Middle to long-term results of distal femoral tension band hemiepiphysiodesis in the treatment of idiopathic genu valgum

Idiopathic genu valgum is a common deformity in children. Guided growth is the treatment of choice in severe or symptomatic cases, although long-term results are mostly unknown. The purpose of this study was to determine the middle- to long-term results and complications of tension band plating in the treatment of idiopathic genu valgum, and the association between obesity and idiopathic genu valgum. A retrospective review of patients with idiopathic genu valgum treated by tension band plating between January 2007 and September 2017 was performed. Data from 99 patients (198 limbs) were reviewed. All underwent bilateral medial distal femoral tension band plating and subsequent plate removal and were followed by a mean of 56.1 months (12-120 months) after surgery. Full correction was achieved in all patients, with a mean correction rate of 0.52 degrees per month. No cases of infection or premature physeal closure were recorded. Screw breakage at the time of removal occurred in five limbs (2.5%). Fifteen limbs (7.5%) developed a minor overcorrection. 44.4% of our patients were either overweight or obese, which is higher than the national average. A third of our patients complained of an unsightly scar at the latest follow-up. Tension band plating is an effective, well tolerated, and reproducible technique in the treatment of idiopathic genu valgum. The risk of premature physeal closure is minimal. We recommend achieving a minor overcorrection before plate removal in patients with more than a year of expected growth. Also, predicting correction based on the mean correction rate is discouraged.