Complications and errors in guided growth surgery

Abstract

Objectives: Guided growth (GG) is a widely used treatment option in growing children with varus/valgus deformities (VVD) or limb length discrepancy (LLD). The outcomes of these different techniques have been widely reported. There is, however, a paucity of reports addressing adverse events (AEs) of GG. We reviewed the clinical results of GG for VVD or LLD with an emphasis on describing AE. Methods: AEs were collected and analyzed for all cases treated at a single European institution with GG for VVD or LLD. AEs were classified into five categories: improper indications, malpositioned implants, errors in timing of hardware removal, general surgical complications, and implant failures/incomplete removals. Results: During the defined time period, 117 patients for LLD and 106 patients were operated for VVD. In total, there were 111 AEs (LLD = 60, VVD = 51). These were subdivided into categories: improper indications (31) (LLD = 20, VVD = 11), malpositioned implants (26) (LLD = 23, VVD = 3), errors in timing of hardware removal (25) (LLD = 9, VVD = 16), general surgical complications (20) (LLD = 5, VVD = 15), and implant failures/incomplete removals (9) (LLD = 3, VVD = 6). Conclusions: Most AEs can be avoided through correct radiological analysis of limb alignment and a basic understanding of the principles of GG. Furthermore, it is essential to place the implant precisely and ensure regular follow-up evaluations. While ostensibly a simple procedure, therapeutic decisions regarding planning of GG need to be thoughtfully made, the actual performance of the GG surgery should not be relegated to an under-supervised junior team member. Careful follow-up is imperative.

Keywords

• complication
• eight plate
• guided growth
• hardware failure
• hemiepiphysiodesis