Dr Taral V Nagda
Dr Rajeev Nirawane
Institute of Paediatric Orthopaedic Disorders
www.ipodindia.org
taralnagda@gmail.com

Indications

• Correcting angular deformity in a growing child with open physis
  

• Any age/ Size
• Any accessible physis
• Any diagnosis including sick physis
• 1 year of growth remaining
• Any plane frontal sagital oblique

Contraindications

• Closed Physis
• Skeletal Maturity
• Physiological Deformities

Equipments needed

• C ARM
• Radiolucent table
• 1mm and 1.5 mm guide wires
• E plate
• 4.5mm self tapping cannulated screws (15-30mm)
• Stop Drill

Surgical steps

Step 1 : LOCALIZATION OF PHYSIS

• Under image intensifier 1.5 mm guide wire is passed at the center of physis
• Confirmed in both AP & Lat views

Step 2: SKIN INCISION

• About 1.5 cm centered over guide wire
• The incision is deepened till perichomdrium
• E plate is positioned with its central hole sliding over the guide wire over the perichondrium
• The plate should be along the midline of the bone axis on lateral view

Step 3 GUIDE WIRES

• 2 guide wires are passed  through the holes on either sides of the physis
• They  need not be parallel but  care should be taken is not to violate the physis

Step 4 SELF TAPPING CANNULATED SCREWS

• Screw length is measured
• Should not be too short
• Generally 15-30 mm screws are sufficient
• Cortex is drilled
• Self tapping screws are passed

Step 5 Closure and Dressing

The closure is done in layers and compression dressing is applied.

No cast or immobilization is needed

Full weight bearing supported walking and knee mobilization are started the next day

Post op Protocol

• Day care surgery
• No immobilisation
• Immediate mobilisation
• Xrays once in 3 months
• Implant removal once the deformity is corrected

Case report-

8 yr old girl with renal osteodystrophy with genu valgum

Immediate post op xray

3 month follow up

6 month follow up

Advantages of E plate over staples

• Flexibility
• Unconstrained implant
• Load sharing
• One plate per physis
• Fully threaded cannulated screws resist pull-out forces
• Diverging screws function like a hinge to gently guide natural growth
• Easy to remove