Guided growth for leg length discrepancies, angular deformities and fixed knee flexion deformities treatment

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Abstract


Materials and methods. The data of 4 groups with patients from 4 to 14 years old were studied. Group 1: 22 patients (34 knees), with angular deformities about the knee. Group 2: 38 patients (38 knees) with leg length discrepancies. Group 3: 15 patients (27 knees) with knee flexion contracture and cerebral palsy. Patients of 1–3 groups were operated by guided growth. The reference group (40 patients, 60 knees) was formed to determine the normal knee extension values in children according to X-ray and goniometry data.

Results. The mean angle of deformity before and after surgical treatment in group 1 were: 15.3 and 1.6º; in group 3: 160 and 4º recurrence, respectively, (p<0.05). The mean leg length discrepancy before and after surgery in group 2 were: 30 and 8 mm (p<0.05). The mean correction rate in group 1 was 0.6º per month, in group 2 – 0.9 mm per month, in group 3 – 2.9º per month. The mean score on the Gillette FAQ in group 3 increased after surgical treatment from 3.63 to 4.13. In reference group the mean angle of passive extension was 5º recurrence with goniometry lying on back, and 15º recurrence on X-ray. The mean active extension in a standing position was 4º recurrence. Smaller values of the tibiofemoral angle with goniometry in the standing position and passive extension with X-ray and goniometry can serve as clinical and radiological criteria for knee flexion contracture.

Conclusion. Guided growth is an effective technique for correcting leg length discrepancy and angular deformities about the knee in children. Close outpatient observation allows to not only timely identify orthopedic pathology, but also to effectively correct it without major reconstructive operation.


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About the authors

Mariia O. Volkova

National Medical Research Center for Children’s Health

Author for correspondence.
Email: volkova-mo@mail.ru

Russian Federation, Moscow

Graduate Student

Dzhamilia M. Kukueva

Pirogov Russian National Research Medical University

Email: dzhamaa7@gmail.com

Russian Federation, Moscow

Student

Konstantin V. Zherdev

National Medical Research Center for Children’s Health

Email: drzherdev@mail.ru

Russian Federation, Moscow

D. Sci. (Med.), Prof.

Oleg B. Chelpachenko

National Medical Research Center for Children’s Health

Email: chelpachenko81@mail.ru
ORCID iD: 0000-0002-0333-3105

Russian Federation, Moscow

Cand. Sci. (Med.)

Sergei P. Yatsyk

National Medical Research Center for Children’s Health

Email: yatsyk@nczd.ru
ORCID iD: 0000-0001-6966-1040

Russian Federation, Moscow

D. Sci. (Med.), Prof., Corr. Memb. RAS

Ivan E. Nikitenko

National Medical Research Center for Children’s Health

Email: iv.nikitenko1984@yandex.ru

Russian Federation, Moscow

Cand. Sci. (Med.)

Igor V. Timofeev

National Medical Research Center for Children’s Health

Email: doctor_timofeev@mail.ru

Russian Federation, Moscow

Cand. Sci. (Med.)

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Supplementary files

Supplementary Files Action
1.
Fig. 1. External appearance and radiographs of the lower extremities before (the deformity angle was formed on the right and 19 and 15º, respectively) and after the operation (the tibial-femoral angle was 5º on the right and 8º on the left). The duration of the correction is 22 months.

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2.
Fig. 2. The appearance and radiographs of the lower endpoints of the patients before and after the operation and the appearance 4 years after the insertion of the plates. Duration of correction – 18 months.

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3.
Fig. 3. The appearance and radiographs of the lower extremities before surgery and after removal of the plates. The duration of the correction is 11 months.

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