Table 2.

Prevention and treatment of complications related to growth modulation

Complication	Predisposing factor	Prevention	Treatment
Postoperative pain	> 11 years old, four or more plates, femoral plates, bilateral operations83	Physical therapy84	NSAIDs, physical therapy
Screw migration	< 10 years old, rickets, neurofibromatosis, or other conditions that produce osteopenia85	Accurate epiphyseal screw placement Sufficient screw length Close monitoring85	Hardware exchange
Superficial surgical site infection	Obesity, diabetes mellitus	Optimization of patient status, proper asepsis, and surgical site preparation	Antibiotics ± debridement
Overcorrection	Poor follow-up86	Regular follow-up appointments (every 3 months)	Mild: Observation Moderate/severe: Growth modulation vs. osteotomy
Undercorrection	Blount’s disease, obesity, advanced skeletal age, pseudoachondroplasia, or severe deformities21	Proper patient selection	Osteotomy
Broken screws	Poor surgical technique Blount’s disease, obesity87,88	Metaphyseal end of the plate coapted to bone89 Solid screws/Double plate or quad plates21	Hardware exchange
Physeal arrest	Poor surgical technique	Avoid iatrogenic injury of the perichondral ring	Physeal bar resection ± deformity correction

Notes. NSAIDs, non-steroidal anti-inflammatory drugs.