Sleeper Plate for Guided Growth: Does the Plate Material Change the Risk of Tethering?
Notice bibliographique
Résumé
BACKGROUND: Pediatric coronal plane deformities are commonly managed by guiding growth by placing an extraperiosteal 2-hole plate across the growth plate with 1 epiphyseal and 1 metaphyseal screw. Once the correction is achieved, removing the metaphyseal screw only (sleeper plate) has been described to facilitate easier future corrections if deformity rebounds. A complication commonly described with this approach is tethering, where the patient continues to overcorrect despite the elimination of tension across the physis. This study aims to evaluate the safety and efficacy of sleeper plates and assess the rate of tethering in stainless steel (SS) versus titanium alloy (Ti) plates. METHODS: This study retrospectively reviewed patients who underwent guided growth procedures for coronal plane deformities between February 2014 and September 2023. Fifty-two sleeper plates were identified in 34 patients, out of which 30 were SS and 22 were Ti. We examined for rebounding necessitating screw reinsertion and tethering requiring plate removal. This was done by measuring mechanical lateral distal femoral angle (mLDFA), the medial proximal tibial angle (MPTA), and mechanical axis deviation (MAD) during follow-up. RESULTS: The median age at plate insertion was 8.6 (SS) years versus 9.7 (Ti). The median age at screw removal was 10.7 years for the SS group and 10.8 years for the Ti group after deformity correction. There was no statistically significant difference between the 2 groups with respect to age at plate insertion ( P -value=0.945) and the age at screw removal ( P -value=0.85). Overall, 40% of plates rebounded with 27% in SS and 59% in the Ti group ( P -value=0.027), which could be explained by longer follow-up in the Ti group that was statistically different ( P -value <0.001). 4/52 plates had tethering, and, of note, all the tethers were seen in the Ti group, with the median duration between screw removal and tethering first noticed being 1.1 years. All 4 patients corrected over time with the removal of the whole plate, none developed a physeal bar, and all went on to achieve normal alignment. The study had over 80% power to detect differences in tethering with a statistically significant P -value of 0.015. CONCLUSION: Sleeper plate is a viable technique for correcting coronal plane deformity, though tethering leading to overcorrection is a potential complication, especially with Ti implants. Based on our results, we advise avoiding Ti implants for sleeper plates. LEVEL OF EVIDENCE: Level III.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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