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    Singleportal test

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    Singleportal Test Video

    Portal 2 - Single Portal Chambers 1 - by tmast98

    However, this assumption is made based on standard radiographs and the method for how these data are obtained is not further described.

    Therefore, another purpose of our study was to see if the results from this former study could be confirmed by our findings. LLD was analyzed by orthoroentgenography with a perpendicular X-ray beam centered exactly in the joint space of each hip, knee, and ankle, respectively.

    Skeletal maturity was evaluated according to the atlas of Greulich and Pyle [ 13 ] by the use of left-hand X-rays. Ten consecutive patients were operated with the double-portal approach, followed by ten consecutive patients with the single-portal approach.

    The patients were not randomized. The surgical technique in Group I included a 1-cm skin incision laterally over the proximal tibial physis.

    Under image intensification, an awl was advanced 1. Thereafter, the drill bit was advanced from the lateral approach to the contralateral cortex at the medial side and ablation of the medial 1—1.

    In Group II, the epiphysiodesis of the proximal tibia was performed by using a lateral incision for ablation of the lateral part and a medial incision for ablation of the medial part of the physis.

    After ablation of the lateral part of the tibial physis, the 6-mm drill bit was advanced to the medial part of the physis. This part of the physeal plate was ablated in the same manner as on the lateral side, with fan-shaped oscillated drilling and a curved curette.

    For epiphysiodesis of the proximal fibula, a 5-mm skin incision anterior-laterally over the proximal fibular physis was performed.

    From this incision, an awl was advanced into the physis, entering the physeal plate anteriorly in order to avoid damage of the peroneal nerve. Through this opening in the anterior cortex of the fibula, a 3-mm curved curette was used to ablate the central part of the physeal plate.

    Surgical tourniquet was not used in any of the patients. The surgical time and duration of image intensification for the tibial epiphysiodesis were recorded.

    For this purpose, six tantalum spheres of 0. The spheres were spread widely in a manner to allow analysis of the three-dimensional dynamics of the epiphysis relative to the metaphysis.

    With the patient lying in a supine position and the knee placed in the center Fig. Using the RSA software, the change in distance across the physis between two subsequent examinations was calculated, as well as the change between each examination and the initial examination.

    The precision of our RSA measurements was evaluated based on repeated examinations performed on eight patients and calculated as described by Digas et al.

    The images show the tantalum spheres which were placed on each side of the ablated physis six spheres on each side and those which were located in the calibration cage that is placed around the knee during X-ray acquisition.

    Note the increasing thinning of the growth plate and bony overgrowth. All analyses were done by the same trained radiologist R. The mean error values and condition numbers, which give the exact value of the maximum inaccuracy, were within currently accepted limits [ 16 ].

    Growth across the physis was calculated as the change in distance between the tantalum spheres in the epiphysis and those in the metaphysis.

    Statistical evaluation was performed by the use of the independent t -test. The surgical time was measured from skin incision to completed closure of the wound, including the time used for the placement of the tantalum spheres.

    The time for fluoroscopy during surgery was read off the display on the image intensifier. There were no peri- or post-operative complications.

    Gender M male, F female. Leg length discrepancy at surgery. Estimated leg length discrepancy at maturity. Simultaneous epiphysiodesis of the distal femoral physis 0 no, 1 yes.

    Growth in millimeters from week 12 to week Translation and rotation in all patients was less than 0. No asymmetrical growth was observed.

    Our study shows that a single-portal technique for percutaneous epiphysiodesis of the tibia is as effective as the double-portal technique.

    The surgical time and time for fluoroscopy were significantly shorter for the single-portal technique. No failures of the percutaneous epiphysiodeses were observed in either group.

    Percutaneous epiphysiodesis for LLD is a well-established method. However, failure to achieve fusion of the operated physis has been described.

    Both single-portal and double-portal techniques for percutaneous epiphysiodesis have been described. In the original description of percutaneous epiphysiodesis, a double-portal approach was used [ 5 ].

    A single-portal approach for percutaneous epiphysiodesis is described for the femur as well as the tibia [ 6 , 7 ]. Complication rates are found to be higher in the single-portal techniques, whereas the increase of complications is mainly ascribed to crossing of the midline in single-portal techniques [ 6 ].

    In the femur, the middle part of the physis is quite close to the femoral notch, which makes it likely to perforate into the knee joint when ablating this part of the physis, resulting in postoperative hemarthrosis of the knee.

    Therefore, single-portal techniques for percutaneous epiphysiodesis of the femur might not be recommended.

    In the tibia, however, crossing of the midline does not compromise any anatomical structures but the physis itself.

    In our study, the single-portal technique of the tibial epiphysiodesis was not associated with a higher complication rate than the double-portal technique.

    Surgical techniques used for percutaneous epiphysiodesis might differ somewhat. Our surgical technique is comparable to the technique as described by Canale et al.

    These results confirm the conclusions of Lauge-Pedersen et al. There is no standard method to monitor the effect of percutaneous epiphysiodesis.

    Physeal arrest might be documented by ordinary radiographs [ 19 ]. However, the interpretation of standard X-ray films according to the success of an epiphysiodesis might be difficult.

    In our study, RSA was an excellent method for monitoring percutaneous epiphysiodesis when comparing two different surgical techniques. Symptoms which could be attributed to overgrowth of the fibula were not found.

