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Comparison of plate and screw constructs versus screws only for anterior distal femoral hemiepiphysiodesis in children

Nazareth, Alexandera,,b; Gyorfi, Michael J.c; Rethlefsen, Susan A.b; Wiseley, Benjaminc; Noonan, Kennethc; Kay, Robert M.a,,b

Journal of Pediatric Orthopaedics B: January 2020 - Volume 29 - Issue 1 - p 53–61
doi: 10.1097/BPB.0000000000000661

The study aim was to compare methods of anterior distal femoral hemiepiphysiodesis (ADFH) for treatment of fixed knee flexion deformities in ambulatory children with neuromuscular conditions and flexed knee gait. This is a retrospective review of 47 children (14 female, 33 male, age at surgery: 12.1 ± 2.7 years) who underwent ADFH between 2009 and 2016. Subjects were grouped by ADFH construct: one transphyseal screw (N = 11), two transphyseal screws (N = 28) or plates and screws (P/S group, N = 8). Clinical/radiographic variables were analyzed using paired t tests, χ2 tests, multiple regression and analysis of covariance. Participants experienced significant reduction in knee flexion contractures (Δ12°, P < 0.006), with no difference among groups (P = 0.43). Postoperative knee pain was significantly more prevalent in the P/S group (5/8, 63%) than the 1-SCR group (0/11, 0%) and the 2-SCR group (2/28, 7%) (P = 0.002). ADFH results in significant reduction of knee flexion deformity and improved knee extension during gait. Plate and screw constructs, the 1 and 2 transphyseal screw techniques are equally effective, but plate and screw constructs may be associated with a higher risk of persistent postoperative knee pain.

aKeck School of Medicine, University of Southern California

bChildren’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, California

cUniversity of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA

Correspondence to Susan A. Rethlefsen, PT, DPT, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd., M/S 69, Los Angeles, CA 90027, USA, Tel: +1 323 361 4120; fax: +1 323 361 1310; e-mail:

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