip (mean sli
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Long-term outcome of slipped capital femoral epiphysis: a 38-year follow-up of 66 patients
Journal of Children's Orthopaedics, 2011Co-Authors: Anders Wensaas, Svein Svenningsen, Terje TerjesenAbstract:Purpose The purpose of this retrospective study was to evaluate the long-term outcome of different methods of treatment in slipped capital femoral epiphysis (SCFE), to find risk factors for poor outcome, and to assess whether prophylactic fixation is indicated. Methods Sixty-six patients (76 hips) treated for SCFE with a mean follow-up of 38 years (range 21–57 years) were evaluated. All except seven patients had chronic SCFE. Ten patients (15%) had bilateral affection. Three methods of treatment had been used: screw fixation (35 hips), bone-peg Epiphysiodesis (30 hips), and bone-peg Epiphysiodesis combined with corrective femoral osteotomy (11 hips). The long-term clinical outcome was classified as good when the patient had not undergone total hip replacement (THR), when the Harris hip score (HHS) was 85 points or above, or the patient had no pain. Good radiographic outcome was defined as no THR or osteoarthritis (OA). Results In 51 patients with chronic slip (mean slip angle 32°) treated with in situ fixation, the clinical outcome was good in 35 patients (69%) and there was no significant difference between screw fixation and bone-peg Epiphysiodesis. Eight patients with large chronic slip (mean slip angle 53°) were treated with bone-peg Epiphysiodesis and corrective femoral osteotomy, and the clinical outcome was poor in six patients. Seven patients with acute slip had larger mean slip angle (57°) and more complications than those with chronic slip, and the long-term outcome was poor in all. Two hips out of 42 (5%) had OA in the contralateral hip at follow-up. Conclusion In situ fixation of chronic SCFE gave satisfactory long-term outcome irrespective of the treatment method. Corrective femoral osteotomy did not improve the outcome in hips with large slip angles. Acute SCFE had poor outcome. Prophylactic fixation of the contralateral hip is barely necessary.
Leonhard E. Ramseier - One of the best experts on this subject based on the ideXlab platform.
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Guided growth with tension band plate or definitive Epiphysiodesis for treatment of limb length discrepancy
Journal of orthopaedic surgery and research, 2019Co-Authors: Paul Borbas, Christoph A. Agten, Andrea B. Rosskopf, Andreas Hingsammer, Karim Eid, Leonhard E. RamseierAbstract:It is not exactly known whether guided growth or definitive Epiphysiodesis techniques are superior in treating limb length discrepancy (LLD). The purpose of the present study was therefore to find out if definitive Epiphysiodesis is associated with more powerful LLD correction than tension band plate Epiphysiodesis. Pediatric patients with LLD treated either with tension band plating as a guided growth technique (temporary Epiphysiodesis) or a percutaneous drilling technique (definitive Epiphysiodesis) around the knee and a minimum follow-up of 12 months were included in this retrospective study. Radiographic measurements were performed by two independent reviewers. The reduction in side difference between preoperative radiographs and last follow-up was calculated and compared between surgical techniques. Thirty-eight patients (mean age 13.6 years) were included, 17 treated with temporary and 21 with definitive Epiphysiodesis. Average follow-up was at 578 days. The reduction of the LLD in 12 months was 5.7 mm in patients treated with temporary Epiphysiodesis and 8.4 mm with definitive Epiphysiodesis, respectively (p = 0.22). In both groups, LLD could be statistically significantly reduced after 12 and 24 months. Definitive Epiphysiodesis had a lower revision rate (4.8% vs. 17.6%). Intra- and interobserver reliability of the measurements was excellent. As in earlier studies supposed, temporary Epiphysiodesis with tension band plating seems to correct LLD less powerful compared to definitive percutaneous Epiphysiodesis. However, in the present study, the differences of LLD correction were not statistically significant. We do not recommend the use of tension band plates for LLD correction due to inferior correction with higher complication and revision rate.
