Abstract
OBJECTIVES: Oblique placement of tension band plates is a common surgical variance in guided growth, raising concerns about its clinical safety, particularly the potential for inducing iatrogenic deformities. This study aimed to evaluate the comprehensive impact of this plate autocorrection on limb torsion, as well as on coronal and sagittal plane alignment. METHODS: This retrospective study analyzed 56 children who underwent guided growth for genu varum or valgum. At treatment initiation and termination, we measured the plate-diaphysis angle (α), femoral/tibial torsion, and coronal/sagittal plane alignment. Coronal plane correction was assessed using mechanical and anatomic lateral distal femoral angles (mLDFA, aLDFA) and medial proximal tibial angles (mMPTA, aMPTA). Sagittal plane stability was evaluated using the posterior distal femoral angle (PDFA) and posterior proximal tibial angle (PPTA). RESULTS: A significant autocorrection of the plates toward the diaphyseal axis was observed (p < 0.001). The intended coronal plane correction was successfully achieved, as evidenced by statistically significant improvements in all four coronal alignment parameters (mLDFA, aLDFA, mMPTA, aMPTA; all p < 0.05). Critically, this rotation was not associated with any significant change in femoral or tibial torsion (p > 0.05 for both). Furthermore, sagittal plane alignment remained stable throughout the treatment period, with no significant alterations in PDFA or PPTA (all p > 0.05). CONCLUSION: Inadvertent obliquity of tension band plates and their subsequent autocorrection is a clinically benign phenomenon. It effectively achieves the desired coronal correction without inducing adverse torsional or sagittal plane deformities. This study provides robust, evidence-based reassurance for surgeons that guided growth remains a safe and effective procedure despite this common surgical variance.