Guided growth: Current concepts and novel techniques for harnessing a child’s growth potential

Abstract

The principle of guided growth is grounded in the observations of Hueter and Volkmann, who proposed that longitudinal bone growth is stimulated by tension and inhibited by compression. The importance of guided growth lies in its ability to address limb malalignment in a more physiological and less invasive manner compared to traditional osteotomies. By modulating growth at the physis, guided growth allows for gradual correction of deformities, minimizing the disruption to the child’s developing musculoskeletal system and harnessing the child’s own growth potential. Guided growth has been most frequently applied for coronal plane angular deformities around the knee, but is increasingly used for deformities in other locations throughout the growing skeleton. A wide range of deformities with underlying idiopathic and non-idiopathic etiologies are amendable to guided growth procedures. Understanding the influence of the underlying etiology, type, and severity of deformity, the growth rate of the treated physis, and skeletal age is essential for treatment success. This review explores current concepts and novel applications of guided growth and highlights areas that warrant further investigation. The focus is on the clinical aspects of guided growth to correct angular or rotational deformities in both the upper and lower extremities.

Keywords

guided growth deformities upper extremity lower extremity

Key concepts

Guided growth is useful for deformities in both upper and lower extremities

Understanding the influence of underlying etiology, severity of deformity, growth rate of the treated physis, and skeletal age is essential for timing guided growth

Guided growth for rotational deformities is promising but warrants further research

Introduction

The principle of guided growth is grounded in the fundamental observations of Hueter and Volkmann, who proposed that longitudinal bone growth is stimulated by tension and inhibited by compression.^1–4 Applying compression selectively to one side of the growth plate, while allowing the opposite side to expand freely, can progressively correct the deformity.^5,6 This minimally invasive approach has transformed the treatment of pediatric orthopedic deformities, offering a less aggressive alternative to osteotomies, particularly for angular limb deformities.⁷

The historical roots of guided growth can be traced back to the early 20th century, when Phemister recognized the potential of physeal manipulation, using bone blocks to influence lower-limb alignment.^8,9 However, it is Haas who laid down the principles of growth manipulation for angular deformities and delaying growth.¹⁰ Blount further refined these concepts, introducing staples that laid the groundwork for modern guided growth procedures.^9,11 Métaizeau’s development of the percutaneous epiphysiodesis using transphyseal screws (PETS) and Stevens’ tension band plate (TBP) marked a significant advancement, providing a stable and reliable means of applying controlled forces across the physis.^9,12,13 These techniques create an intra- or extraphyseal fulcrum on the side of the deformity, enabling gradual correction of deformities while minimizing the risk of physeal damage.¹²

The importance of guided growth lies in its ability to address limb malalignment in a more physiological and less invasive manner compared to traditional osteotomies.^14,15 By modulating growth at the physis, guided growth allows for gradual correction of deformities, minimizing the disruption to the child’s developing musculoskeletal system and harnessing the child’s own growth potential.^16–18 This approach offers several advantages, including reduced surgical morbidity, shorter recovery times, and a lower risk of complications associated with osteotomies.^19,20

However, guided growth primarily corrects deformities at the physis even if the deformity is not at the physis. In such cases, the overall alignment can be corrected through guided growth, but one must consider the potential for secondary deformities. Studies have shown some improvement in diaphyseal deformities following guided growth, particularly in younger patients, but this is not always observed.²¹ Therefore, guided growth is not universally effective for all angular deformities.

Another important consideration is the wide range of underlying etiologies that can contribute to limb malalignment and deformities. These etiologies can be idiopathic or non-idiopathic, and the outcomes and rates of correction can be difficult to predict. In some cases, deformities arise from a normal, healthy physis that is well amendable to guided growth. In other cases, deformities arise from a pathological physis, where growth is impaired due to the underlying etiology. This often results in slower correction, longer treatment times, or unsuccessful guided growth. However, when the underlying disease can be effectively treated, growth may revert to a more normal rate, allowing for faster correction of the deformity.^21,22

This review explores the current concepts and novel applications of this technique and highlights areas warranting further investigation. Our focus will be on the clinical aspects of guided growth for correcting angular or rotational deformities in both the upper and lower extremities.

Mechanism of guided growth

According to the Hueter–Volkmann principle, growth is inhibited by compression and accelerated by tension.² Understanding guided growth first requires an understanding of physiological physeal growth, which occurs through endochondral ossification. In this process, mesenchymal stem cells differentiate into chondrocytes that progress through the reserve, proliferative, and hypertrophic zones before being replaced by bone.^23–25 These zones are mechanosensitive, responding dynamically to the magnitude, frequency, and duration of applied loads. Among them, the hypertrophic zone, which is the least rigid and most deformable region of the growth plate, is the primary contributor to longitudinal growth and the most sensitive to loading differences (Figure 1).^23,26

Figure 1.

Process of endochondral ossification in long bone growth.

Several studies have shown that increasing the magnitude, frequency, or duration of compression progressively disrupts growth plate architecture and suppresses hypertrophic volume expansion. By contrast, dynamic tension enhances growth plate height and proliferation, particularly at moderate frequencies, whereas excessive tensile loading inhibits growth and promotes apoptosis (Figure 2).^6,23

Figure 2.

Heřt’s curve demonstrating the relationship between the load on the physis and its growth activity.

An important aspect of physiological growth is a negative feedback loop that corrects minor deviations in growth. By contrast, pathological physeal growth and/or abnormal mechanical forces interfere with this feedback loop, limiting its ability to correct larger deviations, leading to more persistent deformities. These deviations may exceed the capacity of correction using the feedback loop, necessitating external interventions to restore normal growth.^27,28

Minimally invasive techniques, such as tension-band plating or PETS, utilize controlled, localized tethering to modulate asymmetric physeal growth and correct deformities. Sustained compression of approximately 0.6 MPa can completely arrest growth, while surgically applied PETS or tension-band plates generate local stresses approaching 1 MPa, sufficient to halt physeal expansion on the compressed side.²³ Upon removal of these compression forces, growth potential is re-established, and new growth has been demonstrated.^23,29,30 Despite this, theoretically, prolonged temporary epiphysiodesis using implants could lead to permanent growth arrest. Therefore, a practical recommendation is not to maintain implants in situ for much more than 2 years if further growth is required in the part of the growth plate following deformity correction.⁶ Knowledge of these stress thresholds and cellular responses allows optimization of implant design, placement, and timing to balance effective correction with preservation of growth potential.

In summary, guided growth is a mechanobiological process that links molecular, cellular, and tissue-level responses to mechanical stress. Controlled manipulation of these processes forms the foundation of modern strategies for correcting pediatric skeletal deformities.

Methods

For this current concept review, a thorough search of the literature was performed through PubMed and EMBASE to identify original articles. Appropriate search terms, including “guided growth,” “hemi-epiphysiodesis,” and relevant synonyms were applied. Cross-reference search results of included studies and gray literature were included. We primarily concentrated on studies published from 2007 onward, following the introduction of the TBP, though earlier relevant studies were also considered. Most studies that could be included for this narrative review had a level of evidence of three, with a higher level of evidence found to be scarce.

