Torsional guided growth: current concepts and perspectives of clinical application (literature review).

Abstract

Background. Torsional deformities of long bones in children are usually treated with a osteotomy, acute or gradual correction and different types of fixation. This method is relatively traumatic and can cause severe complications. On the other hand, guided growth is the gold standard for frontal and sagittal planes deformities treatment in growing children. This method is highly-efficient, minimally invasive, allows immediate weight bearing and has low complication rate. Thus, recently guided growth has been studied in terms of horizontal plane deformities correction as well. Aim of the study – to present modern concepts of torsional guided growth, and to define the ways of its improvement for further clinical application. Materials and Methods. This literature review included nine articles (five preclinical studies on animals, three clinical studies and one literature review) which were published from 2013 to 2023. The articles search was performed using PubMed/MEDLINE, Embase (Elsevier), Web of Science, Google Scholar. Results and Discussion. All of the analyzed studies demonstrate the possibility of the torsional guided growth application for axial plane deformities correction. Three main surgical methods were suggested. Correction efficiency mainly depends on the interplate angle, proper plate positioning and remaining longitudinal growth. Limitations of these studies were: small group number; absence of preoperative CT scans in animal studies; torsional profile measurement using computed tomography was performed only in one of three clinical studies. There were no preoperative planning of deformity correction/creation amount, so it wasn`t possible to evaluate the accuracy of the suggested methods. Main complications were secondary deformities and limb discrepancy. Conclusion. Further clinical application of torsional guided growth in children may be possible after solving the problem of secondary deformities and shortening and possibility of the preoperative planning of the amount of deformity correction.