A Randomized Controlled Trial of Leg Length Discrepancy Techniques
Leg Length Discrepancy
About this trial
This is an interventional treatment trial for Leg Length Discrepancy focused on measuring RCT, Epiphysiodesis, Tantalum beads, Patient centered outcome data, Cost effective analysis
Eligibility Criteria
Inclusion Criteria:
- Open growth plates
- Skeletally immature requiring isolated complete epiphysiodesis of the distal femur and/or proximal tibia
- At least one year of predicted growth remaining
- Less than 18 years of age
- Predicted limb length discrepancy 2-7 cm
Exclusion Criteria:
- Patients undergoing additional orthopedic procedures at time of epiphysiodesis
- Metabolic bone disease or "sick physis" syndrome, that may cause bone to grow in an unpredictable manner.
- Pregnancy
Sites / Locations
- Boston Children's Hospital
- Hospital for Special SurgeryRecruiting
- Hospital for Sick Children
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Percutaneous Drill Epiphysiodesis
Percutaneous Screw Epiphysiodesis
A 5 mm incision will be made centered over the physis both medially and laterally. A 4.5 mm drill will be passed repeatedly across the physis in a divergent manner. Curettes will then be used to further remove and disrupt the growth plate. Fluoroscopy will be used throughout to ensure proper passage of the drill and curettes. Omnipaque dye will then be inserted to confirm ablation of the physis.
In the distal femur, guide wires will be placed in an antegrade fashion, with an 8 mm skin incision proximal to the physis both medially and laterally. The guide wire will be placed with the medial wire crossing the physis at the junction of the middle and medial third of the physis. The lateral guide wire will cross the physis at the junction of the lateral and middle third of the physis. The wires will extend into the epiphysis, but will not enter the joint. The guide wires will be over drilled with a 5 mm drill, and 7.3 mm fully threaded cannulated screws will be placed across the growth plate. For tibias, screw placement will be retrograde, with 8 mm incisions made medially and laterally distal to the physis, with guide wires aiming proximally.