We prioritized studies that investigated guided growth interventions targeting either the upper or lower extremity. Only articles published in English were considered for inclusion. Our analysis specifically focused on literature addressing angular and/or rotational deformity correction. Studies evaluating guided growth for longitudinal correction (e.g. for the treatment of leg length discrepancies) were excluded from this review.

Guided growth in the lower extremity

Guided growth techniques have found extensive application in the lower extremity, addressing a variety of conditions affecting the hip, knee, ankle, and foot, which disrupt normal limb alignment and hence function.

Hip

Guided growth techniques at the hip have been explored as a strategy to address hip (sub)luxation and coxa valga. Their use has been reported in several conditions, including cerebral palsy, developmental dysplasia of the hip (DDH), and hereditary multiple exostoses around the hip.^31–37 Multiple studies have specifically examined guided growth of the proximal femur, in which a screw is placed across the medial aspect of the proximal femoral physis.^{33–35,38–42} This creates a temporary medial tether while preserving superolateral growth, resulting in progressive varus of the proximal femur.

Screw sizes of 4.5 mm or 6.5–7.0 mm have been recommended and should be tailored to patient size.^{31,33–35,39} Both partially and fully threaded screws have been used: fully threaded implants might be easier to remove and/or exchange. At least two threads should be placed in the epiphysis, but more epiphyseal purchase is beneficial. In younger children, an intraoperative arthrogram (Figure 3) is helpful for optimizing screw positioning and avoiding penetration of the joint surface.³⁹ Over time, the femoral head can grow off the screw, and this may lead to the need for screw exchange.

Figure 3.

Intraoperative imaging prior to arthrogram (a). Intraoperative view with arthrogram (b). The arthrography confirms that the tip of the transphyseal screw is well within the margins of the cartilaginous femoral head.

Most publications on this technique report on its use in children with cerebral palsy. A systematic review⁴¹ found this technique safe and effective for guiding proximal physeal growth to correct coxa valga deformities, prevent further hip displacement, and reduce hip subluxation.^41,43,44 It has shown significant improvements in key radiographic measures, including migration percentage (MP), head-shaft angle (HSA), neck-shaft angle, and acetabular index (Figure 4).^{32,34,35,41,45} The HSA correction rates are reported as a mean change of 12.28° (95% CI 11.17–13.39) after 2 years.⁴¹ Higher correction rates are seen in younger patients and in those with a more eccentric (medial) screw position.^5,35,40 Overall high success rates are reported, only 5%–21% of children subsequently required pelvic and/or femoral osteotomies after guided growth.^34,35,41 These studies included children with Gross Motor Function Classification System (GMFCS) levels 3 or higher, a mean MP of at least 33%, and a mean age of 7 years with or without associated soft tissue releases.

Figure 4.

Guided growth around the hip. Radiographs are preoperative (a), direct postoperative (b), and after 14 month follow-up (c). A decrease in coxa valga and hip migration is seen. In (c), continued physeal growth means the screw threads no longer cross the physis, and screw revision is planned.

While the current literature has not yet defined strict indications, in general, MP below 50%, HSA greater than 145°, and acetabular index (AI) less than 30° are recommended thresholds.³⁸ Deformities exceeding these thresholds are unlikely to be completely corrected with guided growth alone, although they may be useful to delay surgery to an older age. Current evidence consists mainly of retrospective single-center cohort studies, and prospective randomized trials are essential to further define the role of this minimally invasive treatment for progressive hip migration in children with CP.³⁸

Beyond cerebral palsy, proximal femoral guided growth has been reported in other etiologies. Multiple studies describe its application in children with DDH, addressing associated proximal femur growth disturbances and coxa valga.^31,37,46 These studies consistently report improvements in proximal femoral morphology with a reduction of the neck valgus.^31,37,46 Coxa breva often persists, rebound deformity can occur,³⁶ and the effect on acetabular development remains uncertain.^36,37

A small study of children with Hereditary Multiple Exostosis (HME) presenting with coxa valga and hip subluxation demonstrated a positive response to proximal femoral guided growth, comparable to outcomes in children with CP.³² This study reported significant decreases in HSA (−12 ± 5°) and MP (−7% ± 8%) over a minimum follow-up of 2 years.³²

A commonly reported problem during treatment is the physis growing off the screw, which may occur in up to 50% of cases, depending on the duration of treatment and the patient’s age.^15,33,41 In younger children, due to the small size of the head, it is recommended to place the screw more centrally across the middle quarter of the medial physis. This approach ensures a larger purchase of the screw and reduces the frequency of screw exchange while still successfully tethering the physis.⁴⁰

Another consideration is the potential impact of guided growth on femoral head sphericity. By creating a medial tether in one place and allowing growth on the superolateral side, the sphericity of the femoral head may be altered. A recent study demonstrated changes in the alpha angle suggestive of sphericity loss.⁴⁷ The relevance of femoral head sphericity varies depending on the underlying pathology and the child’s functional status. In children with CP, hip migration often affects non-ambulatory individuals, and sphericity is probably less critical. Alternatively, in ambulatory children with DDH or other hip disorders amendable to guided growth, femoral head sphericity plays a crucial role. In these cases, loss of sphericity might provoke symptoms and early degenerative changes.^48-50

Further research is required to characterize the effects on sphericity, three-dimensional femoral head shape, function, and patient-reported outcomes. Uncertainty also exists regarding premature (partial) physeal closure and overcorrection after proximal femur guided growth. Careful consideration is warranted when using this technique in ambulatory pediatric patients, as it may have functional implications.

Knee

The use of guided growth techniques around the knee is frequently indicated for the management of lower limb angular deformities particularly in the coronal plane (genu varum and genu valgum) but also in the sagittal plane to address fixed flexion deformities. The potential for treating rotational deformities is also gaining attention.

Coronal plane deformities

Angular coronal plane deformities around the knee are encountered relatively frequently in children due to disturbances in skeletal growth. A broad range of idiopathic and non-idiopathic etiologies lead to either varus or valgus deformity, including fractures, Blount’s disease, rickets, infections, and skeletal dysplasia. Depending on the severity, lower-limb angular deformity may lead to cosmetic complaints, functional problems, pain, gait disturbances, and subsequently joint degeneration.^51,52 Indications for guided growth include persistent or progressive deformities categorized by a mechanical axis in zone 2 or higher according to Stevens, accompanied by pain, patellofemoral instability, and/or gait abnormalities.^53,54

Blount staples are a technique with demonstrated efficacy, but the staples are prone to migration. This can be partly mitigated by the use of multiple staples, but the need for revision is common and can be difficult, especially if the staple prongs have also diverged.^12,55,56 Furthermore, some studies have demonstrated that a single tether is more efficient in correcting angular deformities than multiple tethers.⁵⁷ Therefore, currently, the most widely used guided growth techniques for angular deformities around the knee are tension band plating (Figure 5), flexible staples with a working mechanism similar to TBPs, and PETS.^12,13,58 TBPs and PETS approaches have been associated with complication rates less than 10%.⁷ PETS have been reported to show faster correction rates compared to TBPs,⁵⁹ and some series report no growth disturbance or physeal bars following screw removal.^60,61 By contrast, others report ongoing angular correction after screw removal in up to a quarter of patients, suggestive of physeal growth disturbance, especially in those with very eccentrically placed screws.⁶² Overall, both TBPs and PETS are viable temporary hemi-epiphysiodesis techniques. Concerns have been raised regarding the potential development of intra-articular deformities following guided growth. Such changes have been reported in the context of longitudinal correction using dual tension-band plating, particularly at the level of the proximal tibia.⁶³ However, using hemiepiphysiodesis for angular correction, these changes appear to be minimal and are unlikely to result in clinically relevant intra-articular deformity.⁶⁴

Figure 5.

