Allowing kids to be kids is what makes Orthofix products designed for pediatric care so remarkable. Innovative designs and fresh technology allow boys and girls to enjoy the activities of childhood, even in the process of healing.
Orthofix pain management systems, bracing products, mini fixators and limb deformity correction devices are made specifically to protect, restore and heal children born with congenital defects and for children who are injured.
The following is some patient information for pediatric limb deformities that can be corrected with the new pediatric products from Orthofix.
Childhood Limb Deformities
In normal skeletal growth, limbs are equal in length and are properly aligned from the hips to the ankles. Sometimes, however, congenital abnormalities, infection, injury or other conditions can cause long bones of the leg (e.g., tibia, femur) to grow out of alignment.
This misalignment often may result in joint deformities of the leg known as valgus (knock knees) or varus (bowed legs) deformities. In these situations, normal use of the leg is impaired and walking or running may be painful. Unfortunately, bracing is not effective in the management of these conditions. The correction of limb deformities requires one of two surgical procedures: either an osteotomy [os-te-ot´o-me] or the minimally invasive hemi-epiphysiodesis [hemi-ep-i´fiz-e-o-de´sis] procedure.
Corrective Surgical Procedures
Correction using the osteotomy method is a significant surgical procedure that involves cutting the misaligned bone, adding or removing a wedge of bone (depending on the type of deformity) and realigning the bone. The realigned bone must be fixed into place with pins or with a plate and screw combination followed by a cast. Another alternative is to fix the realigned bone in place using pins in the bone segments and connecting them to an external frame. In addition to the inherent risks of such a surgery, the child must endure a prolonged hospital stay and delayed weight bearing, followed by a course of physical therapy.
In many cases, multiple osteotomy surgeries may be necessary to fully correct the leg's alignment.
In contrast, correction using hemi-epiphysiodesis is a much less invasive surgical method for correcting pathological angular deformities. Epiphysiodesis is a term from the Greek in which "physis" means growth plate and "desis" means tether. This procedure, traditionally known as "epiphyseal stapling" utilizes surgical staples (typically two or three) on one side of the physis, restricting its growth while permitting continued growth on the opposite, non-instrumented side. Gradually, the bone realigns and the deformity is corrected. Since the bone is not cut (as with an osteotomy), there is no neurovascular risk, instability from the cut, or significant period of healing.
Despite the fact that epiphyseal stapling has been used with success for more than 50 years, there are drawbacks and limitations to the use of staples. Staples are rigid, U-shaped implants that allow no flexibility during the growth and realignment of the bone. Additionally, the staples compress the growth plate on one side. Surgical planning for the precise placement of the staples is complicated. Furthermore, when rigid implants such as staples are confronted by the powerful forces generated by physis (growth), the staples may migrate, bend or break and compromise the outcome. Staple retrieval or revision may prove difficult, resulting in inadequate correction (or overcorrection) of the deformity.
Correction Through Guided Growth Using the Orthofix eight-Plate
The new eight-Plate technique of guided growth overcomes the drawbacks associated with traditional stapling and can give the patient improved correction of pathological angular deformity.
The Orthofix eight-Plate or 'guided growth plate' is a unique, figure-eight shaped device about the size of a paper clip that allows gradual correction of a patient's limb deformity. The eight-Plate holds one side of the growth plate. As the opposite side of the physis continues to expand and grow, the screws diverge within the plate, effectively serving as a hinge. This hinge action also avoids compressing the growth plate that is being guided. And because of its flexibility, the chances of the plate or screws bending or breaking under the forces of bone growth are virtually eliminated.
Correction Occurs Gently Over Time
The eight-Plate temporarily restrains growth on one side of the bone plate while natural growth is allowed to continue on the opposite side. Gradually over time, (typically from several months up to one year) the deformity is corrected. To ensure timely and adequate correction, your child needs to be seen by the surgeon every three months for a check-up. When the deformity is corrected, the surgeon will remove the eight-Plate, under anesthesia, in an out-patient surgery.
Implantation of the eight-Plate is performed under anesthesia and takes about an hour. During the procedure, the surgeon will make a 2-3 cm (approximately 1 inch) incision at the physis of the bone to be corrected.
The eight-Plate is secured to the bone with two small titanium screws. For knock knees it is placed on the medial side of the bone (i.e., inner side); for bowed legs, the eight-Plate is placed on the lateral side of the bone (i.e., outer side). Multiple deformities can be addressed during the same procedure, inserting one eight-Plate per physis. The incision is closed, generally with resorbable sutures. After recovery from anesthesia, the patient can go home.
Sometimes, our children need a little extra correction. And if that correction is needed for a joint deformity, rest assured that you and your child are not alone. We understand that surgery on our little ones is traumatic for you and the child, but consistent correction and gratifying clinical results have been achieved with guided growth using the eight-Plate.