    A weakness of our study is the rather low number of patients included in our investigation. However, considering that patients are exposed to radiation more often when performing RSA compared to normal follow-up after epiphysiodesis, we kept the number of patients as low as possible.

    In our study, a single-portal technique for percutaneous epiphysiodesis of the proximal tibia was as effective as a double-portal technique.

    Additionally, this study might further contribute to a better understanding of the effects of percutaneous epiphysiodesis. National Center for Biotechnology Information , U.

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    test singleportal -

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    The surgical time was measured from skin incision to completed closure of the wound, including the time used for the placement of the tantalum spheres.

    The time for fluoroscopy during surgery was read off the display on the image intensifier. There were no peri- or post-operative complications.

    Gender M male, F female. Leg length discrepancy at surgery. Estimated leg length discrepancy at maturity.

    Simultaneous epiphysiodesis of the distal femoral physis 0 no, 1 yes. Growth in millimeters from week 12 to week Translation and rotation in all patients was less than 0.

    No asymmetrical growth was observed. Our study shows that a single-portal technique for percutaneous epiphysiodesis of the tibia is as effective as the double-portal technique.

    The surgical time and time for fluoroscopy were significantly shorter for the single-portal technique.

    No failures of the percutaneous epiphysiodeses were observed in either group. Percutaneous epiphysiodesis for LLD is a well-established method.

    However, failure to achieve fusion of the operated physis has been described. Both single-portal and double-portal techniques for percutaneous epiphysiodesis have been described.

    In the original description of percutaneous epiphysiodesis, a double-portal approach was used [ 5 ]. A single-portal approach for percutaneous epiphysiodesis is described for the femur as well as the tibia [ 6 , 7 ].

    Complication rates are found to be higher in the single-portal techniques, whereas the increase of complications is mainly ascribed to crossing of the midline in single-portal techniques [ 6 ].

    In the femur, the middle part of the physis is quite close to the femoral notch, which makes it likely to perforate into the knee joint when ablating this part of the physis, resulting in postoperative hemarthrosis of the knee.

    Therefore, single-portal techniques for percutaneous epiphysiodesis of the femur might not be recommended. In the tibia, however, crossing of the midline does not compromise any anatomical structures but the physis itself.

    In our study, the single-portal technique of the tibial epiphysiodesis was not associated with a higher complication rate than the double-portal technique.

    Surgical techniques used for percutaneous epiphysiodesis might differ somewhat. Our surgical technique is comparable to the technique as described by Canale et al.

    These results confirm the conclusions of Lauge-Pedersen et al. There is no standard method to monitor the effect of percutaneous epiphysiodesis.

    Physeal arrest might be documented by ordinary radiographs [ 19 ]. However, the interpretation of standard X-ray films according to the success of an epiphysiodesis might be difficult.

    In our study, RSA was an excellent method for monitoring percutaneous epiphysiodesis when comparing two different surgical techniques.

    Symptoms which could be attributed to overgrowth of the fibula were not found. A weakness of our study is the rather low number of patients included in our investigation.

    However, considering that patients are exposed to radiation more often when performing RSA compared to normal follow-up after epiphysiodesis, we kept the number of patients as low as possible.

    In our study, a single-portal technique for percutaneous epiphysiodesis of the proximal tibia was as effective as a double-portal technique. Additionally, this study might further contribute to a better understanding of the effects of percutaneous epiphysiodesis.

    National Center for Biotechnology Information , U. Journal List J Child Orthop v. Published online Jun Author information Article notes Copyright and License information Disclaimer.

    Received Feb 22; Accepted May This article has been cited by other articles in PMC. Abstract Purpose We modified the method for tibial epiphysiodesis by solely using a lateral approach to the physis.

    Results From 0 to 6 weeks after epiphysiodesis, the mean longitudinal growth across the operated physis in the tibia in Group I was 0.

    Conclusions In our study, a single-portal technique from the lateral side for percutaneous epiphysiodesis of the proximal tibia was as effective as the double-portal technique.

    Introduction The most common surgical techniques for epiphysiodesis are the Phemister technique [ 1 ], the White technique [ 2 ], epiphyseal stapling [ 3 ], epiphysiodesis with percutaneous screws [ 4 ], and the percutaneous technique as first described by Bowen and Johnson in [ 5 ].

    Open in a separate window. Results There were no peri- or post-operative complications. Discussion Our study shows that a single-portal technique for percutaneous epiphysiodesis of the tibia is as effective as the double-portal technique.

    Conclusion In our study, a single-portal technique for percutaneous epiphysiodesis of the proximal tibia was as effective as a double-portal technique.

    Conflict of interest None. Operative arrestment of longitudinal growth of bones in the treatment of deformities.

    J Bone Joint Surg Am. Growth arrest for equalizing leg lengths. J Am Med Assoc. Control of bone growth by epiphyseal stapling; a preliminary report.

    Clin Orthop Relat Res. Percutaneous epiphysiodesis of the lower extremity: A method for the study of the kinematics of the skeletal system.

    Acta Orthop Scand Suppl. Radiostereometric analysis for monitoring percutaneous physiodesis. J Bone Joint Surg Br. Prospective evaluation of fifty-three consecutive percutaneous epiphysiodeses of the distal femur and proximal tibia and fibula.

    A straight-line graph for leg-length discrepancies. Multiplier method for predicting limb-length discrepancy. Keep me logged in.

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