EPIPHYSIODESIS
Epiphysiodesis is a surgery that the surgeons at the Medical City Children’s Orthopedics and Spine Specialists perform on the physis, or growth plate, of the longer leg. The surgery can involve drilling the growth plate, placing screws across it or tethering it on either side with plates to prevent the bone from growing.
If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.
When to Use the Epiphysiodesis Procedure
Our doctors consider Epiphysiodesis when a child may have a limb length discrepancy between 2 and 6 cm (0.8 to 2.4 inches) at maturity. Our surgeons perform the Epiphysiodesis surgery on the long/healthy leg. Stopping the growth of the longer leg will minimize the amount of lengthening required for the shorter leg. Ultimately, patients may not reach their tallest potential height after undergoing this process. However, their legs will be of equal length. Most bone growth in the legs happens near the knees, so the growth plates that are closest to the knee in the femur (thigh bone) or tibia (shin bone) are the ones that are typically fused. To repeat, this procedure stops/slows the growth of the long, healthy leg. Therefore, the procedure allows the short leg to “catch up” through natural growth. Eventually, the short leg matches the length of the long leg.
Accurate Height Prediction
Timing becomes key for this procedure. A surgeon must accurately predict the full potential height of the child and determine when to start the procedure. The procedure should begin so that limbs are of nearly equal length by the end of the child’s skeletal growth. Despite all of medicine’s technological advances, determining the exact time to perform an epiphysiodesis procedure remains an educated guess. The surgeon needs to evaluate the remaining growth potential and decide when to stop growth to obtain the desired correction. The surgeon also needs to choose which growth center (or centers) need to stop to obtain the correction. This evaluation process remains an inexact science. In most cases, our surgeons will accurately estimate the timing. However, doctors can under-correct or over-correct the leg lengths with epiphysiodesis.
Understanding Guided Growth Surgery
What is Guided Growth Surgery?
Guided growth surgery is a modern medical technique aimed at addressing skeletal deformities in children, such as bowlegs or knock-knees. Traditional surgical methods can be quite invasive, often requiring extensive recovery times. However, guided growth surgery offers a less intrusive alternative that focuses on gradually correcting limb alignment.
How Does It Work?
The procedure involves strategically placing small plates and screws around the affected growth plates in the limbs. These devices serve as a roadmap for the bones’ development, carefully steering them towards proper alignment as the child grows. This method harnesses the natural growth process, allowing changes to occur incrementally, which often results in a more harmonious correction over time.
Benefits of Guided Growth Surgery
- Minimally Invasive: With smaller incisions, there is less tissue damage compared to traditional surgeries.
- Flexibility: The hardware used is designed to accommodate natural movements, offering flexibility as the child’s body evolves.
- Gradual Improvement: By leveraging the child’s natural growth, the procedure supports a steady and balanced correction, minimizing the potential for immediate complications.
Guided growth surgery is a promising approach for children facing certain limb discrepancies, providing a patient-friendly alternative that aligns with the body’s natural processes.
QUESTIONS AND ANSWERS
What is the epiphysiodesis procedure in children, and what benefit does it provide?
Leg length discrepancy (LLD) is a medical condition where there is a significant difference in the lengths of an individual’s legs. While many people experience slight variations in leg length without issue, a substantial discrepancy can lead to challenges in mobility and development. This condition becomes particularly concerning in children and adolescents, where it can affect overall growth and functional alignment.
Epiphysiodesis is a surgical procedure that involves intentionally disrupting the growth plate, typically using screws or other methods, to slow down or halt the growth of a specific bone. Doctors use this procedure to address limb length discrepancies or angular deformities in children and adolescents. By intentionally altering the growth of one limb, surgeons can help equalize limb lengths or correct angular abnormalities, leading to better alignment and function.
By addressing the underlying cause of the discrepancy, epiphysiodesis offers a targeted approach to improving mobility and ensuring balanced development. This procedure can be a crucial intervention for those affected by significant leg length differences, ultimately enhancing their quality of life.
How do surgeons perform Epiphysiodesis, and explain the potential risks and complications?
Surgeons conduct Epiphysiodesis on patients under general anesthesia. During the procedure, the surgeon makes a small incision near the growth plate and either inserts screws or uses another technique to compress or disrupt the growth plate. The disruption of the growth plate slows down bone growth on one side while allowing the unaffected side to continue growing, helping to achieve the desired limb length equality or alignment.
Potential risks and complications of epiphysiodesis may include infection, damage to nearby structures, overcorrection or under-correction of limb length, delayed or early growth plate closure, pain, or the need for additional surgeries if the desired correction fails to meet its goal.
How long does it take to recover and what is the expected outcome after Epiphysiodesis?
The recovery after epiphysiodesis involves a period of reduced activity and careful monitoring. After the surgery, the child may need to use crutches or a walker for a brief period. Doctors may recommend Physical therapy to aid in rehabilitation and regain strength and mobility.
The outcome of epiphysiodesis varies based on the individual case, the specific bone involved, and the surgical technique used. Over time, the affected limb’s growth plate closes, and the limb lengths become more equalized, or angular deformities are corrected, contributing to improved function and alignment. Patients will need Long-term follow-up with orthopedic specialists to monitor the child’s growth and address any potential issues.
There are many different methods to make legs the same length. If your child has a problem with one leg being shorter than the other, call us for a consultation. We are experts in this field.
Understanding Traumatic Growth Arrest
Traumatic growth arrest occurs when a growth plate, in the softer area of bone found at the end of long bones in children and adolescents, is damaged due to an injury. Growth plates are crucial as they determine the future length and shape of the mature bone. If an injury disrupts this area, it can halt normal bone development.