Guided growth of the distal femur to correct the mechanical axis and the genu valgum.

With relation to screw position in tension band plating, early hypotheses suggested that divergent screws would accelerate correction by immediately engaging the plate and reducing slack.^12,65 Subsequent biomechanical studies have contradicted this assumption. Parallel screws would result in faster and greater angular correction than divergent screws, likely due to their superior ability to toggle at the plate–screw interface, effectively shifting the center of rotation to a more favorable extraphyseal position.^66,67 Overall plate size, screw length, and initial screw angle do not appear to significantly impact treatment results.^66–69 Therefore, it is recommended that surgeons place screws according to anatomic constraints to avoid the joint surface and growth plate, rather than prioritizing screw alignment. Close proximity and convergence of the epiphyseal screw toward the growth plate should probably also be avoided because it bears a higher risk of physeal migration.⁷⁰

The timing of the procedure depends on skeletal age, underlying etiology, and degree of deformity. Sufficient growth should remain to allow for complete deformity correction, and the rate of growth in relation to underlying etiology and age should be considered. Overall correction rates have been reported: 0.87°/month (0.65–1.3) at the distal femur, and 0.72°/month (0.5–1) for proximal tibial deformities.^71,72 It must be noted, though, that for non-idiopathic deformities with slower growth rates, like skeletal dysplasias, slow correction rates should be anticipated and timing of the procedure adjusted accordingly.^22,72,73 Furthermore, correction of femoral valgus deformity is reported to be significantly faster than correction of femoral varus deformity. For guided growth of the tibia, no difference in correction rates was found regarding varus versus valgus corrections.⁷²

The rebound phenomenon after implant removal around the knee has been widely studied, but it is a phenomenon that is still poorly understood. Definitions vary across the literature; some are based on mechanical axis deviation change (≥3 mm) and others on joint orientation angle change (≥3°–5°) toward the initial deformity after material removal.^74–76 Despite this variation, most studies report rebound rates up to 50%.^74–78 Leveille et al.⁷⁵ reported an overall mean change of 6.9° (0–23) in hip-knee-angle (HKA) after implant removal. Rebound was defined as a change of 5°, and those classified as rebound had a mean change of 11.1° (5°–23°) in HKA. Reported risk factors include younger age, valgus deformity, higher deformity correction rate, greater total correction, and underlying pathology.^74–77 In cases at higher risk of rebound, some overcorrection is probably advantageous; based on the current literature, a specific recommendation on indication and amount of overcorrection cannot be made.

Another option for patients at high risk for rebound deformity is the sleeper plate technique.⁷⁹ This technique involves removing only the metaphyseal screw from the TBP after deformity correction, leaving the plate and epiphyseal screw in place to allow for potential reactivation if rebound occurs. Several studies suggest that the sleeper plate technique can be useful,⁷⁹ although others report substantial risk of ongoing angular correction after metaphyseal screw removal due to tethering—particularly in the tibia, for younger patients, titanium implants, and in patients with HME.^80–82 Reinsertion of the metaphyseal screw may be technically challenging or impossible due to osseous overgrowth of the plate.⁶⁸ Therefore, the benefits might not outweigh the possible complications associated with this technique, and careful follow-up of alignment is essential.

Sagittal plane deformities

Fixed flexion deformities around the knee can also be addressed using guided growth techniques. These procedures are commonly performed in patients with neuromuscular conditions but they are not limited to this patient population. A recent systematic review demonstrated a mean angular correction achieved of 14.5° ± 2.2°, representing a 63% decrease in the deformity angle.⁸³ On average, the rate of correction was 0.8° ± 0.3°/month, with the desired correction achieved after a mean duration of 19.1 ± 7.7 months. The same review also reported a very low overall complication rate of 7%, with the most reported complication being knee pain that would resolve after physiotherapy and/or hardware removal. Other complications mentioned include infections, hardware loosening, which required revision surgery, and wound dehiscence. No cases of unplanned overcorrection were reported, although rebound was reported in 3% of patients.⁸³ The most commonly utilized implants are TBPs and PETS, with a growing preference for PETS due to a lower incidence of implant-related soft tissue irritation.⁸⁴ The optimal surgical timing remains controversial, and although recommendations differ, most suggest that at least 2 years of remaining growth are required to allow correction to occur.^83,85,86 Others suggest much earlier intervention to facilitate more modulation.

Rotational deformities

A novel application for guided growth is to correct rotational deformities. Various surgical techniques have been described, all involving implants placed obliquely over the distal femur and/or the proximal tibia physis. It has been reported in animal and small clinical series using TBPs, specifically designed plates, plate–fibertape, and screw-cable constructs.^87–90

Initial animal studies demonstrate that rotational deformities can be corrected through guided growth.^91–95 In subsequent clinical studies, an effect averaging between 25° and 30° (±20°–35°) for the femur and 9.5° (±5°–17°) for the tibia is reported over a mean correction period of 12–22 months.^87–89 It has to be noted that the sample size in these human studies is small, with a total of only 16 patients reported on across the available literature.

Animal studies report a very high risk of rebound, up to approximately 20°, which approaches the amount of initial correction.⁹⁶ Secondary angular deformities and leg length discrepancies have been observed in animal models, with a 4%–7% decrease in longitudinal growth. In the available small sample clinical studies, both rebound and secondary angular deformities have thus far not been observed.⁸⁸ Longitudinal growth discrepancies of approximately 12 mm were estimated for unilateral rotational guided growth.⁸⁹ In studies with bilateral rotational guided growth, no length differences were seen.^88,89

Overall, based on these reports, rotational guided growth is a promising technique, but warrants further study in correction and rebound rate, optimal implant design, potential secondary deformities, and long-term effects.

Ankle and foot

Coronal plane deformities

Guided growth at the distal tibia has been described to correct coronal plane deformities using either medial malleolar transphyseal screws or TBPs placed over the medial side of the distal tibia physis. Ankle valgus is most often seen in posttraumatic cases, neuromuscular disorders, and HME. It can lead to pain, difficulties with bracing, and early ankle osteoarthritis.⁹⁷ Both PETS and TBPs have demonstrated adequate deformity correction in this region. Malleolar screws have been associated with a higher rate of complications: 23% with malleolar screws versus 4% with tension band plating, with screw migration being most common.⁹⁸ While some authors have suggested that the correction rate is faster with screws, the evidence is conflicting.^53,98,99 Chang et al.¹⁰⁰ found a correction rate of 0.37° ± 0.04°/month for transphyseal screws. Stevens et al.⁹⁹ found a correction rate of 0.60°/month (range 0.15°–1.6°/month) for tension band plating. However, Driscoll et al.⁹⁸ compared both treatments and found that the mean correction rate was faster in the malleolar screw-treated ankles (0.55° ± 0.41°/month) than in the TBP-treated ankles (0.36° ± 0.32°/month).

