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

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Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Objectives

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).

Methods

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.

Results

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, p = 0.004), however, follow-up time was similar between groups (p = 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 (p = 0.010), and in the PETS + PDC group from 3.01 to 1.2 cm (p = 0.005), achieving a correction of 1.71 cm for PETS and 1.83 cm for PETS + PDC (p = 0.871). A correction of LLD to ≤ 2 cm was achieved in 8 PETS (89%) and 4 PETS + PDC cases (67%) (p = 0.525). Two PETS patients (22%) and 1 PETS + PDC (17%) patient returned to the OR for further correction due to persistent LLD (p = 1.000). No differences existed in total number of complications, angular deformity or return to physical activity between groups (p ≥ 0.05 for each comparison).

Conclusions

This study showed equal efficiency in resolving LLD between the PETS and PETS + PDC procedures with minimal operative complications.

Level of Evidence III.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author notes

  1. Manaf H. Younis and Regina Hanstein have contributed equally to this manuscript.

Authors and Affiliations

  1. Saudi Hospital, Mansour Ben Omeir St., Amman, Jordan

    Manaf H. Younis

  2. Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY, USA

    Regina Hanstein, Eric D. Fornari, Jaime A. Gomez, Melinda S. Sharkey & Jacob F. Schulz

  3. Albert Einstein College of Medicine, Bronx, NY, USA

    Kainaat Javed

Authors
  1. Manaf H. Younis
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Correspondence to Manaf H. Younis.

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MHY, RH, KJ, EDF, MSS and JFS declare that they have no conflict of interest. JAG reports a consultancy and honoraria with Stryker Spine outside the submitted work.

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Younis, M.H., Hanstein, R., Javed, K. et al. Does Combining Drilling and Curettage to Percutaneous Trans-epiphyseal Screws Improve Correction of Limb Length Discrepancy? A Comparative Study. JOIO 58, 190–198 (2024). https://doi.org/10.1007/s43465-023-01070-7

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  • DOI: https://doi.org/10.1007/s43465-023-01070-7

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