Comparison between Role of Epiphysiodesis Vs Tibial Osteotomy in Treatment of Varus Deformity of the Tibia

Abstract

SUMMARY O steopenia of prematurity is a disease which affects preterm infants due to many risk factors to which preterm infants are exposed in the incubator such as, delayed enteral feeding, prolonged immobilization, prolonged periods of total parenteral nutrition with insufficient mineral intake compared to the transplacental mineral supply from the mother during intrauterine life. Prevention of such disease is very important to avoid bone fracture and childhood bone complications. In the current trial we aimed at monitoring and evaluating the benefits and harms of physical activity programs for promoting bone mineralization and growth. Also we added a new biochemical maker of bone resorption, CTX that might me a good indicator for early diagnosis of osteopenia of prematurity and might carry a biochemical evidence of bone resorption in VLBW premature infants in response to physical activity programme. 36 preterm infants were enrolled in our study and were randomized into 2 groups; 18 preterm infants subjected to exercise protocol and 18 preterm infants as control group received only tactile stimulation. Both groups received the same caloric intake and parenteral calcium, phosphorus and magnesium. All neonates included in this study were subjected to full history taking, complete clinical assessment, baseline and at discharge, laboratory measurements including serum calcium, phosphorus, alkaline phosphatase, CTX, urinary calcium/ phosphorus ratio and at discharge, together with DEXA scan at discharge. Both control and exercise groups were comparable as regards demographic, birth anthropometric measurements and baseline laboratory data. The results of the current analysis revealed that there was statistical significant increase in weight, length and OFC at the end of enrollment in both groups. The weight and the rate of weight gain significantly higher in the exercise group compared to the controls. This study demonstrated significantly lower serum phosphorous levels, higher serum ALP and urinary Ca/PO4 ratio among the control group at completion of the physical activity program. Moreover, upon comparing post-intervention to baseline measurements, we found significant increase in ALP in both groups with much more increase among the control group. While urinary Ca/PO4 ratio significantly decreased in the exercise group, it showed a significant rise in the control group at completion of the study. We observed that serum CTX level was higher among the control group at the end of the study period but did not reach a significant level with serum CTX level at discharge positively correlated to ALP measurements both baseline and at discharge and negatively correlated to serum phosphorous at discharge. Moreover, a significant increase in the whole body bone mineral density at the completion of the physical activity program compared with the control group was observed. The whole body bone mineral capacity, body area, lean fat and fat mass showed no significant difference between the two groups. These results suggest beneficial effects of physical activity versus tactile stimulation on short-term growth, bone strength and metabolism in preterm infants and that exercise has an important role in bone development during the neonatal period. Despite the favorable effects of exercise on bone mineral density, physical activity was not accompanied by significant changes in turnover markers.