Abstract
Percutaneous epiphysiodesis using transphyseal screws is a common method for treatment of limb length discrepancy and angular deformity. The authors report 3 cases of a previously unreported complication following treatment with percutaneous epiphysiodesis using transphyseal screws: bending of the transphyseal screw. In each case, this rare complication was associated with difficult removal of the screw. This retrospective case report accessed the medical records of 3 children, 2 boys and 1 girl, 9 to 14 years old. All of the children had 4.0-mm cannulated stainless steel screws ranging from 40 to 50 mm in length. Two of the patients had partially threaded and 1 had fully threaded screws with bending noted a minimum of 6 months following implantation. Additionally, each of the screws bent near the physis of the bone, which was not located at the center of the screw in every case or at the transition from threaded to nonthreaded portions in each partially threaded screw. To the authors' knowledge, these are the first reported cases of cannulated screw bending following transphyseal tibial or femoral placement for the correction of leg length or angular deformity in a pediatric population. Although the true incidence rate is unknown, screw bending following percutaneous epiphysiodesis presents complications in the hardware removal process. Further biomechanical tests should be conducted to determine the best screw design to minimize bending of transphyseal screws from physiologic growth. [Orthopedics. 2017; 40(4):e717–e720.]
- 1.Stevens PM, Belle RM. Screw epiphysiodesis for ankle valgus. J Pediatr Orthop. 1997; 17(1):9–12.
10.1097/01241398-199701000-00003 Crossref Medline, Google Scholar - 2.Métaizeau JP, Wong-Chung J, Bertrand H, Pasquier P. Percutaneous epiphysiodesis using transphyseal screws (PETS). J Pediatr Orthop. 1998; 18(3):363–369.
10.1097/01241398-199805000-00018 Crossref Medline, Google Scholar - 3.Mesa PA, Yamhure FH. Percutaneous hemiepiphysiodesis using transphyseal cannulated screws for genu valgum in adolescents. J Child Orthop. 2009; 3(5):397–403.
10.1007/s11832-009-0203-8 Crossref Medline, Google Scholar - 4.Ilharreborde B, Gaumetou E, Souchet P, Efficacy and late complications of percutaneous epiphysiodesis with transphyseal screws. J Bone Joint Surg Br. 2012; 94(2):270–275.
10.1302/0301-620X.94B2.27470 Crossref Medline, Google Scholar - 5.Khoury JG, Tavares JO, McConnell S, Zeiders G, Sanders JO. Results of screw epiphysiodesis for the treatment of limb length discrepancy and angular deformity. J Pediatr Orthop. 2007; 27(6):623–628.
10.1097/BPO.0b013e318093f4f4 Crossref Medline, Google Scholar - 6.Nouth F, Kuo LA. Percutaneous epiphysiodesis using transphyseal screws (PETS): prospective case study and review. J Pediatr Orthop. 2004; 24(6):721–725.
10.1097/01241398-200411000-00023 Crossref Medline, Google Scholar - 7.Driscoll MD, Linton J, Sullivan E, Scott A. Medial malleolar screw versus tension-band plate hemiepiphysiodesis for ankle valgus in the skeletally immature. J Pediatr Orthop. 2014; 34(4):441–446.
10.1097/BPO.0000000000000116 Crossref Medline, Google Scholar - 8.Podeszwa DA, Wilson PL, Holland AR, Copley LA. Comparison of bioabsorbable versus metallic implant fixation for physeal and epiphyseal fractures of the distal tibia. J Pediatr Orthop. 2008; 28(8):859–863.
10.1097/BPO.0b013e31818e19d7 Crossref Medline, Google Scholar - 9.Slone HS, Stacey SC, Mooney JF. Mechanical failure of single cannulated screw fixation of unstable slipped capital femoral epiphysis. J Pediatr Orthop B. 2014; 23(1):49–54.
10.1097/BPB.0b013e328364eb74 Crossref Medline, Google Scholar - 10.MacWilliams BA, Harjinder B, Stevens PM. Guided growth for correction of knee flexion deformity: a series of four cases. Strategies Trauma Limb Reconstr. 2011; 6(2):83–90.
10.1007/s11751-011-0110-7 Crossref Medline, Google Scholar - 11.Al-Aubaidi Z, Lundgaard B, Pedersen NW. Anterior distal femoral hemiepiphysiodesis in the treatment of fixed knee flexion contracture in neuromuscular patients. J Child Orthop. 2012; 6(4):313–318.
10.1007/s11832-012-0415-1 Crossref Medline, Google Scholar
