Does Combining Drilling and Curettage to Percutaneous Trans-epiphyseal Screws Improve Correction of Limb Length Discrepancy? A Comparative Study.

Abstract

Physeal drilling and curettage (PDC) and percutaneous epiphysiodesis using transphyseal screws (PETS) are among the most widely used techniques to treat leg-length discrepancy (LLD). This study compared the efficacy and outcomes between PETS alone and PETS combined with PDC (PETS + PDC). Retrospective study of children who underwent epiphysiodesis of the proximal tibia or distal femur with either PETS or PETS + PDC between 2008 and 2018 at a single institution. Radiographic parameters and complications were reviewed at completion of treatment and most recent follow-up. A total of 23 epiphysiodeses in 15 patients, average age 13.1 years, with either PETS (13 femur/tibias) or PETS + PDC (10 femur/tibias) were included. PETS patients were treated for a longer time (median: 24 months vs 11 months, <i>p</i> = 0.004), however, follow-up time was similar between groups (<i>p</i> = 0.577), on average 2.7 years. In the PETS group, LLD decreased from 2.55 to 0.84 cm at most recent follow-up (<i>p</i> = 0.010), and in the PETS + PDC group from 3.01 to 1.2 cm (<i>p</i> = 0.005), achieving a correction of 1.71 cm for PETS and 1.83 cm for PETS + PDC (<i>p</i> = 0.871). A correction of LLD to ≤ 2 cm was achieved in 8 PETS (89%) and 4 PETS + PDC cases (67%) (<i>p</i> = 0.525). Two PETS patients (22%) and 1 PETS + PDC (17%) patient returned to the OR for further correction due to persistent LLD (<i>p</i> = 1.000). No differences existed in total number of complications, angular deformity or return to physical activity between groups (<i>p</i> ≥ 0.05 for each comparison). This study showed equal efficiency in resolving LLD between the PETS and PETS + PDC procedures with minimal operative complications.<b>Level of Evidence</b> III.