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Physeal Bar Excision

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Book cover Pediatric Lower Limb Deformities

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Abstract

While several surgical options are available for management of a physeal arrest, the treatment choice must be tailored to the individual patient to ensure the most optimal outcome. A complete understanding of location, extent, and etiology of a physeal bar are paramount and used in conjunction with predicted remaining physeal growth and the presence of acquired angular deformity to determine the viability of bar resection. Both the technical intricacies of physeal bar excision and the timing of the procedure are essential to success.

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References

  1. Birch JG. Surgical technique of physeal bar resection. Instr Course Lect. 1992;41:445–50.

    CAS  PubMed  Google Scholar 

  2. Bright RW. Operative correction of partial epiphyseal plate closure by osseous-bridge resection and silicone-rubber implant. An experimental study in dogs. J Bone Joint Surg. 1974;56-A(4):655–64.

    Google Scholar 

  3. Craig JG, Cramer KE, Cody DD, Hearshen DO, Ceulemans RY, van Holsbeeck MT, et al. Premature partial closure and other deformities of the growth plate: MR imaging and three-dimensional modeling. Radiology. 1999;210(3):835–43. PubMed PMID: 10207489.

    Article  CAS  PubMed  Google Scholar 

  4. Kasser JR. Physeal bar resections after growth arrest about the knee. Clin Orthop Relat Res. 1990;255:68–74.

    PubMed  Google Scholar 

  5. Langenskiöld A. An operation for partial closure of an epiphysial plate in children, and its experimental basis. J Bone Joint Surg. 1975;57-B(3):325–30.

    Google Scholar 

  6. Langenskiöld A. Surgical treatment of partial closure of the growth plate. J Pediatr Orthop. 1981;1(1):3–11.

    Article  PubMed  Google Scholar 

  7. Langenskiöld A. Growth disturbance after osteomyelitis of femoral condyles in infants. Acta Orthop Scand. 1984;55(1):1–13.

    Article  PubMed  Google Scholar 

  8. Langenskiöld A. Partial closure of the epiphyseal plate. Principles of treatment. 1978. Clin Orthop Relat Res. 1993;297:4–6.

    PubMed  Google Scholar 

  9. Langenskiöld A, Osterman K. Surgical treatment of partial closure of the epiphysial plate. Reconstr Surg Traumatol. 1979;17:48–64.

    PubMed  Google Scholar 

  10. Peterson HA. Partial growth plate arrest and its treatment. J Pediatr Orthop. 1984;4(2):246–58.

    Article  CAS  PubMed  Google Scholar 

  11. Rathjen KE, Hurt JH, Birch JG, Wilkes D, Bruce R, Mason R, editors. Epiphysiolysis for the treatment of partial physeal arrest. POSNA Annual Meeting, 2003, Amelia Island, FL.

    Google Scholar 

  12. Rathjen KE, Hurt JH, Birch JG, Wilkes D, Bruce R, Mason R. Epiphysiolysis for the treatment of partial physeal arrest. Pediatric Orthopaedic Society of North America Annual Meeting, May 2–4, 2003, Amelia Island, FL.

    Google Scholar 

  13. Langenskiold A. Tibia vara: osteochondrosis deformans tibiae. Blount’s disease. Clin Orthop Relat Res. 1981;(158):77–82. PubMed PMID: 7273529

    Google Scholar 

  14. Beck CL, Burke SW, Roberts JM, Johnston 2nd CE. Physeal bridge resection in infantile Blount disease. J Pediatr Orthop. 1987;7(2):161–3. PubMed PMID: 3558798.

    Article  CAS  PubMed  Google Scholar 

  15. Salter R, Harris W. Injuries involving the epiphyseal plate. J Bone Joint Surg. 1963;45-A:587.

    Google Scholar 

  16. Peterson HA. Physeal fractures: Part 3. Classification. J Pediatr Orthop. 1994;14(4):439–48.

    Article  CAS  PubMed  Google Scholar 

  17. Salter R. Epiphyseal plate injuries. In: Letts R, editor. Management of pediatric fractures. New York, NY: Churchill Livingston; 1994. p. 11.

