Guided Growth Surgery
While often corrected through non-surgical treatment options, severe congenital abnormalities, or deformities, may require surgical treatment to achieve proper realignment. Patients suffering from severe bowlegs or knock-knees will often benefit most from guided growth surgery.
Common Congenital Abnormalities
At skeletal maturity, the bones in the legs are typically equal in length and align correctly from the hips to ankles. However, congenital abnormalities, infection, injury, or other developmental problems can cause limbs to grow out of alignment. This malalignment may result in deformities of the legs such as bowlegs (genu varum), knock-knees (genu valgum), or limb length inequality.
Congenital Abnormalities Corrective Surgical Treatment Options
During corrective surgery, the pediatric orthopaedic surgeon will use either traditional osteotomy or hemi-epiphysiodesis. Traditional osteotomy is a more complex procedure that involves cutting the bone, adding or removing a wedge of bone (depending on the type of deformity), and realigning the bone. The realigned bone is then fixed with pins, a rod, or with a plate and screw combination.
While the traditional osteotomy approach is effective, the hemi-epiphysiodesis is the preferred because it is a much less invasive surgical method for correcting angular deformities and allows the surgeon to address multiple deformities during the same procedure.
Hemi-epiphysiodesis surgery (in which a growth plate is used) is performed under anesthesia and generally takes about an hour. During the procedure, the surgeon will make a 1 inch incision at the growth plate, through which a titanium plate is secured to the bone with two small titanium screws. For knock-knees, the device is placed on the medial side of the bone. For bowlegs, the plate is placed on the lateral side of the bone. Since the bones are never cut during the hemi-epiphysiodesis procedure, there is less neurovascular risk, decreased instability, and a shorter duration of healing.
Guided Growth Plate
The “guided growth” plate is a unique, figure-eight shaped device about the size of a paper clip that allows gradual correction of the deformity. Common devices utilized include the Eight-Plate and the Peanut Plate. The screws attaching the plate to the bone diverge like a hinge, decreasing the compression on the growth plate and allowing for increased flexibility. Flexibility is critical to proper correction because it decreases the chances that the screws will bend or break under the forces of bone growth. In addition, the growth plate restricts the bone growth to one side of the deformity, allowing the bone to gradually realign.
Post-Guided Growth Surgery Recovery
Casting is not required after hemi-epiphysiodesis surgery using a guided growth device; however, immediate weight bearing is encouraged. Depending on comfort level and physician recommendations, the majority of children who undergo guided growth plate surgery should be able to return to many of their normal activities within 2 to 3 weeks.
As with any surgical procedure, pain is to be expected but should decrease during the first 2 weeks after surgery, and is normally completely gone 4 weeks after surgery. Upon physician approval, participation in school physical education programs or sports can be resumed. For approximately 3 months after surgery, regular appointments with the surgeon are typically required. Once the deformity is corrected, the surgeon will remove the device in an out-patient surgery setting.
Guided Growth Surgery in Tampa-St. Petersburg, Florida
Dr. Scott Beck is a fellowship-trained board-certified pediatric orthopaedic surgeon specializing in the treatment of congenital orthopaedic anomalies, including bowlegs and knock-knees. To learn more about Children’s Orthopaedic and Scoliosis Surgery Associates’ specialties, schedule an appointment at one of their four area Tampa Area locations.