Shaw Kylie G, Sanders Julia S
University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO.
Children's Hospital Colorado, Orthopedics Institute, Aurora, CO.
J Pediatr Soc North Am. 2024 Feb 12;5(2):684. doi: 10.55275/JPOSNA-2023-684. eCollection 2023 May.
Percutaneous epiphysiodesis using transphyseal screws (PETS) is a commonly used technique for guided growth. Technical challenges specific to the distal femur include difficulty obtaining a start point, accurately predicting trajectory across the physis, and achieving adequate thread purchase in the epiphysis. A previously unreported complication is peri-implant fracture. We present a case of peri-implant fracture after epiphysiodesis for leg length discrepancy, ultimately treated with retrograde intramedullary nail fixation. We recommend a modified PETS technique and close attention to orthopaedic principles to avoid this unfortunate complication. •Stress riser fractures can occur due to low bone strength and high mechanical stress, cortical defects, changes in stiffness at the ends of a construct, and changes in cross-sectional area of the bone.•Percutaneous epiphysiodesis using cannulated screws (PETS) may be safely used for guided growth of the distal femur when the surgeon can utilize a single start point, with trajectory through the physis at the junction of the lateral and middle thirds, to allow adequate purchase in the epiphysis, and to avoid stress riser creation.•A modified technique utilizing retrograde guidewire placement with antegrade screw placement may help mitigate technical challenges and avoid complication.
使用经骨骺螺钉的经皮骨骺阻滞术（PETS）是一种常用的引导生长技术。股骨远端特有的技术挑战包括难以获得起始点、准确预测穿过骨骺的轨迹以及在骨骺中实现足够的螺纹锚固。一种先前未报道的并发症是植入物周围骨折。我们报告一例因腿长差异行骨骺阻滞术后发生植入物周围骨折的病例，最终采用逆行髓内钉固定治疗。我们推荐一种改良的PETS技术，并密切关注骨科原则以避免这种不幸的并发症。•应力集中骨折可能由于骨强度低和机械应力高、皮质缺损、结构末端刚度变化以及骨横截面积变化而发生。•当外科医生能够利用单个起始点，使轨迹穿过外侧和中间三分之一交界处的骨骺时，使用空心螺钉的经皮骨骺阻滞术（PETS）可安全用于股骨远端的引导生长，以在骨骺中实现足够的锚固，并避免产生应力集中。•一种采用逆行导丝置入和顺行螺钉置入的改良技术可能有助于减轻技术挑战并避免并发症。
