Growth Modulation for Angular and Length Correction

When correcting pediatric limb deformities, the ultimate goals are to restore the mechanical axis to neutral and achieve equal limb lengths by maturity, ideally without resorting to an osteotomy. Employing guided growth, proper alignment is accomplished gradually, without neurovascular risks. To optimize the outcome of guided growth, children should be followed until skeletal maturity. Guided growth is applicable in virtually any aged child with any etiology of deformity, provided the physes are open and at least a year of growth is anticipated. The only recognized contraindications to guided growth are physiologic deformities (such as genu varum < 2 years and genu valgum < 6 years—or projected limb length discrepancy <1.5 cm) at maturity and physeal closure due to damage or skeletal maturity. In addition to correction of coronal knee deformities, guided growth is also applicable for progressive hip, ankle, elbow, and wrist deformities, as well as for sagittal or oblique plane deformity.