Growth modulation for coronal deformity correction by using Eight Plates-Systematic review.

Abstract

Coronal deformities are commonly encountered in paediatric orthopaedics and surgical treatment is indicated for severe deformities causing pain, function and cosmetic problems. In a growing bone, major surgical intervention like osteotomy with internal or external fixation can be avoided by growth modulation (hemiepiphysiodesis) using 8-plates. Our aim is to review the published literature on the use of 8-plates for deformity correction. We conducted a systematic review on 8-plate growth modulation for coronal deformity correction. We carried out detailed literature search on PubMed, Google Scholar, EMBASE, and Cochrane databases. We analysed selected studies for patient demographics, rate of deformity correction, clinical outcome and complications. We identified seven studies using 8-plate for deformity correction involving 215 patients (350 Limbs). The mean age was 9.5 years (2-16 years M/F Ratio 1.1:1); underlying aetiology was Idiopathic in 33% and Pathological 67% cases. The deformities were successfully corrected in 196/215 patients (91.2%) and partial/no correction in 19/215 patients (8.8%). The mean time to correction was 15.3 Months (10.3-25) and follows up of 18.9 months (12.4-24). The deformity corrected at 1.28 °/month (0.93-1.53), lateral distal femoral angle changed at 0.87°/month (0.65-1.0) and medial proximal tibial angle changed at 0.72 (0.5-1). Complications were reported in 12/215 patients (5.6%) including hardware failure in 5, overcorrection/leg length difference in 5, infection 1 and stiffness 1. The rebound was reported in 8 patients (3.7%). Growth modulation with 8-plates has high efficacy and low complications for deformity correction; and has been used widely across all paediatric age groups and aetiology. The literature is mostly retrospective and heterogeneous to develop age and aetiology specific recommendations.