    Google Scholar 

  18. Lampasi M, Magnani M, Donzelli O. Aneurysmal bone cysts of the distal fibula in children: long-term results of curettage and resection in nine patients. J Bone Joint Surg Br. 2007;89(10):1356–62. PubMed PMID: 17957078.

    Article  CAS  PubMed  Google Scholar 

  19. Clayer M, Boatright C, Conrad E. Growth disturbances associated with untreated benign bone cysts. Aust N Z J Surg. 1997;67(12):872–3. PubMed PMID: 9451345.

    Article  CAS  PubMed  Google Scholar 

  20. Sanpera Jr I, Fixsen JA, Hill RA. Injuries to the physis by extravasation. A rare cause of growth plate arrest. J Bone Joint Surg Br. 1994;76(6):278–80. PubMed PMID: 8113292.

    PubMed  Google Scholar 

  21. Bloom JD, Mozersky DJ, Buckley CJ, Hagood Jr CO. Defective limb growth as a complication of catheterization of the femoral artery. Surg Gynecol Obstet. 1974;138(4):524–6. PubMed PMID: 4816140.

    CAS  PubMed  Google Scholar 

  22. Macnicol MF, Anagnostopoulos J. Arrest of the growth plate after arterial cannulation in infancy. J Bone Joint Surg Br. 2000;82(2):172–5. PubMed PMID: 10755421.

    Article  CAS  PubMed  Google Scholar 

  23. Barnett LS. Little League shoulder syndrome: proximal humeral epiphysiolysis in adolescent baseball pitchers. A case report. J Bone Joint Surg Am. 1985;67(3):495–6. PubMed PMID: 3972875.

    CAS  PubMed  Google Scholar 

  24. Sabick MB, Kim YK, Torry MR, Keirns MA, Hawkins RJ. Biomechanics of the shoulder in youth baseball pitchers: implications for the development of proximal humeral epiphysiolysis and humeral retrotorsion. Am J Sports Med. 2005;33(11):1716–22. PubMed PMID: 16093541.

    Article  PubMed  Google Scholar 

  25. Birch JG, Herring JA, Wenger DR. Surgical anatomy of selected physes. J Pediatr Orthop. 1984;4(2):224–31.

    Article  CAS  PubMed  Google Scholar 

  26. Broughton NS, Dickens DR, Cole WG, Menelaus MB. Epiphysiolysis for partial growth plate arrest. Results after four years or at maturity. J Bone Joint Surg Br. 1989;71(1):13–6. PubMed PMID: 2914983.

    CAS  PubMed  Google Scholar 

  27. Williamson RV, Staheli LT. Partial physeal growth arrest: treatment by bridge resection and fat interposition. J Pediatr Orthop. 1990;10(6):769–76. PubMed PMID: 2250063.

    Article  CAS  PubMed  Google Scholar 

  28. Carlson WO, Wenger DR. A mapping method to prepare for surgical excision of a partial physeal arrest. J Pediatr Orthop. 1984;4(2):232–8.

    Article  CAS  PubMed  Google Scholar 

  29. Ecklund K, Jaramillo D. Patterns of premature physeal arrest: MR imaging of 111 children. AJR Am J Roentgenol. 2002;178(4):967–72. PubMed PMID: 11906884.

    Article  PubMed  Google Scholar 

  30. Loder RT, Swinford AE, Kuhns LR. The use of helical computed tomographic scan to assess bony physeal bridges. J Pediatr Orthop. 1997;17(3):356–9.

    CAS  PubMed  Google Scholar 

  31. Sailhan F, Chotel F, Guibal AL, Gollogly S, Adam P, Berard J, et al. Three-dimensional MR imaging in the assessment of physeal growth arrest. Eur Radiol. 2004;14(9):1600–8. PubMed PMID: 15064854.

    Article  PubMed  Google Scholar 

  32. Cheon JE, Kim IO, Choi IH, Kim CJ, Cho TJ, Kim WS, et al. Magnetic resonance imaging of remaining physis in partial physeal resection with graft interposition in a rabbit model: a comparison with physeal resection alone. Invest Radiol. 2005;40(4):235–42. PubMed PMID: 15770142.

