S Koob1, M Kehrer2, M Hettchen2, T Jansen2, J Schmolders2, R Placzek2. 1. Clinic for Orthopedics and Trauma Surgery, University of Bonn, Bonn, Germany. sebastian.koob@ukbonn.de. 2. Clinic for Orthopedics and Trauma Surgery, University of Bonn, Bonn, Germany.
Abstract
OBJECTIVE: Presenting the implantation of the PediatrOS™ FlexTack™ (Merete, Berlin, Germany) for growth guidance and a modified explantation procedure to facilitate explantation and prevent bone and soft tissue damage. INDICATIONS: Implantation: Genua vara and valga, coxa vara, varus and valgus deviation of the ankle joint, the elbow joint and the wrist Modified Explantation: Removal of the implant after successful limb correction or dislocation of the implant. CONTRAINDICATIONS: Implantation: Closed growth plates, insufficient remaining growth potential, acute or chronic infection, insufficient osseous structures, severe muscular, nervous or vessel diseases endangering the respective limb Explantation: General inoperability of the patient. SURGICAL TECHNIQUE: Implantation: Localization of the growth plate. Insertion of K‑wire parallel to joint line on the joint side. Setting of the implant. Insertion of second K‑wire and insertion with the implantation instrument and hammer. Modified Explantation: Cutting of the implant bridging part. Both ends of the bridging part are bent vertically to prevent soft tissue damage. Dissection of both implant arms from the bone with the chisel. Extraction in 360° motion using tooth extraction pliers. POSTOPERATIVE MANAGEMENT: Implantation: Full weight bearing. X‑ray controls every 3 months to control growth correction. Explantation: Full weight bearing. RESULTS: Complications such as breaking of the k‑wires, breaking of the chisel or extraction of adhering bone tissue occurred in 14 of the 64 (21.9%) explanted FlexTack implants. Complication-free removal using the original instruments provided by the manufacturer was possible for five implants. The modified explantation procedure as described above was applied in 45 explanted implants (70.3%) with complete removal of the implant without further complications within the follow up period.
OBJECTIVE: Presenting the implantation of the PediatrOS™ FlexTack™ (Merete, Berlin, Germany) for growth guidance and a modified explantation procedure to facilitate explantation and prevent bone and soft tissue damage. INDICATIONS: Implantation: Genua vara and valga, coxa vara, varus and valgus deviation of the ankle joint, the elbow joint and the wrist Modified Explantation: Removal of the implant after successful limb correction or dislocation of the implant. CONTRAINDICATIONS: Implantation: Closed growth plates, insufficient remaining growth potential, acute or chronic infection, insufficient osseous structures, severe muscular, nervous or vessel diseases endangering the respective limb Explantation: General inoperability of the patient. SURGICAL TECHNIQUE: Implantation: Localization of the growth plate. Insertion of K‑wire parallel to joint line on the joint side. Setting of the implant. Insertion of second K‑wire and insertion with the implantation instrument and hammer. Modified Explantation: Cutting of the implant bridging part. Both ends of the bridging part are bent vertically to prevent soft tissue damage. Dissection of both implant arms from the bone with the chisel. Extraction in 360° motion using tooth extraction pliers. POSTOPERATIVE MANAGEMENT: Implantation: Full weight bearing. X‑ray controls every 3 months to control growth correction. Explantation: Full weight bearing. RESULTS: Complications such as breaking of the k‑wires, breaking of the chisel or extraction of adhering bone tissue occurred in 14 of the 64 (21.9%) explanted FlexTack implants. Complication-free removal using the original instruments provided by the manufacturer was possible for five implants. The modified explantation procedure as described above was applied in 45 explanted implants (70.3%) with complete removal of the implant without further complications within the follow up period.
Entities:
Keywords:
Explantation; Growth deformity; Growth guidance; Growth plate; Tension band