Regarding timing and implant size, skeletal age must be considered since patients who are too young may not have a sufficiently developed distal tibial epiphysis to facilitate guided growth implants.¹⁰¹ Medial malleolar transphyseal screws are feasible from age 4, while TBPs are feasible from age 6.^98,99 Another factor to take into account is the rebound of the deformity. For ankle valgus, it has been reported that rebound occurs in 80% of ankles with an average rebound rate of 0.28° ± 0.08°/month.¹⁰⁰ Therefore, timing should be determined by skeletal age, size of the distal tibial epiphysis, the desired speed and rate of correction, and underlying disease.

A novel indication for guided growth in the lower leg is anterolateral bowing of the tibia (Figure 6), a deformity associated with the development of congenital pseudarthrosis of the tibia (CPT). In two series comprising a total of 13 patients with anterolateral bowing, it has been reported that improvement of alignment using TBPs at the distal tibia could reduce the risk of developing a (re-)fracture and pseudarthrosis.^102,103 Only 1 of the 13 reported patients experienced a refracture, and none of the pre-fracture patients experienced a tibial fracture during the 5-year follow-up period.^102,103 Although early results are promising, larger series and longer follow-up are needed to further determine the success rate and identify specific pre-fracture CPT types that are suitable for this minimally invasive technique.

Figure 6.

Radiographs of anterolateral bowing of the tibia in a patient with neurofibromatosis 1.

Sagittal plane deformities

Guided growth may also be a viable option for managing equinus deformities (Figure 7). This is mostly reported in patients treated via the Ponseti method for clubfoot. Anterior distal tibial hemiepiphysiodesis using TBPs has demonstrated safety and efficacy in treating recurrent equinus deformity with or without associated flat top talus deformity.¹⁰⁴ The correction rates and changes in anterior distal tibial angle (ADTA) have been reported in various studies.^104–106 Overall, a mean correction rate of 0.6°–1.2°/month was observed, with a mean reduction in ADTA of 11.7°–17.3°.^104–106

Figure 7.

Guided growth for equinus deformities.

Rebound is a common phenomenon in surgically treated clubfeet with guided growth. Besselaar¹⁰⁷ showed in 32 clubfoot patients (46 feet) that despite good initial correction at a median follow-up of 20 months after plate removal, both ADTA and ankle dorsiflexion showed significant rebound towards preoperative values. When using this approach, repeat interventions and/or timing towards the end of growth should be considered.

Angular deformities of the hallux

The management of juvenile hallux valgus (JHV) remains a topic of debate due to the limited evidence base supporting specific interventions. Notably, there is a lack of studies directly comparing surgical and non-surgical approaches. Guided growth at the first metatarsal for JHV is an option and involves methods such as stapling, screws, or hemi-physeal removal using drills and curettes.^5,108 A systematic review reported on 147 feet and demonstrated modest radiological improvements with a mean hallux valgus angle decreasing from 29.2° ± 3.7° to 23.8° ± 4.5°, and intermetatarsal angle improving from 13.9° ± 1.1° to 11.4° ± 1.2°. Overall, 14.2% experienced complications, including recurrence and the need for revision surgery.¹⁰⁸ Because of the relatively slow correction rates, the procedure may be effective in mild to moderate deformities when performed early, as younger patients demonstrated better outcomes. Current recommendations suggest performing guided growth with at least 2 years of growth remaining to maximize corrective potential.^5,108

Cavovarus foot deformity

In a subgroup of patients with cavovarus deformity, first metatarsal correction with or without additional soft tissue procedures can be a good option. It has been shown that in patients with sufficient remaining growth, dorsal hemiepiphysiodesis of the first metatarsal can be a less invasive alternative to osteotomy of the base of the first metatarsal. In a pilot study of 13 children treated with dorsal hemiepiphysiodesis plus plantar fascia release, clinical improvement occurred at 28 months. Hindfoot alignment improved from 6° varus to 5° valgus.¹⁰⁹ Similarly, in 8 children undergoing dorsal hemiepiphysiodesis with plantar fascia release, significant radiographic correction was achieved at a median 4.3-year follow-up. Moreau–Costa–Bartani angle: increased from 112° to 120°, whereas the Meary angle decreased from 10° to 5°, with no complications described.¹¹⁰ Optimal timing is around ages 8–11 years, when hindfoot varus remains flexible and first metatarsal physeal growth persists. These early results are promising, but larger series and longer follow-up are necessary to determine predictors of success.

Guided growth in the upper extremity

Although guided growth is well established for lower extremity applications, its use in the upper extremity is less widespread in current clinical practice.¹¹¹ Nevertheless, a limited but growing body of evidence supports its potential use in addressing upper limb deformities. Application to the distal humerus, distal radius, and ulna has been described.

Humerus

Distal humerus deformity leading to cubitus valgus or varus can be either congenital or posttraumatic, with the latter being the most common. Depending on the type and severity of deformity, they can lead to significant functional and cosmetic issues. Due to the limited growth potential of the distal humerus, such deformities are rarely corrected by normal growth and often require osteotomy. Guided growth can be a less invasive option, although the evidence remains limited.

Two guided growth techniques that have been explored in small experimental studies are PETS (Figure 8) and tension band plating.^112,113 While the number of cases studied is limited and results vary, some results show moderately positive outcomes.^113–115

Figure 8.

Guided growth around the elbow.

Soldado et al. investigated the use of medial oblique PETS in five children with cubitus varus. No correction of deformity was observed in this study. This lack of improvement may have been due to the short duration of follow-up.¹¹² In addition, two case reports have described improvements in the carrying angle following treatment with tension band plating. Both reports show some radiological and clinical improvement in cubitus varus deformity, but the reported improvements may fall within the limits of measurement error.^114,115

Martínez-Álvarez et al. published a series of lateral distal humeral hemiepiphysiodesis using TBPs for posttraumatic cubitus varus correction in 15 patients. Significant improvements were found in the radiological measurements humero-ulnar angle (HUA), Baumann angle (BA), and shaft-condylar angle (SCA), as well as in the clinical measurements of the carrying angle. Correction rates per year varied from 2.4° for HUA, 1.5° for BA, and 1.4° for SCA. They could not find any correlation between age at intervention and the degree of correction (for radiographic and clinical parameters), but they did find a correlation between longer implant duration and clinical correction rates. Thirty-three percent of patients required additional surgery due to aseptic screw loosening, highlighting the need for careful surgical technique and close follow-up.¹¹³

Some correction of guided growth at the distal humerus might be expected, but due to the slow growth speed in this region, correction is expected to be slow. Its use is limited to mild-to-moderate deformities and to younger children with sufficient growth remaining. Based on current evidence, no clear guidelines can be formulated.

