Interposition graft, younger age may improve success rate after physeal bar resection surgery

At a single pediatric institution, investigators found younger age and placement of an interposition material graft improved the rate of success for patients who underwent physeal bar resection surgery. Researchers presented their results at the Limb Lengthening and Reconstruction Society Annual Scientific Meeting.

“In this heterogeneous cohort, about half (55%) of patients undergoing a bar resection demonstrated growth for at least 6 months postoperatively, with 41% having more than 2 years of growth,” study co-author David Podeszwa, MD, told Healio.com/Orthopedics. “Neither gender, etiology, location nor bar size influenced the success of the resection. It is important to note that almost all who continued to grow for more than 2 years had premature slowing of growth prior to skeletal maturity. Therefore, continued growth is not normal growth. Half of all ‘successful’ resections still required a subsequent procedure.”

Podeszwa and colleagues identified 83 patients who underwent physeal bar resection for the lower extremities between 1981 and 2017. Investigators recorded patient demographics, physeal bar etiology, surgical details, operative complications and subsequent surgery. Imaging was evaluated preoperatively, intraoperatively and postoperatively until patients reached skeletal maturity, cessation of growth of affected physis or reconstructive surgery. At each visit, investigators recorded anatomic angles and growth.

Overall, 34 patients successfully resumed growth for at least 1 year and 12 patients demonstrated modest growth and then prematurely ceased growth. There were 37 patients who failed to show any growth.

Interposition material and bar type were significantly different among the success and failure groups. Patients who had successful growth, had modest growth or had no growth used interposition material 97.1%, 83.3% and 86.5% of the time, respectively. Patients who failed vs. those who succeeded had a significantly higher incidence of peripheral bars. Researchers noted age at time of surgery was significant. Patients who had successful growth were younger than those who did not. No significant difference was seen between the groups with regard to the location of the bar and etiology of the bar. Due to Blount’s disease, 43 proximal tibia patients of 50 patients had physeal bars; 22 patients failed to demonstrate growth and 16 patients had successful growth. – by Monica Jaramillo

Reference:

Podeszwa D, et al. Results of physeal bar resection at a single pediatric institution. Presented at: Limb Lengthening and Reconstruction Society Annual Scientific Meeting; July 13-14, 2018; San Francisco.

Disclosure: Podeszwa reports no relevant financial disclosures.