A Novel Minimally Invasive Surgical Technique for Eight-Plate Hemiepiphysiodesis: Description and Evaluation

Background: Temporary hemiepiphysiodesis with tension band plates or eight-plates is a common surgical procedure to treat malalignment of the lower limb axis in skeletally immature patients. The objective of this study was to compare a new minimally invasive surgical procedure with the conventional procedure and evaluate its safety and effectiveness in order to reduce the risk of hypertrophic scarring, which may cause functional impairment as well as cosmetic issues. Methods: Sixty-five growth plates of either the femur or the tibia were evaluated in 33 patients treated for genu valgum or varum between 2010 and 2017. Each growth plate was considered an individual case. The modified procedure was used in 17 cases and the conventional procedure in 48 cases. The modified surgical procedure is characterized by an 8 mm incision and preparation of the epi-periosteal layer, in which the eight-plate is positioned via a guide-wire. Positioning and implantation are controlled via fluoroscopy. Skin incision length, duration of surgery, revision rate, achievement of a defined correction goal, and correction rate were analyzed. Results: Using the minimally invasive procedure, the mean skin incision length (23.94 +/- 10.18 mm vs. 8.75 +/- 2.14 mm, p < 0.001) could be significantly reduced. No significant difference was found in regard to the duration of surgery, revision rate, achievement of the correction goal or correction rate. Conclusions: The minimally invasive procedure results in a reduction in incision length without significant impact on the duration of surgery, revision rate, achievement of correction goal or correction rate. Consequently, the modified procedure can be regarded as equally as effective and safe as the conventional procedure.