Radius

The distal radius physis contributes the majority of longitudinal growth of the radius, and disruptions to this growth plate can result in deformities such as positive ulnar variance and distal radioulnar joint instability. Common causes of such disturbances include multiple hereditary exostoses, Madelung deformity, and physeal fractures. The relatively high growth rates make deformities in this region good candidates for guided growth, but the anatomical features necessitate adaptation to smaller implants like extraperiostal staples and small customized plates.^116,117

Two studies describe the results of guided growth of the distal radius in patients with increased radial inclination and secondary ulnar shift of the carpus, in series with predominantly HME patients. Both measured changes in radial articular angle (RAA), carpal slip (CS), and ulnar tilt (UT) and identified significant improvements. Kelly and James¹¹⁷ unfortunately did not report follow-up time and correction rates, but incomplete correction was frequent, and the authors hypothesized that the procedure might have been undertaken too late. Soler-Jimenez et al. also demonstrated significant improvements in RAA (0.6°/month), CS (1.2°/month), and UT (0.6°/month), at an average follow-up of 28.7 ± 8.9 months. At the time of implant removal, most patients still had open physes, and removal was performed either following intentional overcorrection or upon reaching skeletal maturity. Reported complications included deformity rebound in two cases, neither of which required additional surgical intervention, and one case of screw breakage that did require reoperation.¹¹⁶

Ulna

Guided growth has been reported to be useful for positive ulnar variance. Scheider et al. demonstrated the utility of performing temporary epiphysiodesis using an intraoperatively customized small plate over the distal ulna physis. They report a reduction in ulnar variance from +3.9 mm (+1.9 to +6.1) to +0.1 mm (–3.2 to +5.0) and reduced ulnocarpal wrist complaints after an average correction time of 2.3 years in a cohort of seven wrists.¹¹⁸ The authors concluded that this technique is effective in correcting positive ulnar variance without causing irreversible physeal damage.

Madelung deformity, characterized by an abnormality of the volar-ulnar portion of the distal radial physis,¹¹⁹ may also benefit from guided growth techniques. In a study by Farr et al.,¹²⁰ performed on children with Madelung deformity, 10 wrists out of 41 received an ulnar epiphysiodesis. Of these 10 wrists, none required a second intervention for deformity correction. The authors postulated that ulnar epiphysiodesis may be considered in skeletally immature children older than 10 years of age with Madelung deformity, but correction rates or influencing factors were not provided.

Conclusion

Guided growth represents an essential tool in the treatment of pediatric orthopedic conditions, offering a minimally invasive approach to correct limb deformities. This technique leverages the child’s own growth potential to gradually restore normal alignment, minimizing the need for more invasive surgical procedures.

Most evidence is available for coronal plane deformities around the knee. For this indication, guided growth outcomes are generally favorable. Clear predictors for correction rate and treatment success are available to guide treatment decisions, although rebound after implant removal remains difficult to predict.

Several new indications have emerged throughout the growing skeleton. Guided growth of the proximal femur to treat pediatric hip disorders is gaining popularity, especially in the treatment of neuromuscular hip migration. Promising early results have been reported; however, further validation, including randomized controlled trials, studies assessing patient‑reported outcomes, and changes in femoral head sphericity, is required. Rotational guided growth is another emerging technique, aiming for minimal invasive rotational deformity correction. However, supporting evidence from clinical studies to date is limited. Future rotational guided growth research should focus on correction and rebound rate, optimal implant design, potential secondary deformities, and long-term effects. Also, guided growth for upper extremity deformity is currently based on relatively limited evidence and requires further investigation on optimal patient selection, surgical techniques, and expected outcomes.

In all guided growth procedures, timing is essential to optimize outcomes and should be individually tailored. Considerations should include the underlying etiology, severity of deformity, growth rate of the treated physis, and skeletal age, ensuring sufficient growth potential to allow for complete deformity correction. While challenges remain, ongoing research and technological advancements continue to expand applications and improve outcomes of guided growth in children.

Supplemental Material

sj-pdf-1-cho-10.1177_18632521261456090 – Supplemental material for Guided growth: Current concepts and novel techniques for harnessing a child’s growth potential

Supplemental material, sj-pdf-1-cho-10.1177_18632521261456090 for Guided growth: Current concepts and novel techniques for harnessing a child’s growth potential by Merel C. R. Roelen, Christiaan J. A. van Bergen, Mark F. Siemensma, Deborah M. Eastwood, Ignacio Sanpera and Jaap J. Tolk in Journal of Children's Orthopaedics

Footnotes

Acknowledgements

We would like to thank A.T. Besselaar MD, PhD for contributing expertise and images.

Author contributions

Conceptualization: MR, CvB, MS, and JT, writing—original draft, MR, MS; writing—review and editing, MR, JT, MS, CvB, DE, and IS; supervision, JT, CvB, DE, and IS. All authors have read and agreed to the published version of the manuscript.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research received a grant from the “For Wishdom Foundation” (OTH22-17/MML).

Ethical approval

Ethical approval is not applicable to current concepts reviews.

ORCID iDs

Merel C. R. Roelen

Mark F. Siemensma

Jaap J.Tolk

Supplemental material

Supplemental material for this article is available online.

References

Bartonicek

Nanka

The true history of the Hueter-Volkmann law. Int Orthop 2024; 48: 2755–2762.

Hert

Regulace Rustu Dlouh’ych Kost’i Do D’elky [Regulation of the longitudinal growth of long bones]

Acta Chir Orthop Traumatol Cech 1964; 31: 85–91.

Hueter

Anatomische Studien an den Extremitätengelenken Neugeborener und Erwachsener. Archiv Pathol Anat (Virchows Archiv) 1863; 26: 484–519.

Volkmann

Die Krankheiten der Bewegungsorgane. In: von Pitha

Billroth

(eds) Handbuch der allgemeinen und speziellen Chirurgie. Stuttgart: Ferdinand Enke, 1865, pp.350–351.

Cappello

Expanded indications for guided growth in pediatric extremities. J Pediatr Orthop Soc North Am 2021; 3: 217.

Gottliebsen

Shiguetomi-Medina

Rahbek

Moller-Madsen

Guided growth: mechanism and reversibility of modulation. J Child Orthop 2016; 10: 471–477.

Yang

Gottliebsen

Martinkevich

, et al. Guided growth: current perspectives and future challenges. JBJS Rev 2017; 5: e1.

Phemister

DB.

Operative arrestment of longitudinal growth of bones in the treatment of deformities. J Bone Joint Surg 1933; 15: 1–15.

Hubbard

Cherkashin

Samchukov

, et al. The evolution of guided growth for lower extremity angular correction. J Pediatr Orthop Soc North Am 2023; 5: 738.

10.

Haas

SL.

Retardation of bone growth by a wire loop. JBJS 1945; 27: 25–36.

11.

Blount

Clarke

GR.

Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Joint Surg Am 1949; 31A: 464–478.

12.

Stevens

PM.

Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop 2007; 27: 253–259.

13.

Metaizeau

Wong-Chung

Bertrand

Pasquier

Percutaneous epiphysiodesis using transphyseal screws (PETS). J Pediatr Orthop 1998; 18: 363–369.

14.

Lascombes

Omeroglu

Long bone deformity correction and bone lengthening procedures. J Child Orthop 2016; 10: 469–470.

