Multiplier method may be unreliable to predict the timing of temporary hemiepiphysiodesis for coronal angular deformity
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REVIEW
Open Access
Multiplier method may be unreliable to predict the timing of temporary hemiepiphysiodesis for coronal angular deformity Zhenkai Wu1, Jing Ding1, Dahang Zhao1, Li Zhao1,2*, Hai Li1 and Jianlin Liu1
Abstract Background and purposes: The multiplier method was introduced by Paley to calculate the timing for temporary hemiepiphysiodesis. However, this method has not been verified in terms of clinical outcome measure. We aimed to (1) predict the rate of angular correction per year (ACPY) at the various corresponding ages by means of multiplier method and verify the reliability based on the data from the published studies and (2) screen out risk factors for deviation of prediction. Methods: A comprehensive search was performed in the following electronic databases: Cochrane, PubMed, and EMBASE™. A total of 22 studies met the inclusion criteria. If the actual value of ACPY from the collected date was located out of the range of the predicted value based on the multiplier method, it was considered as the deviation of prediction (DOP). The associations of patient characteristics with DOP were assessed with the use of univariate logistic regression. Results: Only one article was evaluated as moderate evidence; the remaining articles were evaluated as poor quality. The rate of DOP was 31.82%. In the detailed individual data of included studies, the rate of DOP was 55.44%. Conclusion: The multiplier method is not reliable in predicting the timing for temporary hemiepiphysiodesis, even though it is prone to be more reliable for the younger patients with idiopathic genu coronal deformity. Keywords: Temporary hemiepiphysiodesis, Multiplier method, Coronal angular deformity
Background Coronal angular deformity at the metaphyseal level is mainly attributed to three types: congenital, developmental, and acquired [1]. The options for surgical treatment of this condition include guided growth and corrective osteotomy. Osteotomy is often employed for the severe angular deformity or when the physis is closed. However, this procedure has an unpredictable outcome and a high incidence of complications, e.g., compartmental syndrome, neurovascular injury, deep and superficial infections, non-unions, and longer period of rehabilitation [2, 3]. As an alternative to * Correspondence: [email protected] 1 Department of Pediatric Orthopaedics, Xin-Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai 200092, China 2 Department of Pediatric Orthopaedics, Ying-Hua Medical Group of Bone and Joint Healthcare in Children, No. 358, Haibo Road, Shanghai 200000, China
osteotomy, temporary hemiepiphysiodesis seems to be technically easy and minimally invasive. Its application was reported more frequently over the last decade [4–6]. The stapling technique was originally introduced by Blount and Clarke [4]. In 1998, Métaizeau [5] described percutaneous epiphysiodesis using transphyseal screws (PETS). More recently, Stevens designed a system with a non-locking plate and screws calle
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