Hemi-epiphysiodesis

Hemi-epiphysiodesis: Definition, Purpose, Preparation, Procedure, and Results

Children and adolescents can sometimes develop pathological angular deformities in their lower extremities and this can cause them pain whenever they are off playing or doing activities. These deformities can also sometimes cause altered gait as well as joint instability and can be made worse by the children’s continued growth.

These deformities, however, can simply be corrected by using hemi-epiphysiodesis. Although the correction involved is gradual and is done with growth, hemi-epiphysiodesis effectively allows the patients to achieve equal limb-lengths, neutral axial posture and equally horizontal knees with skeletal maturity. As opposed to most corrections involving surgery, hemi-epiphysiodesis allows for these results without destruction of any part of your bone structure, physis or without involving any kind of major surgery.

What is Hemi-epiphysiodesis?

Hemi-epiphysiodesis is also known by the term guided growth, and is generally a surgical technique involving the gradual correction of an angular limb deformity, most commonly in skeletally immature patients or those patients who have not yet fully developed their skeletal system, such as in kids.

What is the Purpose of Undergoing Hemi-epiphysiodesis?

Hemi-epiphysiodesis is a surgical option for people that are seeking an alternative to corrective osteotomies (osteotomies are surgical operations whereby a bone is cut to either shorten or lengthen it or change its alignment). Hemi-epiphysiodesis provides a surgical operation wherein the patient feels less pain, shorter immobilization, an overall lesser surgical risk and a generally decreased cost, hence providing an ideal alternative to most surgical procedures involving the bone, like osteotomies.

Types of Hemi-Epiphysiodesis

There are generally two types of hemi-epiphysiodesis procedures, one is known as Temporary Hemi-epiphysiodesis, and the other involves the extraperiosteal, 2-hole plate method.

- Temporary Hemi-epiphysiodesis involves plating or stapling but can be generally complicated by the premature physeal closure (physeal closure involves bony bridges developing the epiphysis and the metaphysis that can lead to many bone deformities), and also a rebound period of accelerated growth within the bones of those areas, as well as migration of the hardware used. There are much lesser complications involved with another form of hemi-epiphysiodesis, the 2-hole plate method.

- The 2 hole-plate method hemi-epiphysiodesis mostly involves a parallel screw configuration but can also be done using a divergent screw configuration. Although the parallel screw configuration has been proven to be much more efficient than the divergent screw, both forms of 2-hole plate method hemi-epiphysiodesis are controversial in the medical literature. 

How to Prepare for Hemi-Epiphysiodesis

Hemi-epiphysiodesis generally begins with preoperative assessment done by a physician on you. Most commonly, preoperative assessment for hemi-epiphysiodesis involves measurement of your limb lengths as well as clinical angular and rotational deformities you may have. A physical exam will also be included, that will sometimes involve assessment of various functions in your body involving the bone including long bone torsion, gait pattern, patellar tracking and ligamentous laxity. Your doctor can also subject you to radiographic assessment of leg lengths as well as other deformities in your body, and this will involve x-ray or other imaging medical procedures.

When your doctor deems you physically fit and with low enough surgical risk, you will then undergo the surgical procedure after having been set with a schedule.

Hemi-epiphysiodesis: How is the Procedure Performed?

Hemi-epiphysiodesis usually involves placing bone clamps or staples around the growth plate of the bone affected. As the procedure is surgical in nature, the doctor (or specialist) will do this on a surgical table, and you will be anesthetized accordingly so as to not feel pain. The bone clamps will be placed at the appropriate time, months before the bone will complete its growth phase and over the next 1 to 2 years, the bone’s growth will be redirected from its normal deformed growth and will proceed to a straightening of the legs. Depending upon your physician’s assessment, the bone staples or clamps can be left in place once the goal is achieved and the bone deformity is made straight.

Hemi-epiphysiodesis: Results and Post-operative Care

As mentioned before, results involving hemi-epiphysiodesis will generally show in 1-2 years, during the continued growth phase of the child or adolescent. The bone clamps will either be left in place to further prevent deformities or will be removed when the physician or specialist deems the deformity to be permanently cured.

Physical therapy will be necessary in order to regain the range of motion and strength required in most normal day to day activities, especially right after the operation. Radiographs and follow-up imaging tests will sometimes be required every 3 to 6 months in order to monitor the corrected growth and activity of the deformity.

Sometimes the deformity may not be corrected with the use of hemi-epiphysiodesis, and this can be corrected by cutting, straightening or allowing the bone involved to heal in the new and corrected position. During this process, there will be continued use of bone screws, clamps, and plates in order to keep the bone straight during the whole process.