15.

Hsu

Lee

Lin

, et al. Guided growth versus varus osteotomy for type II avascular necrosis following surgery for developmental dysplasia of the hip. Bone Joint J 2022; 104-B: 902–908.

16.

Stevens

PM.

Guided growth for deformity correction. Oper Tech Orthop 2011; 21: 197–202.

17.

Eastwood

Sanghrajka

AP.

Guided growth: recent advances in a deep-rooted concept. J Bone Joint Surg Br 2011; 93: 12–18.

18.

Hucke

Holder

van Drongelen

, et al. Influence of tension-band plates on the mechanical loading of the femoral growth plate during guided growth due to coronal plane deformities. Front Bioeng Biotech 2023; 11: 1165963.

19.

Inan

Senaran

Domzalski

, et al. Unilateral versus bilateral peri-ilial pelvic osteotomies combined with proximal femoral osteotomies in children with cerebral palsy: perioperative complications. J Pediatr Orthop 2006; 26: 547–550.

20.

McNerney

Mubarak

Wenger

DR.

One-stage correction of the dysplastic hip in cerebral palsy with the San Diego acetabuloplasty: results and complications in 104 hips. J Pediatr Orthop 2000; 20: 93–103.

21.

Horn

Wright

Bockenhauer

, et al. The orthopaedic management of lower limb deformity in hypophosphataemic rickets. J Child Orthop 2017; 11: 298–305.

22.

Tolk

Kessling

Yeo

, et al. Guided growth for the correction of angular lower limb deformity: correction rates for idiopathic and non-idiopathic aetiologies. J Child Orthop 2026; 20: 159–166.

23.

Villemure

Stokes

IA.

Growth plate mechanics and mechanobiology. A survey of present understanding. J Biomech 2009; 42: 1793–1803.

24.

D’Andrea

Alfraihat

Singh

, et al. Part 1. Review and meta-analysis of studies on modulation of longitudinal bone growth and growth plate activity: a macro-scale perspective. J Orthop Res 2021; 39: 907–918.

25.

Kaviani

Londono

Parent

, et al. Compressive mechanical modulation alters the viability of growth plate chondrocytes in vitro. J Orthop Res 2015; 33: 1587–1593.

26.

D’Andrea

Alfraihat

Singh

, et al. Part 2. Review and meta-analysis of studies on modulation of longitudinal bone growth and growth plate activity: a micro-scale perspective. J Orthop Res 2021; 39: 919–928.

27.

Frost

HM.

A chondral modeling theory. Calcif Tissue Int 1979; 28: 181–200.

28.

Hamrick

MW.

A chondral modeling theory revisited. J Theor Biol 1999; 201: 201–208.

29.

Akyuz

Braun

Brown

, et al. Static versus dynamic loading in the mechanical modulation of vertebral growth. Spine (Phila Pa 1976) 2006; 31: E952–E958.

30.

Mente

Aronsson

Stokes

Iatridis

JC.

Mechanical modulation of growth for the correction of vertebral wedge deformities. J Orthop Res 1999; 17: 518–524.

31.

Torode

Young

JL.

Caput valgum associated with developmental dysplasia of the hip: management by transphyseal screw fixation. J Child Orthop 2015; 9: 371–379.

32.

Hung

Lee

, et al. Guided growth improves coxa valga and hip subluxation in children with hereditary multiple exostoses. J Pediatr Orthop 2023; 43: e67–e73.

33.

Lee

Kao

Yang

, et al. Guided growth of the proximal femur for hip displacement in children with cerebral palsy. J Pediatr Orthop 2016; 36: 511–515.

34.

Hsieh

Wang

Kuo

, et al. Guided growth improves coxa valga and hip subluxation in children with cerebral palsy. Clin Orthop Relat Res 2019; 477: 2568–2576.

35.

Portinaro

Turati

Cometto

, et al. Guided growth of the proximal femur for the management of hip dysplasia in children with cerebral palsy. J Pediatr Orthop 2019; 39: e622–e628.

36.

Peng

Lee

Kao

, et al. Guided growth for caput valgum in developmental dysplasia of the hip. J Pediatr Orthop B 2018; 27: 485–490.

37.

Shin

Hong

Lee

, et al. Percutaneous medial hemi-epiphysiodesis using a transphyseal screw for caput valgum associated with developmental dysplasia of the hip. BMC Musculoskelet Disord 2017; 18: 451.

38.

van Stralen

Roelen

MCR

Moerman

, et al. GUIDANCE study: guided growth of the proximal femur to prevent further hip migration in patients with cerebral palsy-study protocol for a multicentre randomised controlled trial. BMJ Open 2024; 14: e091073.

39.

Davids

Proximal femur guided growth for the management of hip dysplasia in children with cerebral palsy. J Pediatr Orthop Soc North Am 2021; 3: 245.

40.

Hsu

Lee

, et al. Does screw position matter for guided growth in cerebral palsy hips? Bone Joint J 2020; 102-B: 1242–1247.

41.

Lebe

van Stralen

Buddhdev

Guided growth of the proximal femur for the management of the ‘hip at risk’ in children with cerebral palsy-a systematic review. Children (Basel) 2022; 9: 609.

42.

Zakrzewski

Carl

McCarthy

JJ.

Proximal femoral screw hemiepiphysiodesis in children with cerebral palsy improves the radiographic measures of hip subluxation. J Pediatr Orthop 2022; 42: e583–e589.

43.

Chang

Chi

Lee

ZL.

Progressive coxa vara by eccentric growth tethering in immature pigs. J Pediatr Orthop B 2006; 15: 302–306.

44.

McCarthy

Noonan

Nemke

, et al. Guided growth of the proximal femur: a pilot study in the lamb model. J Pediatr Orthop 2010; 30: 690–694.

45.

Galan-Olleros

Munoz de la Espada

Garcia-Fernandez

, et al. Unilateral hip reconstruction combined with contralateral guided growth versus bilateral reconstruction in children with cerebral palsy and unilateral hip displacement. J Pediatr Orthop B 2025; 35: 178–185.

46.

Agus

Onvural

Kazimoglu

, et al. Medial percutaneous hemi-epiphysiodesis improves the valgus tilt of the femoral head in developmental dysplasia of the hip (DDH) type-II avascular necrosis. Acta Orthop 2015; 86: 506–510.

47.

Chiu

Lee

, et al. Outcome and femoral head deformity following hip guided growth in children with cerebral palsy at skeletal maturity. J Pediatr Orthop 2025; 45: 423–430.

48.

Stulberg

Cooperman

Wallensten

The natural history of Legg-Calve-Perthes disease. J Bone Joint Surg Am 1981; 63: 1095–1108.

49.

Thomas

Palmer

Batra

, et al. Subclinical deformities of the hip are significant predictors of radiographic osteoarthritis and joint replacement in women. A 20 year longitudinal cohort study. Osteoarthritis Cartilage 2014; 22: 1504–1510.

50.

Casartelli

Maffiuletti

Valenzuela

, et al. Is hip morphology a risk factor for developing hip osteoarthritis? A systematic review with meta-analysis. Osteoarthritis Cartilage 2021; 29: 1252–1264.

