Researchers and orthopedic specialists evaluating lower limb deformity correction face critical choices among techniques like transphyseal screws. Recent systematic reviews and clinical studies outline the efficacy, safety profiles, and distinct biological environments shaping pediatric and adult orthopedic interventions.
Guided Growth Dynamics and Transphyseal Screw Innovations in Pediatric Orthopedics
Temporary epiphysiodesis serves as a widely utilized strategy for managing angular limb deformities and limb-length discrepancies in skeletally immature patients according to recent systematic literature reviews. The physiological basis of this procedure relies on the Hueter-Volkmann principle, where asymmetric compression applied directly across the growth plate slows down growth on the tethered side while allowing the contralateral physis to grow unrestricted.
Early interventions once relied on permanent epiphysiodesis via open Phemister or percutaneous Bowen techniques. However, those irreversible procedures demanded precise timing to prevent over-correction or under-correction. While physeal stapling later offered a reversible alternative, it introduced complications including staple migration, breakage, and physeal arrest.
To address these setbacks, Métaizeau and colleagues introduced percutaneous epiphysiodesis using transphyseal screws, commonly referred to as PETS. By placing single-threaded cannulated screws obliquely across the physis, surgical teams achieved minimal soft tissue dissection, immediate postoperative weight-bearing capacity, and the reversibility of growth inhibition once hardware is removed. The technique has since expanded across the lower extremities to manage coxa valga at the proximal femur in patients with cerebral palsy, sagittal-plane flexion contractures at the anterior distal femur, and coronal-plane knee deformities at the lateral proximal tibia and distal femur.
Pathological Bone Conditions and Clinical Evidence Gaps
Despite the widespread adoption of transphyseal screws, medical literature historically lacked comprehensive outcome data concerning children diagnosed with complex pathological bone conditions. Previous systematic reviews and meta-analyses primarily evaluated PETS within idiopathic patient populations.
Conditions such as Blount disease, hereditary multiple exostoses, osteogenesis imperfecta, and various neuromuscular disorders create fundamentally different biological environments for guided growth. These underlying pathologies can alter correction rates and overall surgical success compared to idiopathic cohorts. To examine these variables, investigators conducted a comprehensive electronic search across major databases including PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, capturing literature up to May 31, 2026. The evaluation framework combined implant-specific terminology, procedural descriptions, and pathological etiologies to isolate eligible clinical studies.
Adult Deformity Correction and Precision Methodology
Beyond pediatric guided growth, adult deformity correction demands rigorous preoperative planning and precise execution to restore mechanical alignment and preserve long-term joint health.
The Ilizarov Technique and Distraction Osteogenesis
Systematic Review Protocols and Safety Considerations in Pharmacological Management
Comprehensive database investigations, such as descriptive systematic reviews conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, evaluate alternative therapies including cannabidiol for chronic pain management.
Utilizing major research engines like PubMed, PubMed Central, Medline, the Cochrane Library, and ScienceDirect, investigators screen thousands of records to synthesize clinical efficacy and safety data. Search protocols implement specific medical subject headings combined via Boolean logic. For instance, database queries for cannabinoid evaluations applied medical subject heading strings such as Cannabidiol/therapeutic use
alongside chronic pain management terms to obtain related literature.
Rigorous quality appraisal tools—including the Scale for the Assessment of Narrative Review Articles, the Assessment of Multiple Systematic Reviews, and the Cochrane Risk of Bias 2 tool—allow research teams to filter eligible human studies from thousands of initial citations. By maintaining stringent inclusion criteria regarding patient demographics, publication timelines, and study designs, modern systematic reviews establish an evidence-based foundation across both surgical orthopedics and adjunctive pain therapies.