You might be interested to read:
- Nerve Conduction Study (NCS)

- Spinal Diagnostics

Show Less Show Comments
Questions & Answers
Q:
What is the best way to treat permanent back and neck pain and stiffness?
A:

Here are some tips:

Neck Pain Tips: Sleep with a cervical pillow

Orthopedic or cervical pillows are made with special contours to support the space beneath the neck and head. They are also more concave for the head and provide more support to the neck.

Neck Pain Tips: Sleep on your back

The best position to lie to sleep is on your back. If you sleep on your stomach or on your side, make sure your pillow is not too thick. It should raise your head no more than 4 to 6 inches. This will keep your neck and head from turning to either side.

Neck Pain Tips: Position your computer screen at eye level

While you are working at a computer, sit comfortably in your chair with your computer in front of you. Close your eyes and then open them. When you open your eyes, you should see the middle of the computer screen. If your gaze is not in the middle of the screen, adjust the height of the screen using items like books.

To keep your head from gradually drifting forward, take frequent breaks to stretch. Getting up to walk around at least once every half-hour is one of the best neck pain tips.

Neck Pain Tips: Use a telephone headset

Never hold a phone between your shoulder and your ear. Use a headset or other hands-free system to talk on the phone and avoid abusing your neck and spine.

Neck Pain Tips: Exercise your neck muscles

One of the best neck pain tips is using the chin tuck. You can do this often throughout the day. In addition to helping strengthen the muscles that hold the head in alignment over the shoulders, it also helps strengthen the scalene and sub-occipital muscles.

Read more tips here: Neck Pain Tips: Sleeping, Posture, Exercising, Hydration & Prevention

Read more
Temed Holdings
4 answers
Q:
What is the best treatment for neck pain and shoulder Pain?
A:

One of the best treatment for neck pain and shoulder pain is exercises:

Neck Pain Exercises: Neck Extension

  1. To begin this neck pain exercise, sit up straight in a chair with your feet flat on the floor.
  2. Looking straight ahead, tuck your chin slightly (starting position)
  3. Place the palm of your hand on the back of your neck, at the base of your head
  4. Apply slight forward pressure with your hand, while resisting the forward motion of your neck and head
  5. Hold for a count of 5 and return to the starting position and relax
  6. Repeat the neck pain exercises 5-10 times

Neck pain exercises: Side bend

  1. Sit up straight in a chair with your feet flat on the floor.
  2. Looking straight ahead, tuck your chin slightly (starting position)
  3. Place your left hand, palm down, on the left side of your head (around your ear)
  4. Slightly push your head to the right side with your hand, while resisting the sideways motion of your neck and head
  5. Hold for a count of 5 and return to the starting position and relax.
  6. Repeat 5-10 times
  7. Repeat the neck pain exercises with the other side.

Neck pain exercises: Neck flexion

  1. Sit up straight in a chair with your feet flat on the floor.
  2. Looking straight ahead, tuck your chin slightly (starting position)
  3. Place the tips of your fingers on your forehead
  4. Slightly push your head backward with your fingers, while resisting the backward motion of your neck and head
  5. Hold for a count of 5 and return to the starting position and relax.
  6. Repeat the neck pain exercises 5-10 times

More exercises here: Neck Pain Exercises

Read more
Temed Holdings
4 answers
Q:
How do I reduce the shoulder and neck pain?
A:

Here are some tips:

Neck Pain Tips: Sleep with a cervical pillow

Orthopedic or cervical pillows are made with special contours to support the space beneath the neck and head. They are also more concave for the head and provide more support to the neck.

Neck Pain Tips: Sleep on your back

The best position to lie to sleep is on your back. If you sleep on your stomach or on your side, make sure your pillow is not too thick. It should raise your head no more than 4 to 6 inches. This will keep your neck and head from turning to either side.

Neck Pain Tips: Position your computer screen at eye level

While you are working at a computer, sit comfortably in your chair with your computer in front of you. Close your eyes and then open them. When you open your eyes, you should see the middle of the computer screen. If your gaze is not in the middle of the screen, adjust the height of the screen using items like books.

To keep your head from gradually drifting forward, take frequent breaks to stretch. Getting up to walk around at least once every half-hour is one of the best neck pain tips.

Neck Pain Tips: Carry weight evenly

Many people make the mistake of carrying a heavy briefcase or their purse on their shoulder or on one side of their body. Doing this causes strain in the muscles and leads to pain.

Remove non-essentials from your briefcase or purse. Consider using a backpack to evenly distribute the weight across your shoulders. If you choose to carry a purse or backpack, keep your shoulders level while carrying it.

Neck Pain Tips: Maintain a proper posture

The most common posture contributing to neck pain is the “head-and-shoulders-forward” posture. In this position, the neck slopes forward, putting the head in front of the shoulders.

In this position, the head pulls the upper back forward also in a slumped position. This places a strain on the entire spinal column.

More tips here: Neck Pain Tips: Sleeping, Posture, Exercising, Hydration & Prevention

Read more
Temed Holdings
4 answers