    Article  PubMed  Google Scholar 

  33. Hasler CC, Foster BK. Secondary tethers after physeal bar resection: a common source of failure? Clin Orthop Relat Res. 2002;(405):242–9. PubMed PMID: 12461380

    Google Scholar 

  34. Lurie B, Koff MF, Shah P, Feldmann EJ, Amacker N, Downey-Zayas T, et al. Three-dimensional magnetic resonance imaging of physeal injury: reliability and clinical utility. J Pediatr Orthop. 2014;34(3):239–45. PubMed PMID: 24096448.

    Article  PubMed  Google Scholar 

  35. Anderson M, Green W. Lengths of the femur and tibia: norms derived from orthoroentgenograms of children from five years of age until epiphyseal closure. Am J Dis Child. 1948;75:279.

    Article  CAS  PubMed  Google Scholar 

  36. Anderson M, Green WT, Messner MB. Growth and predictions of growth in the lower extremities. J Bone Joint Surg. 1963;45-A:1–14.

    CAS  PubMed  Google Scholar 

  37. Anderson M, Messner MB, Green WT. Distribution of lengths of the normal femur and tibia in children from one to eighteen years of age. J Bone Joint Surg. 1964;46-A:1197–202.

    Google Scholar 

  38. Greulich W, Pyle S. Radiographic atlas of the skeletal development of the hand and wrist. Stanford, CA: Stanford University Press; 1959.

    Google Scholar 

  39. Charles YP, Dimeglio A, Canavese F, Daures JP. Skeletal age assessment from the olecranon for idiopathic scoliosis at Risser grade 0. J Bone Joint Surg Am. 2007;89(12):2737–44. PubMed PMID: 18056507.

    Article  PubMed  Google Scholar 

  40. Dimeglio A, Charles YP, Daures JP, de Rosa V, Kabore B. Accuracy of the Sauvegrain method in determining skeletal age during puberty. J Bone Joint Surg Am. 2005;87(8):1689–96. PubMed PMID: 16085606.

    Article  PubMed  Google Scholar 

  41. Bollini G, Tallet JM, Jacquemier M, Bouyala JM. New procedure to remove a centrally located bone bar. J Pediatr Orthop. 1990;10(5):662–6. PubMed PMID: 2394821.

    Article  CAS  PubMed  Google Scholar 

  42. Lee KM, Cheng AS, Cheung WH, Lui PP, Ooi V, Fung KP, et al. Bioengineering and characterization of physeal transplant with physeal reconstruction potential. Tissue Eng. 2003;9(4):703–11. PubMed PMID: 13678448.

    Article  CAS  PubMed  Google Scholar 

  43. Li L, Hui JH, Goh JC, Chen F, Lee EH. Chitin as a scaffold for mesenchymal stem cells transfers in the treatment of partial growth arrest. J Pediatr Orthop. 2004;24(2):205–10. PubMed PMID: 15076609.

    Article  CAS  PubMed  Google Scholar 

  44. Tobita M, Ochi M, Uchio Y, Mori R, Iwasa J, Katsube K, et al. Treatment of growth plate injury with autogenous chondrocytes: a study in rabbits. Acta Orthop Scand. 2002;73(3):352–8. PubMed PMID: 12143986.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of orthopedic Surgery, Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn Street, Dallas, TX, 75219, USA

    Karl E. Rathjen MD & Anthony I. Riccio MD

Authors
  1. Karl E. Rathjen MD
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  2. Anthony I. Riccio MD
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Corresponding author

Correspondence to Karl E. Rathjen MD .

Editor information

Editors and Affiliations

  1. Professor, Department of Orthopedics; Chief, Division of Pediatric Orthopedics, Rutgers-New Jersey Medical School, Newark, New Jersey, USA

    Sanjeev Sabharwal

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Rathjen, K.E., Riccio, A.I. (2016). Physeal Bar Excision. In: Sabharwal, S. (eds) Pediatric Lower Limb Deformities. Springer, Cham. https://doi.org/10.1007/978-3-319-17097-8_5

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  • DOI: https://doi.org/10.1007/978-3-319-17097-8_5

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17096-1

  • Online ISBN: 978-3-319-17097-8

  • eBook Packages: MedicineMedicine (R0)

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