Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. The successful treatment of genu recurvatum as a complication following eight-Plate epiphysiodesis in a 10-year-old girl: a case report with a 3.5-year follow-up Arthur J. Kievit a , Dennis C. van Duijvenbode b and Michel H.J. Stavenuiter b We report a case of genu recurvatum following eight-Plate epiphysiodesis and the successful treatment of this complication. A 10-year-old patient underwent epiphysiodesis of the knee with eight-Plates. She was followed up and genu recurvatum developed as a complication. At the 12-month follow-up after epiphysiodesis, the treated knee showed a flexion of 1358 and an extension of 358. Lateral radiograph evaluation showed an extension change of the femur. During reoperation, the eight-Plates were repositioned more posterior, which resulted in successful treatment of the hyperextension. Eight-Plates can lead to (treatable) articular surface angle changes in the sagittal plane. J Pediatr Orthop B 00:000–000  c 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Journal of Pediatric Orthopaedics B 2013, 00:000–000 Keywords: complication, eight-Plate, guided growth, leg-length discrepancy, pediatric a Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam (ORCA), Amsterdam Medical Center, University of Amsterdam, Amsterdam and b Department of Orthopaedic Surgery, Center for Orthopaedic Research Alkmaar (CORAL), Medical Center Alkmaar, Alkmaar, The Netherlands Correspondence to Arthur J. Kievit, MD, MSc, Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam (ORCA), Academic Medical Center, University of Amsterdam, Room G4-242, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands Tel: + 31 205 667 736; fax: + 31 205 669 117; e-mail: a.j.kievit@amc.nl Introduction If left untreated, growth disorders of the long bones of the lower limb can affect quality of life, induce gait disturbances, and lead to pain, and in some cases, instability. Furthermore, it can affect joints such as the hip or the ankle and may lead to early osteoarthritis [1,2]. Growth disorders can be treated with epiphysiodesis, for which several techniques have been described [1,3–5]. Epiphysiodesis is a surgical technique in which the growth of specific growth plates is halted by fixation. The use of eight-Plates (Orthofix, McKinney, Texas, USA) as introduced by Stevens is a relatively new method for fixation, where staples and screws have been used for decades [6–12]. The advantages of eight-Plates are fewer hardware failures, except if used in Blount’s disease [13], easy insertion technique with guided growth instead of compressive force, and they leave the epiphysis untouched if performed correctly [1,2]. There are studies comparing eight-Plates with staples that suggest that eight-Plates are a good alternative for staples as they show less hardware failure and guide growth in a more controlled manner [2,14]. Usually, these methods are used for hemiepiphysiodesis. To our knowledge, no report has described total epiphysiodesis using eight-Plates. This report provides an insight into what happens with the femoral condyles with different locations of placing eight-Plates. The goal of this case report is to report our experience with this technique and to warn of the possibility of the following rare complication. It also shows how this complication can be treated if diagnosed early. Case report On 15 August 2008, a 10-year-old Somalian girl, at that time, otherwise healthy, was referred to our department by our pediatric colleagues for examination and treatment of a 30 mm leg-length difference because of hemihyper- trophy of the left lower limb. The cause of the hypertrophy was investigated, but not found. At first, she was referred to an orthopedic shoemaker for adjusted shoe wear. However, the patient was unsatisfied with the cosmetic appearance of the shoe adjustment. It was decided to treat the growth difference by a surgical intervention by performing a temporary epiphysiodesis on 6 August 2009 with bilateral eight-Plates on the distal femur and the proximal tibia, unilateral on the fibula in accordance with the previous literature [15]. The leg- length discrepancy was because of both the femur length and the tibia length; therefore, the choice was made to perform guided growth of both the femur and the tibia. The leg-length difference and the plates on the femur as well as the tibia and fibula are shown in Fig. 1. Before surgery, flexion was 1501 in both knees and there was bilateral hyperextension of about 201. The leg-length difference at the 12-month check-up was 20 mm. Physical examination showed an increase in extension and a decrease in flexion of the left knee. It seemed that the trajectory of movement of the articular surface had changed. Flexion for the left leg was now 1351 and extension was 351; for the right leg, this was 160 and 201, respectively. Two directional radiographs were made. The anterior–posterior (AP) radiograph showed diverting screws in all eight-Plates. This confirmed that all plates Case report 1 1060-152X  c 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/BPB.0b013e3283623b2c