Core Principle
The physis can be selectively restrained on one side
→ continued growth on the opposite side leads to gradual correction
This concept is based on the Hueter–Volkmann principle:
Increased compression → decreased growth
Reduced compression → increased growth
Indications
Coronal plane deformities
Genu varum
Genu valgum
Sagittal plane deformities
Flexion deformity
Recurvatum (selected cases)
Specific conditions
Idiopathic deformities
Blount disease (early stages)
Rickets / metabolic bone disease
Skeletal dysplasia (selected patients)
Contraindications
Skeletal maturity
Physeal closure or damage
Severe deformity requiring immediate correction
Poor remaining growth potential
Techniques
Temporary Hemiepiphysiodesis (Guided Growth)
Most commonly used method
Uses implants to tether one side of physis
Implants:
Tension band plate (8-plate)
Staples (historical, less used)
Transphyseal screws (selected cases)
Permanent Epiphysiodesis
Used for limb length discrepancy
Not reversible
Not considered guided growth
Mechanism of Correction
Gradual angular correction over time
Correction rate depends on:
Age
Physeal activity
Deformity location
Typical correction rate:
Distal femur: ~0.7–1° per month
Proximal tibia: ~0.5–0.7° per month
Preoperative Planning
Full-length standing radiographs
Mechanical axis analysis
Determine:
Deformity origin
Remaining growth
Surgical Technique (Guided Growth)
Minimally invasive
Plate placed extraperiosteally
Screws inserted across metaphysis and epiphysis
Goal:
Tether growth without damaging physis
Postoperative Management
Immediate weight-bearing allowed
Routine follow-up every 3–4 months
Radiographic monitoring
Timing
Requires accurate prediction of remaining growth
Overcorrection risk if implants not removed in time
Complications
Overcorrection
Undercorrection
Implant failure
Screw breakage
Physeal damage (rare)
Rebound deformity after removal
Prognosis
Excellent in idiopathic deformities
Variable in pathological physes
Early intervention improves outcomes
Pits & Pearls
Timing is more important than technique
Distal femur corrects faster than proximal tibia
Always monitor regularly to avoid overcorrection
Rebound growth is common in younger patients
Pitfalls
Late intervention
Inadequate follow-up
Misidentifying deformity origin
Ignoring remaining growth potential
References
Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop. 2007.
Stevens PM, Klatt JB. Guided growth for pathological physes: radiographic improvement during realignment. J Pediatr Orthop. 2008.
Burghardt RD, Herzenberg JE. Temporary hemiepiphysiodesis with the eight-plate. J Pediatr Orthop. 2010.
Boero S, Michelis MB. Guided growth for correction of knee deformities in children. J Child Orthop. 2011.
Danino B, Rödl R. Growth modulation techniques in paediatric orthopaedics. EFORT Open Rev. 2018.