Stress Strain State of the Proximal Tibia in a Child with Tibia Vara Using Unilateral Hemiepiphysiodesis with Different Types of Devices
Background. The current standard of pediatric frontal knee deformities treatment is a guided growth technique. Several devices are used for temporal growth plate blocking: Blount staples and different plates with screws. Up to now there is no any research devoted to stress-strain state analysis of the epimetaphyseal part of the pediatric bone with one side temporal growth plate block on it.
Objective. To study the stress-strain state of the pediatric proximal tibia model with lateral hemiepiphysiodesis using different types of devices in loading conditions typical to the tibia vara.
Materials and methods. 3D models of the proximal child’s tibia with lateral hemiepiphysiodesis using Blount staples or locking or non-locking plate were analyzed in a load conditions typical to tibia vara by finite element method using Solid Works program.
Results. Increased compressive stress was found in the medial part of the proximal tibial growth plate in load conditions typical to tibia vara. New areas of high stress in the metaphyseal bone below growth plate were deteced. The maximum stress was registered in lockers noted in the contact area of the proximal screws to the plate, and in the upper part of the Blount staples.
Conclusion. Varus deformity of the proximal tibia leads to higher compressive stress in the medial part of the proximal tibial growth plate. Lateral hemiepiphysiodesis of the proximal tibial growth plate using different types of lockers leads to different pattern of stress strain state of proximal tibial epimetaphysis. Minimal load increase in metaphysis bone tissues is observed if locking plates are used, Blount staples application causes significant enhance of load in bone tissue in its place.
Burlakov E.V. Biomechanical analisys of loading characterisics of intercondylar surface of the knee joint in frontal plane/ E.V. Burlakov, D.V. Alatov, V.D. Makušyn, L.L. Sablukova // Medycynskaja texnyka. - 2008. - N2. - S. 27-32
Kenys V.M. Pediatric lower limb deformity correction using guided growth method/ Kenys V.M., Klыčkova Y.Ju., Melʹčenko E.V. et al.// Vestnik travmatologii i ortopedii im. N.N. Priorova”, 2013.-N 4.-S.50-55.
Korž N. A. Temporal block of the growth plate for pediatric lower limb deformity correction (review of the literature) / N. A. Korž, S. A. Xmyzov, A. Y. Korolʹkov, D. V. Ershov// Orthopaedics, Traumatology and Prosthetics. - 2013. № 2.-S: 114–121.
Simenač B.I. «Joint load factor» and its role in theoretic orthopedics / B.I. Simenač, B.A. Pustovojt, Je.P. Baburkina ta in.// Orthopaedics, Traumatology and Prosthetics.- 1995. - № 2. - S. 3-10.
Burghardt R. D. A technical note on improved instrumentationfor Blount staple insertion / R. D.Burghardt, A. D. Kanellopoulos, J. E. Herzenberg // J. Children’s Orthopaedics. -2012. -Vol. 6 (4). — Р. 347–350, doi: 10.1007/s11832-012-0422-2
Burghardt R. D. Mechanical failures of eight-plateguided growth system for temporary hemiepiphysiodesis/ R.D. Burghardt R.D., S.C. Specht, J.E.Herzenberg// J Pediatr Orthop. 2010 Sep;30(6):594-7. doi: 10.1097/BPO.0b013e3181e4f591.
Heller M.O. The influence of alignment on the musculo-skeletal loading conditions at the knee/ M.O. Heller, W.R. Taylor, C. Perka та ін.// Langenbecks Arch Surg.- 2003 Oct;388(5):291-7.
Oto M. Adolescent Blount disease in obese children treated by eight-plate hemiepiphysiodesis/ M. Oto, G. Yılmaz G, Bowen J.R. et al.// Eklem Hastalik Cerrahisi. 2012 Apr;23(1):20-4.
Skeletal Tissue Mechanics/[Martin R. B., Burr D. B., Sharkey N. A., Fyhrie D. P.]. — London.: Springer, 2015. — 500 p.
Stevens P.M. Guided growth for angular correction: a preliminary series using a tension band plate/P.M. Stevens // J. Pediatr Orthop. 2007;27(3):253-9.
Yilmaz G. Guided growth with a noncannulated screw-plate system for angular deformity of the knee: a preliminary report/ G. Yilmaz, M.Oto, A.M Thabet. // J. Pediatr Orthop. 2014 Apr-May;34(3):336-45.
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