51.

Brouwer

van Tol

Bergink

, et al. Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 2007; 56: 1204–1211.

52.

Lee

, et al. Balance control and lower limb joint work in children with bilateral genu valgum during level walking. Gait Posture 2021; 90: 313–319.

53.

Masquijo

Artigas

de Pablos

Growth modulation with tension-band plates for the correction of paediatric lower limb angular deformity: current concepts and indications for a rational use. EFORT Open Rev 2021; 6: 658–668.

54.

Stevens

MacWilliams

Mohr

RA.

Gait analysis of stapling for genu valgum. J Pediatr Orthop 2004; 24: 70–74.

55.

Kumar

Gaba

Sud

, et al. Comparative study between staples and eight plate in the management of coronal plane deformities of the knee in skeletally immature children. J Child Orthop 2016; 10: 429–437.

56.

Hosseinzadeh

Ross

Walker

, et al. Three methods of guided growth for pediatric lower extremity angular deformity correction. Iowa Orthop J 2016; 36: 123–127.

57.

Sanpera

Jr Raluy-Collado

Frontera-Juan

, et al. Guided growth: the importance of a single tether. An experimental study. J Pediatr Orthop 2012; 32: 815–820.

58.

Koob

Kehrer

Hettchen

, et al. Temporary epiphysiodesis using the FlexTack implant (tension band) featuring a modified explantation technique. Temporare Epiphyseodese mit dem FlexTack-Implantat (“Tension Band”) unter Anwendung eines modifizierten Explantationsverfahrens. Oper Orthop Traumatol 2018; 30: 359–368.

59.

Sabry

Genedy

MKA

Abouelwafa

, et al. Percutaneous epiphysiodesis transphyseal screw versus tension-band plating as hemiepiphysiodesis in treating coronal angular knee deformities: a systematic review and meta-analysis of comparative studies. BMC Musculoskelet Disord 2025; 26: 355.

60.

Neal

Kiebzak

GM.

Epiphyseal-entry cannulated screws for temporary guided growth of the knees: a retrospective review of 89 cases. J Pediatr Orthop B 2024; 33: 114–118.

61.

Abdelaziz

Ghaly

Fayyad

, et al. Transphyseal hemiepiphysiodesis: is it truly reversible? J Pediatr Orthop 2024; 44: 619–625.

62.

Shim

Lim

Factors affecting postoperative courses after removal of transphyseal screws inserted for correction of genu valgum. J Pediatr Orthop 2024; 44: e411–e418.

63.

Tolk

Merchant

Calder

, et al. Tension-band plating for leg-length discrepancy correction. Strateg Trauma Limb 2022; 17: 19–25.

64.

Hvidberg

Antfang

Gosheger

, et al. Morphology of the knee after guided growth using tension-band devices: a retrospective multicenter study of 222 limbs and 285 implants. Acta Orthop 2023; 94: 609–615.

65.

Burghardt

Herzenberg

Standard

, et al. Temporary hemiepiphyseal arrest using a screw and plate device to treat knee and ankle deformities in children: a preliminary report. J Child Orthop 2008; 2: 187–197.

66.

Schoenleber

Iobst

Baitner

, et al. The biomechanics of guided growth: does screw size, plate size, or screw configuration matter? J Pediatr Orthop B 2014; 23: 122–125.

67.

Eltayeby

Iobst

Herzenberg

JE.

Hemiepiphysiodesis using tension band plates: does the initial screw angle influence the rate of correction?

J Child Orthop 2019; 13: 62–66.

68.

Raluy-Collado

Sanpera

Frontera-Juan

, et al. Screw length in the guided growth method. Arch Orthop Trauma Surg 2012; 132: 1711–1715.

69.

Kim

Kwon

Choi

, et al. Effect of Screw Configuration on the Rate of Correction for Guided Growth Using the Tension-band Plate. J Pediatr Orthop 2021; 41: e899–e903.

70.

Galan-Olleros

Sanchez Del Saz

Miranda-Gorozarri

, et al. Physeal migration during knee-guided growth with tension band plates: influence of implant position. J Pediatr Orthop 2024; 44: e174–e183.

71.

Kumar

Sonanis

SV.

Growth modulation for coronal deformity correction by using Eight Plates-Systematic review. J Orthop 2018; 15: 168–172.

72.

Danino

Rodl

Herzenberg

, et al. Growth modulation in idiopathic angular knee deformities: is it predictable? J Child Orthop 2019; 13: 318–323.

73.

Danino

Rodl

Herzenberg

, et al. Guided growth: preliminary results of a multinational study of 967 physes in 537 patients. J Child Orthop 2018; 12: 91–96.

74.

Farr

Alrabai

Meizer

, et al. Rebound of frontal plane malalignment after tension band plating. J Pediatr Orthop 2018; 38: 365–369.

75.

Leveille

Razi

Johnston

CE.

Rebound deformity after growth modulation in patients with coronal plane angular deformities about the knee: who gets it and how much?

J Pediatr Orthop 2019; 39: 353–358.

76.

Ramazanov

Ozdemir

Yilmaz

, et al. Rebound phenomenon after hemiepiphysiodesis: determination of risk factors after tension band plate removal in coronal plane deformities of lower extremities. J Pediatr Orthop B 2021; 30: 52–58.

77.

Park

Kang

Kim

JY.

Prediction of rebound phenomenon after removal of hemiepiphyseal staples in patients with idiopathic genu valgum deformity. Bone Joint J 2016; 98-B: 1270–1275.

78.

Haider

Shah

Acquaah

, et al. Guided growth for genu valgum in mucopolysaccharidoses: beware the rebound. J Pediatr Orthop. Epub ahead of print 15 July 2025. DOI: 10.1097/BPO.0000000000003048.

79.

Keshet

Katzman

Zaidman

, et al. Removal of metaphyseal screw only after hemiepiphysiodesis correction of coronal plane deformities around the knee joint: is this a safe and advisable strategy? J Pediatr Orthop 2019; 39: e236–e239.

80.

Gerges

Messner

Lim

, et al. Efficacy and safety of “sleeper plate” in temporary hemiepiphysiodesis and the observation of “tethering”. J Pediatr Orthop 2022; 42: e762–e766.

81.

Bakircioglu

Kolac

Yigit

, et al. Does the sleeper plate application for temporary epiphysiodesis make life easier or complicated? Increased risk of tethering. J Pediatr Orthop 2023; 43: 572–577.

82.

Retzky

Pascual-Leone

Cirrincione

, et al. The perils of sleeper plates in multiple hereditary exostosis: tibial deformity overcorrection due to tether at empty metaphyseal hole. J Pediatr Orthop 2023; 43: 471–474.

83.

Al Badi

Lorange

Alzeedi

, et al. Distal femur anterior hemiepiphysiodesis for fixed knee flexion deformity in neuromuscular patients: a systematic review. JBJS Rev 2023; 11: 00001.

84.

Stiel

Babin

Vettorazzi

, et al. Anterior distal femoral hemiepiphysiodesis can reduce fixed flexion deformity of the knee: a retrospective study of 83 knees. Acta Orthop 2018; 89: 555–559.

