Treatment of pediatric patients with lower leg deformities associated with physeal arrest: analysis of 28 cases

Aim. To retrospectively analyze the results of two treatment methods for lower leg deformities associated with partial growth arrest. Materials and methods. Group I comprised 15 children who underwent osteotomy, acute overcorrection, and external fixation by Ilizarov with subsequent lengthening of the segment. Group II comprised 13 patients who underwent epiphysiodesis of the healthy part of the growth plate by drilling, osteotomy with external fixation by use of an Ortho-SUV Frame, and subsequent gradual deformity correction and lengthening. Results. In group I, overcorrection of varus deformities by mechanical axis deviation (MAD) was 18.28 ± 5.25 mm, overcorrection by mechanical medial proximal tibial angle (mMPTA) was 14.86 ± 4.45°, and overcorrection by mechanical lateral distal tibial angle (mLDTA) was 12.85 ± 3.02°. Overcorrection of valgus deformities according to MAD was 15.12 ± 8.28 mm, overcorrection by mMPTA was 10.38 ± 2.77°, and overcorrection by mLDTA was 7.5 ± 3.9°. Recurrence of the deformity was observed in 11 (73%) cases (range, 5–16 months). In group II, the accuracy of correction (AC) in varus deformities for MAD was 98% and 94% for mMPTA and mLDTA. For valgus deformities, AC for MAD was 90% and 96% for mMPTA and mLDTA. The AC for anatomical proximal posterior tibial angle and anatomical anterior distal tibial angle was 96% for procurvation deformities and that for recurvation deformities was 92%. Deformity recurrence was observed in only one case within 6 months after frame removal. In 2 cases, repeat limb length discrepancy correction surgeries were performed. Conclusion. Use of epiphysiodesis of the healthy portion of the growth plate in combination with osteotomy, computer-assisted external fixation with subsequent gradual deformity correction, and lengthening in patients with deformities associated with partial physeal arrest significantly decreased the number of deformity recurrences.