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Guiding Femoral Rotational Growth in an Animal Model
Amir Arami, MD1; Elhanan Bar-On, MD, MPH2; Amir Herman, MD, PhD3; Steven Velkes, MD, ChB1; Snir Heller, MD1
1 Orthopedic Department, Rabin Medical Center, 39 Jabotinski Street, Petah Tikva 49100, Israel
2 Paediatric Orthopedic Unit, Schneider Children’s Medical Center, 14 Kaplan Street, Petah Tikva 49202, Israel. E-mail address: elbar@013.net
3 Orthopaedic Department, Sheba Medical Center, Tel Hashomer 52621, Israel
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Investigation performed at Schneider Children’s Medical Center and Rabin Medical Center, Petah Tikva, Israel

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Nov 20;95(22):2022-2027. doi: 10.2106/JBJS.L.00819
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Guided growth is most commonly utilized about the knee and ankle for the correction of coronal-plane deformities by the use of plates positioned perpendicular to the physis. Sagittal-plane deformity correction has been described as well. The purpose of our study was to examine the ability to affect axial-rotational growth. Our hypothesis was that placement of plates in an oblique orientation relative to the physis can induce rotational growth deformity.


Our hypothesis was tested with use of a mathematical model and a bone model and subsequently in a rabbit model. Thirteen six-week-old rabbits underwent a rotational guided growth procedure involving the distal aspect of the right femur, with a sham procedure performed on the left side. Two plates were positioned in an oblique orientation relative to the physis, medially and laterally, to guide either internal or external rotational growth. After the rabbits were killed six weeks after the surgery, the femoral rotational profile was assessed by computed tomography scans of the dissected femora and the growth plates were examined histologically.


A significant effect on the rotational profile was found in the treated femora. When the plates were positioned to guide external rotation, the rotational profile was significantly greater in the treated femora (29.0° compared with 11.3° in the sham femora; p = 0.008). There was a positive linear correlation between the right-left difference in rotational profile and the change in inter-plate angle (R2 = 0.72, p = 0.001). Every 1° of inter-plate angle change induced 0.367° of rotational profile difference (p = 0.001). Histologically, a swirling effect of the physeal cell columns was seen in the treated femora.


Guided growth using plates was demonstrated to alter axial-rotational growth in a predictable fashion in a rabbit model.

Clinical Relevance: 

Guided growth using plates may be effective for correction of rotational and multiplanar deformities.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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