Key Impacts and Consequences:
- Stunted Growth: The affected bone may cease or slow down in its growth, resulting in a shorter bone.
- Potential Deformity: Over time, uneven growth can cause deformities, leading to functional and aesthetic issues.
How Does This Condition Manifest?
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Common Signs: Children experiencing traumatic growth arrest might show uneven limb length, noticeable changes in the bone’s shape, or limited movement over time.
- Injury Sources: It often stems from fractures or severe impacts incurred during activities like sports, falls, or accidents.
Traumatic growth arrest is a condition that underscores the importance of addressing injuries comprehensively in growing children to prevent long-term complications.
Understanding Septic Growth Arrest
Septic growth arrest is a serious medical condition that primarily affects young children. It is a complication that arises when a severe blood infection, known as sepsis, occurs during infancy.
What Happens During Sepsis?
When a child contracts sepsis, it triggers a systemic infection that can spread rapidly throughout the body. This condition poses significant risks to various bodily systems, including the skeletal system.
Impact on Growth Plates
Sepsis can disrupt the normal development of growth plates—areas of growing tissue near the ends of long bones in children. These growth plates are critical for proper bone development. When they are damaged, the bones may cease to grow or develop abnormally, which is what leads to septic growth arrest.
Long-term Consequences
The implications of septic growth arrest are profound. Affected children might experience stunted growth and potential deformities, as their bones fail to develop as they should. Early diagnosis and treatment of sepsis are crucial to prevent these long-term complications.
Understanding septic growth arrest underscores the importance of prompt medical attention when dealing with sepsis in infancy. The condition highlights the interconnectedness of bodily systems and the far-reaching impact of severe infections.
Understanding Skeletal Dysplasia
Skeletal dysplasia is a term used to describe a group of rare genetic conditions that impact the development of bones and cartilage. These disorders can significantly affect the structure and growth of the skeleton, often being evident from early in fetal development.
Key Characteristics
- Genetic Influence: Typically, skeletal dysplasia is the result of genetic mutations that alter the normal growth patterns of bones and cartilage.
- Varied Manifestations: The severity and specific symptoms can vary widely, affecting different parts of the skeleton. Some individuals may experience limb shortening, while others may have more widespread skeletal anomalies.
- Prevalence: This condition is considered rare, occurring in about 1 out of every 4,000 births globally.
Implications and Diagnosis
Parents and healthcare providers can often identify signs of skeletal dysplasia through prenatal imaging techniques like ultrasounds. Early detection is crucial as it allows for appropriate planning and intervention strategies to manage symptoms and improve quality of life.
Treatment for skeletal dysplasia may involve a combination of medical care and surgical interventions, tailored to the individual’s specific needs and challenges. The goal is to support physical development and enhance mobility, ensuring the child can lead as active and healthy a life as possible.
Understanding Traumatic Growth Arrest
Traumatic growth arrest occurs when a growth plate, in the softer area of bone found at the end of long bones in children and adolescents, is damaged due to an injury. Growth plates are crucial as they determine the future length and shape of the mature bone. If an injury disrupts this area, it can halt normal bone development.
Key Impacts and Consequences:
- Stunted Growth: The affected bone may cease or slow down in its growth, resulting in a shorter bone.
- Potential Deformity: Over time, uneven growth can cause deformities, leading to functional and aesthetic issues.
How Does This Condition Manifest?
- Common Signs: Children experiencing traumatic growth arrest might show uneven limb length, noticeable changes in the bone’s shape, or limited movement over time.
- Injury Sources: It often stems from fractures or severe impacts incurred during activities like sports, falls, or accidents.
Traumatic growth arrest is a condition that underscores the importance of addressing injuries comprehensively in growing children to prevent long-term complications.
Performing Epiphysiodesis Surgery
Typically, the child/adolescent will undergo general anesthesia for about an hour for this minimally invasive surgery. The procedure targets the physis, or growth plate, of the longer leg. The surgery can involve drilling the growth plate, placing screws across it, or tethering it on either side with plates to prevent the bone from growing.
When the bone becomes resected or removed, a part of the longer bone gets cut, and the ends are connected and held together by metal screws. During the surgery, the growth plate gets scraped or drilled to prevent it from growing further. In many cases, the surgeon will use staples to control its growth. Your doctor will remove the staples once the other leg matches the corrected leg. A 1-inch (2.5-cm) incision occurs, and the growth plate becomes fused.
In some cases, the leg can be made to stop growing permanently by removing cartilage from the leg using a special drill. Temporary epiphysiodesis occurs with eight-Plates and screws, while permanent epiphysiodesis is more common and involves surgical removal of the growth plate.
During the actual procedure, the surgeon makes a long incision in the skin on top of the targeted bone. The surgeon will perform the necessary steps and then close the incision using sutures. The leg is then cast, remaining in place until the bone completely heals. Doctors expect that the patient will stay in the hospital for a few days for close monitoring.
What Happens After Epiphysiodesis Surgery?
To evaluate the procedure in the knee, the patient must visit the doctor two weeks following the procedure. After surgery, the patient can put weight on the leg and can resume regular activities in two to three weeks. Follow-up appointments are scheduled every 4 months or so. This will allow the doctor to keep track of the development of both the long and short legs. Regular monitoring takes place since epiphysiodesis sporadically results in the leg becoming twisted.
Possible Risks and Complications
While the bone heals, the patient could feel moderate to severe pain or discomfort. Surgeons consider Bone atrophy as a significant concern as well, but with physical therapy and the right activities, problems should not exist. Balance issues, bleeding, and scarring are examples of additional hazards or consequences. Additionally, an infection at the wound site has the potential to impede the patient’s healing. