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High recurrence rate seen after medial malleolar screw hemiepiphysiodesis in pediatric patients
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Recently published data indicated hemiepiphysiodesis performed with a transphyseal medial malleolar screw is effective for the management of ankle valgus in pediatric patients, but investigators noted an 81.8% rate of recurrent ankle valgus after screw removal.
Researchers retrospectively identified 63 ankles in 37 pediatric patients who underwent transphyseal medial malleolar screw hemiepiphysiodesis for ankle valgus. Patients had an average age of 11 years at surgery and a mean radiographic follow-up of 1.6 years prior to screw removal. Anteroposterior ankle radiographs on the tibiotalar angle were used to assess valgus deformity. Rates of correction and recurrence of valgus were determined with linear mixed effect models.
Prior to screw removal, the tibiotalar angle had improved significantly at the most recent radiographic follow-up. The mean tibiotalar angle preoperatively was 10.6° and 3.1° at the recent radiograph before screw removal. The average rate of angle correction overall was 0.37° per month before screw removal. The rate of correction postoperatively was significantly affected by clinical diagnosis.
According to results from multiple linear regression analysis, after the length of follow-up was adjusted, clinical diagnosis and age at surgery were significant predictors of postoperative correction of the tibiotalar angle. Investigators found the overall correction decreased by 0.94° as each year of age at the time of surgery increased.
Overall, 22 patients had radiographs after screw removal. Among these patients, investigators found significant differences between the tibiotalar angles on radiographs before screw removal to the most recent follow-up visit. Of the 22 patients, 18 patients had recurrent ankle valgus after screw removal. Patients who underwent screw removal had an average recurrence rate of 0.28° per month, according to researchers. ‒ by Monica Jaramillo
Disclosures: Chang reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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