85.

Palocaren

Thabet

Rogers

, et al. Anterior distal femoral stapling for correcting knee flexion contracture in children with arthrogryposis–preliminary results. J Pediatr Orthop 2010; 30: 169–173.

86.

Shore

McCarthy

Shrader

, et al. Anterior distal femoral hemiepiphysiodesis in children with cerebral palsy: establishing surgical indications and techniques using the modified Delphi method and literature review. J Child Orthop 2022; 16: 65–74.

87.

Halloum

Kold

Rölfing

, et al. Correction of rotational deformities in long bones using guided growth: a scoping review. Efort Open Reviews 2024; 9: 119–128.

88.

Paley

Shannon

Rotational guided growth: a preliminary study of its use in children. Children (Basel) 2022; 10: 70.

89.

Metaizeau

Denis

Louis

New femoral derotation technique based on guided growth in children. Orthop Traumatol Surg Res 2019; 105: 1175–1179.

90.

Halloum

Rahbek

Gholinezhad

, et al. A novel plate design for rotational guided growth: an experimental study in immature porcine femurs. J Orthop Res 2025; 43: 617–621.

91.

Arami

Bar-On

Herman

, et al. Guiding femoral rotational growth in an animal model. J Bone Joint Surg Am 2013; 95: 2022–2027.

92.

Cobanoglu

Cullu

Kilimci

, et al. Rotational deformities of the long bones can be corrected with rotationally guided growth during the growth phase. Acta Orthop 2016; 87: 301–305.

93.

Lazarus

Farnsworth

Jeffords

, et al. Torsional growth modulation of long bones by oblique plating in a rabbit model. J Pediatr Orthop 2018; 38: e97–e103.

94.

Zaidman

Simanovsky

Goldman

, et al. Correction of femoral torsional deformities by rotational guided growth. J Clin Med 2024; 13: 7514.

95.

Abood

Rolfing

Halloum

, et al. An innovative plate concept for rotational guided growth: a porcine pilot study. Cureus 2024; 16: e58169.

96.

Martel

Holmes

Sobrado

, et al. Rotational-guided growth. J Limb Length Reconstr 2018; 4: 97–105.

97.

Noonan

Feinberg

Levenda

, et al. Natural history of multiple hereditary osteochondromatosis of the lower extremity and ankle. J Pediatr Orthop 2002; 22: 120–124.

98.

Driscoll

Linton

Sullivan

, et al. Medial malleolar screw versus tension-band plate hemiepiphysiodesis for ankle valgus in the skeletally immature. J Pediatr Orthop 2014; 34: 441–446.

99.

Stevens

Kennedy

Hung

Guided growth for ankle valgus. J Pediatr Orthop 2011; 31: 878–883.

100.

Chang

Pan

, et al. Rate of correction and recurrence of ankle valgus in children using a transphyseal medial malleolar screw. J Pediatr Orthop 2015; 35: 589–592.

101.

Davids

Valadie

Ferguson

, et al. Surgical management of ankle valgus in children: use of a transphyseal medial malleolar screw. J Pediatr Orthop 1997; 17: 3–8.

102.

Laine

Novotny

Weber

, et al. Distal tibial guided growth for anterolateral bowing of the tibia: fracture may be prevented. J Bone Joint Surg Am 2020; 102: 2077–2086.

103.

Todderud

Carlson

Larson

AN.

Guided growth to treat anterolateral tibial bowing associated with congenital pseudarthrosis of the Tibia. J Pediatr Orthop 2024; 44: e560–e565.

104.

Al-Aubaidi

Lundgaard

Pedersen

NW.

Anterior distal tibial epiphysiodesis for the treatment of recurrent equinus deformity after surgical treatment of clubfeet. J Pediatr Orthop 2011; 31: 716–720.

105.

Ebert

Ballhause

Babin

, et al. Correction of recurrent equinus deformity in surgically treated clubfeet by anterior distal tibial hemiepiphysiodesis. J Pediatr Orthop 2020; 40: 520–525.

106.

Zargarbashi

Abdi

Bozorgmanesh

, et al. Anterior distal hemiepiphysiodesis of tibia for treatment of recurrent equinus deformity due to flat-top talus in surgically treated clubfoot. J Foot Ankle Surg 2020; 59: 418–422.

107.

Besselaar

AT.

Walking with the clubfoot child. Maastricht University, 2025. www.orthopeden.org

108.

Al-Mohrej

Ade-Conde

, et al. Hemiepiphysiodesis for juvenile hallux valgus deformity: a systematic review. Foot Ankle Surg 2023; 29: 448–454.

109.

Sanpera

Jr Frontera-Juan

Sanpera-Iglesias

, et al. Innovative treatment for pes cavovarus: a pilot study of 13 children. Acta Orthop 2018; 89: 668–673.

110.

Domingues

Norte

Thusing

, et al. Is there a place for dorsal hemiepiphysiodesis of the first metatarsal in the treatment of pes cavovarus? J Pediatr Orthop B 2025; 34: 151–156.

111.

Siemensma

van Bergen

CJA

van Es

, et al. Indications and timing of guided growth techniques for pediatric upper extremity deformities: a literature review. Children (Basel) 2023; 10: 195.

112.

Soldado

Diaz-Gallardo

Cherqaoui

, et al. Unsuccessful mid-term results for distal humeral hemiepiphysiodesis to treat cubitus varus deformity in young children. J Pediatr Orthop B 2022; 31: 431–433.

113.

Martínez-Álvarez

Galán-Olleros

Alonso-Hernández

, et al. Guided growth for the treatment of cubitus varus in children: medium- to long-term results. J Clin Med 2023; 12: 2632.

114.

Amnah Almahmudi

Hussain Assaggaf . Lateral condyle temporary hemiepiphysiodesis in treatment of cubitus varus deformity post supracondylar humerus fracture: a case report. Med Case Rep 2020; 6: 150.

115.

Verka

PS.

A novel minimally invasive method in pediatric cubitus varus deformity, distal lateral humerus hemiepiphysiodesis: a case report. J Pediatr Neurol Disord 2021; 4: 1–2.

116.

Soler-Jimenez

Gonzalez-Herranz

Pensado-Senoris

Guided growth with minifragment plates for angular deformities in the distal radius in skeletally immature patients. preliminary results. J Pediatr Orthop 2024; 44: e691–e697.

117.

Kelly

James

MA.

Radiographic outcomes of hemiepiphyseal stapling for distal radius deformity due to multiple hereditary exostoses. J Pediatr Orthop 2016; 36: 42–47.

118.

Scheider

Ganger

Farr

Temporary epiphysiodesis in adolescent patients with ulnocarpal impaction syndrome: a preliminary case series of seven wrists. J Pediatr Orthop B 2021; 30: 601–604.

119.

Arora

Chung

Otto

Madelung and the recognition of Madelung’s deformity. J Hand Surg Am 2006; 31: 177–182.

120.

Farr

Kalish

Bae

, et al. Radiographic criteria for undergoing an ulnar shortening osteotomy in madelung deformity: a long-term experience from a single institution. J Pediatr Orthop 2016; 36: 310–315.

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