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Guided growth (of growth plates), also known as Epiphysiodesis​

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The alignment of your child's limb may be abnormal, and Kemble has recommended guided growth as a surgical option for treatment. This is also known as epiphysiodesis ("epiphysis" - growth plate; and "desis" - to tether). This can only be done if the growth plates are still open. 

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A number of causes can lead to abnormal limb alignment. It can arise following trauma, infection, previous surgery, or sometimes no reason is identified. If the mal-alignment is not too great, and your child is young enough, then the power of the open growth plates can be harnessed to help correct the alignment. In principle, this works by slowing down one side of the growth plate that is growing relatively too fast, to allow the other side to catch up. A common question parents have is: "will this procedure make my child's arm/legs shorter?" In general, guided growth performed for alignment will have minimal impact on the length of the limb. This is because most procedures are either temporary or performed towards the end of growth, and affect only one side of the growth plate. Your child will also have multiple other growth plates in the operated limb which will continue to grow normally. 

 

The following is a schematic diagram of a guided growth procedure using plates and screws

guided growth.jpg

Surgical Treatment:​

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Guided growth​ can be performed using several different techniques. The options are:

  1. guided growth using screws only

  2. guided growth using plate and screw construct (sometimes called "8-plates" or "H-plates")

  3. guided growth by drilling without metal implants. 

 

Kemble will choose the technique that is most appropriate for your child. This depends on the age of your child, the magnitude of alignment problem, the underlying cause, and the location of the alignment problem.

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Post-operative Management

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  • It is normal to have some tingling, numbness or weakness following your procedure. This is often due to a nerve block performed preoperatively to help with your child's pain, or with postoperatively injected local anaesthesia. This will wear off in the first day or two.

  • It is very important post-operatively that your child works with your therapist immediately in trying to regain motion. In most situations, the joint will need to start moving immediately post-operatively.

  • Please keep your dressing/bandage dry. You may use a plastic bag tied above the elbow to prevent the dressing/wound from getting wet during shower/bathing

  • You may remove the outer bandage after 3 days. there will still be dressing on underneath.

  • Around 2 weeks following surgery, you should have your child's wound checked. 

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Recovery

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  • After the wound has been checked, and if this has all healed well, then you may leave the wound open and allow your child to get it wet in showers/swimming pools etc

  • Usually, there is no weightbearing or movement restrictions following guided-growth surgery. However, sports should be avoided for the first 2 weeks. 

  • Because growth plates are generally located at areas of bony prominence around the body, any plates and screws positioned on growth plates can also feel prominent. It is normal to be able to feel the hardware under the skin once the wound has healed, and this may sometimes cause some discomfort. In general, if hardware has been implanted, Kemble will organize for it to be removed once correction has been achieved. 

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What to look out for

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  • Continued drainage from the wounds that does not stop after 1 week

  • Suddenly deterioration in pain when previously pain has been improving

  • If any of the above is noted, please contact Dr Kemble Wang's team. 

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