The following patient information sheet is meant to help patients and family better understand a specific pediatric orthopaedic condition. It is not meant to be comprehensive, and only reflects one viewpoint. This page does not replace a medical evaluation by a pediatric orthopaedic surgeon, and your own surgeon may have a different approach to your condition.
What is guided growth?
Guided growth, or temporary hemiepiphyseodesis, is a strategy for correcting angular deformities of the limbs. The idea is to temporarily stop the growth of one side of the growth plate. The other side will continue to grow, resulting in straightening of the bone with time. When the bone is appropriately corrected, the temporary stop can be removed and the bone should continue to grow and remain straight. Guided growth is a excellent option for straightening bones with the minimal amount of surgical intervention.
When is guided growth used?
Guided growth can only be used in a growing child. In the legs, most girls are finished growing at age 14 years, and most boys at age 16 years. If there is any doubt regarding the amount of growth remaining in a child, an x-ray of the left hand is compared to an atlas to determine “bone age”, which can be different than actual age.
What can I expect with guided growth surgery?
Guided growth surgery most often involves the placement of a small plate with two screws. In some parts of the legs a single screw without a plate is utilized. In the foot a different technique is utilized, which is described in the section on hallux valgus.
The incision is generally under one inch in length, and the surgery is relatively small. If surgery is only performed on one side the child can go home the same day. If it is performed on both legs then generally just one night in the hospital is required. For surgery about the knee a brace is provided, and for surgery about the ankle a walking boot is oftentimes helpful. Your child can then walk with the aid of crutches. Most children can walk without aids by about two weeks, and return to sports by four weeks.
Afterwards, x-rays are obtained every four to six months to monitor straightening of the bone. These follow up visits are very important! Although it is fine to be late or early by a couple of weeks, a follow visit that is months late may allow for the bone to overcorrect. In this situation, the plate may need to be removed and a new plate placed on the opposite side, or a larger surgery may be necessary.
What are the risks of guided growth?
The most significant risk of guided growth surgery is that it will not work properly. In certain cases, the growth plate is either diseased (such as in Blount’s disease) or does not have enough growth remaining (older children). In those cases, the bone may need to be straightened out with a different and larger surgery if inadequate correction was achieved.
As mentioned above, overcorrection is a serious issue in guided growth treatment. Follow up appointments need to be kept, within a couple of weeks, to ensure that the correction is progressing adequately.
The other significant risk is that the deformity can come back after removal of the plate. It is common for the bone to “rebound” somewhat after removal of the plate and screws. To account for this, we generally remove the plate and screws after the bone has slightly overcorrected.
Nerve and blood vessel injury, joint stiffness, infection and wound issues are all quite uncommon with guided growth surgery but all possible. General anesthesia always carries some risk although complications of anesthesia are also very uncommon.
What happens after the plate and screws are removed?
Plate and screw removal is an ambulatory surgery (go home the same day). Walking is generally back to normal within 1-2 weeks, and sports are allowed at 4 weeks. X-rays will be necessary until skeletal maturity to monitor for recurrence of the deformity.