Guided Growth (Hemiepiphysiodesis) for Angular Deformity

⚙️What This Procedure Involves

A small incision (2–3 cm) is made over the growth plate on the side of the deformity. A small two-hole plate with a central screw hole (8-plate) is placed across the growth plate, with one screw in the epiphysis and one in the metaphysis. This restrains growth on one side while allowing it to continue on the other, gradually correcting the deformity. The plate is removed once correction is achieved. The procedure takes 20–30 minutes per plate. Both legs may be treated.

💡Why It May Be Recommended

Guided growth is recommended for angular limb deformity in growing children — genu valgum (knock knees), genu varum (bow legs), and ankle valgus. It is much less invasive than osteotomy and uses the child's own growth to achieve correction.

⚖️Non-Operative Alternatives

Observation (physiological genu valgum in young children usually corrects spontaneously), bracing (limited evidence for effectiveness), and corrective osteotomy (more invasive, reserved for older children or those near skeletal maturity).

📋Preparing for Surgery

Standing alignment X-rays. Bone age assessment to confirm remaining growth. Day-case procedure.

✅Expected Benefits

Gradual, predictable correction of angular deformity using the child's own growth. Success rates exceed 90% when performed at the appropriate age with sufficient remaining growth.

⚠️Common Risks

• Over-correctionUncommon

  If the plate is left too long, the deformity may over-correct.

• Under-correctionUncommon

  If growth is insufficient or the plate fails.

• Second procedureExpected

  Plate removal is always needed — either when correction is achieved or at skeletal maturity.

🔴Less Common but Serious Risks

• Growth plate damageRare

  Permanent physeal arrest from the screws. Very rare with proper technique.

• Hardware failureUncommon

  Screw breakage or plate dislodgement.

• InfectionRare

  Wound infection.

• ReboundUncommon

  Deformity may recur after plate removal if growth continues.

💉Anaesthetic Considerations

General anaesthesia. Day-case procedure.

🏃Recovery and Rehabilitation

Walking immediately. Return to school within days. No activity restrictions. Standing X-rays every six months to monitor correction. Plate removal when correction is achieved (a second short general anaesthetic).

📅Follow-Up

Standing alignment X-rays every six months. Plate removal when correction is achieved.

❓Frequently Asked Questions