Distal Femoral Physeal Bar Resection Combined With Guided Growth for the Treatment of Angular Limb Deformity Associated With Growth Arrest: A Preliminary Report

Abstract

Purpose: Distal femoral growth arrest can result in progressive deformities and functional disability. The treatment is challenging given the significant growth potential of the distal femoral physis. This study addresses the short-term outcomes after distal femoral physeal bar resection combined with guided growth for the treatment of angular limb deformity. Methods: We conducted a retrospective analysis of patients treated with distal femoral physeal bar resection, fat graft interposition, and growth modulation with a tension-band plate. Data recorded included patient demographics, growth arrest cause, physeal bar size, time-to-surgery, details of the operative procedure, and complications. The mechanical axis zones, tibiofemoral angle, and the anatomic lateral distal femoral angle were assessed on 51-inch anteroposterior standing radiographs. Results: Five patients (3 male individuals) with valgus (n=4) and varus deformities (n=1) due to physeal arrests of the distal femur were analyzed. The cause of the physeal arrest was trauma (n=3) and infection (n=2). The average age at the time of surgery was 6.6 years (range: 2 to 11 y). Average size of the physeal bar was 413.4 mm2, which represented 16.8% of the total distal femoral physis (range: 12% to 26%). Four of the 5 patients had a total correction of the deformity in 14.3 months (range: 9 to 22 mo). One patient required correction by osteotomy and external fixation. Postoperatively, 1 patient presented no improvement, and 4 had restoration of the longitudinal bone growth and alignment. Two patients had rebound valgus: one is being observed and another has undergone a repeat guided growth procedure. Conclusions: Distal femoral physeal bar resection combined with tension-band hemiepiphysiodesis provides a viable option for the correction of angular deformities associated with physeal arrest. Longer follow-up is required to evaluate future growth of the distal femoral physis after this combined procedure. Level of Evidence: Level IV—therapeutic study.

Growth modulation with tension-band plates for the correction of paediatric lower limb angular deformity: current concepts and indications for a rational use

“…Physeal insults such as trauma, infections or tumours, may result in complete or partial growth arrest, generating progressive deformities and functional disability. Recently, Masquijo et al 62 published a small case series with partial distal femoral growth arrest that underwent distal femoral physeal bar resection, fat graft interposition, and growth modulation with tension-band plates. Four of the five patients had complete correction and one patient required corrective osteotomy and external fixation.…”

The Role of 99m Tc-DPD Bone SPECT/CT in the Management of Growth Disturbance of the Long Bones in Pediatric Patients: A Retrospective Observational Study

“…The surgical outcomes based on the bone SPECT/CT ndings were satisfactory in all patients. Several studies have reported satisfactory outcomes following bone bridge resection [20,21], whereas others reported that bone bridge re-resection was required in 13/48 patients [22], and one in ve patients experienced no improvement after bone bridge resection [23]. In the present study, with an average followup time of 1.6 years, no repeated bone bridge resection was needed, possibly due to reduced indication for bone bridge resection following thorough evaluation using bone SPECT/CT.…”

The effectiveness of physeal bar resection with or without Hemi-Epiphysiodesis to treat partial growth arrest

“…Physeal bar resection combined with the growth guide technique has been reported to treat partial growth arrest for a decade, while there are no definite indications established [ 21 ]. Fu et al found that physeal bar resection and Hemi-epiphysiodesis are effective treatments for correcting ankle varus deformity [ 10 ].…”