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The Efficacy and Complications of 2-Hole 3.5 mm Reconstruction Plates and 4 mm Noncanulated Cancellous Screws for Temporary Hemiepiphysiodesis Around the Knee

Aslani, Hossein MD*,†; Panjavy, Behnam MD*; Bashy, Ramin H.Z. MD*; Tabrizi, Ali MD; Nazari, Behrooz MD

Journal of Pediatric Orthopaedics: June 2014 - Volume 34 - Issue 4 - p 462–466
doi: 10.1097/BPO.0000000000000115

Background: Persistent angular deformities around the knee can lead to growth-plate damage in childhood and osteoarthritis in adulthood. The treatment options include osteotomy and hemiepiphysiodesis. Tension-band plate hemiepiphysiodesis with 8-plate is an effective way to correct these deformities. However, its high cost makes it less available in many countries. In the present series, we have used 3.5 mm reconstruction plates for tension-band temporary hemiepiphysiodesis.

Methods: Twenty-one patients with bilateral angular deformities of the knee (42 extremities) underwent temporary hemiepiphysiodesis with 3.5 mm reconstruction plates. The diagnosis, BMI, weight, amount of correction of the deformity age, and device failure were analyzed. The mean follow-up period after plate removal was 17 months (ranging from 8 to 24 mo).

Results: The mean age of the patients was 10 years and 3 months (±2 y and 10 mo). Complete correction of the deformities was achieved in 86% of patients. Of the 58 plate and screw constructs, 10% had screw breakage. Patients with genu valgum had 2 screw failures (6.25%), but in the genu varum group there were 4 screw failures (40%). Of the 3 patients who did not have complete correction of the deformities, 2 had mucopolysaccharidosis and 1 was nearing skeletal maturity (16 y old). The age of the patient, body weight, BMI, and degrees of angulation did not have any statistically significant correlation with the screw failure. Screw failures in female patients were more common than in male patients. All implant failures occurred in idiopathic patients.

Conclusions: The efficacy of 3.5 mm reconstruction plates for temporary hemiepiphysiodesis around the knee is similar to that of 8-plates. However, the reconstruction plates have a lower cost and are easily available. Noncanulated 3.5 or 4.5 mm cortical screws seem to be superior to 4 mm noncanulated cancellous screws.

Level of Evidence: Level 3.

*Children’s Medical Center, Tehran University of Medical Sciences

Department of Orthopaedics, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

Department of Orthopaedics, Tulane University, New Orleans, LA

None of the authors received financial support for this study either directly or indirectly, from a third party in support of any aspects of this work.

The authors declare no conflicts of interest.

Reprints: Hossein Aslani, MD, Department of Orthopaedics, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz 5167743943, Iran. E-mail:

© 2014 by Lippincott Williams & Wilkins