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Temporary screw Epiphysiodesis for ankle valgus in children
Acta Orthopaedica Belgica, 2018Co-Authors: Sam Nicolas Skovgard Interne, Leonhard E. Ramseier, Svenja Leu, Stefan Gaukel, Christoph Aufdenblatten, Samuel SkovgaardAbstract:Aim: The aim of this case series was to assess clinical outcomes and achievable correction grades following temporary percutaneous medial malleolar screw Epiphysiodesis. Methods: A retrospective chart review of 16 consecutive children with ankle valgus (23 ankles) treated with medial malleolar screw Epiphysiodesis in one single institution was performed. Tibiotalar angle, fibular station, and the lateral distal tibial angle were measured before screw Epiphysiodesis, and before and after hardware removal. Results: Mean mechanical and anatomical lateral distal tibial angles were significantly improved by Epiphysiodesis (75.6° to 85.2° and 75.7° to 85.3°, respectively, p < 0.005). Similarly, mean tibiotalar angle was significantly improved by screw Epiphysiodesis when comparing to the last follow-up before screw removal (5.8° to 14.2°, p < 0.005). We observed a slight rebound following screw removal. Conclusion: Temporary medial malleolar screw Epiphysiodesis is an effective method to treat ankle valgus in children.
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Minimal invasive Epiphysiodesis using a modified “Canale”-technique for correction of angular deformities and limb leg length discrepancies
Journal of Children's Orthopaedics, 2009Co-Authors: Leonhard E. Ramseier, Atul Sukthankar, G. Ulrich ExnerAbstract:Purpose Leg length discrepancy and angular deformities can, in contrast to adults; easily be corrected with Epiphysiodesis during growth. Goal of this study was to evaluate our results of a modified Canale technique for definitive Epiphysiodesis treating leg length discrepancy and also angular deformities. Methods Between 2000 and 2007, 22 patients (11 boys and 11 girls) were subjected to definitive Epiphysiodesis. In total 73 hemiEpiphysiodesis were performed (26 proximal tibial, 47 distal femoral). Results All patients could be followed to the end of growth. Mean follow-up was 32.2 month (range 13–76 months). In 20 patients the Epiphysiodesis was planed to correct axis and leg length discrepancy. In two patients’ contralateral Epiphysiodesis was performed to avoid further leg length discrepancy because of closed physis of the shorter affected side. A staged procedure was necessary in nine patients to achieve the best possible correction. No complications were seen such as wound healing, knee-joint contractures after Epiphysiodesis of the distal femur and proximal tibia. In two patients three rehemiEpiphysiodesis because of not fully closure of the physis had to be done. Conclusion Definitive Epiphysiodesis using this modified Canale technique is a safe, minimal invasive method to correct leg length discrepancy and angular deformities if preoperative planning is performed properly.
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Minimal invasive Epiphysiodesis using a modified “Canale”-technique for correction of angular deformities and limb leg length discrepancies
Journal of children's orthopaedics, 2009Co-Authors: Leonhard E. Ramseier, Atul Sukthankar, G. Ulrich ExnerAbstract:Purpose Leg length discrepancy and angular deformities can, in contrast to adults; easily be corrected with Epiphysiodesis during growth. Goal of this study was to evaluate our results of a modified Canale technique for definitive Epiphysiodesis treating leg length discrepancy and also angular deformities.
Roger F. Widmann - One of the best experts on this subject based on the ideXlab platform.
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Percutaneous Epiphysiodesis Using Transphyseal Screws: a Case Series Demonstrating High Efficacy.
HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 2017Co-Authors: Emily R. Dodwell, Matthew R. Garner, Elise C. Bixby, Eva Luderowski, Daniel W. Green, John S. Blanco, Roger F. WidmannAbstract:Background Percutaneous Epiphysiodesis using transphyseal screws (PETS) has been associated with implant failure, implant prominence, angular deformities, and delayed growth inhibition.
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Surgical Epiphysiodesis indications and techniques: update.
Current opinion in pediatrics, 2011Co-Authors: Ismat Ghanem, Joseph A. Karam, Roger F. WidmannAbstract:Purpose of review To present a summary of Epiphysiodesis indications and to report most recent advances in the field, along with their clinical relevance. Recent findings Percutaneous Epiphysiodesis using transphyseal screws (PETS) and guided growth using eight plates represent the most recent techniques used for hemiEpiphysiodesis. Summary PETS and guided growth have yielded very good results and low rates of complications and are the current standard for the management of angular deformities of the lower extremities in children. Permanent percutaneous Epiphysiodesis remains the preferred method for the treatment of limb length discrepancies.
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Percutaneous Radiofrequency Epiphysiodesis in a Rabbit Model: A Pilot Study
Clinical orthopaedics and related research, 2010Co-Authors: Roger F. Widmann, Terry D. Amaral, Cemil Yildiz, Xu Yang, Mathias P.g. BostromAbstract:Background Techniques for Epiphysiodesis have evolved from open surgical techniques requiring direct observation of the physis to percutaneous techniques performed with fluoroscopy.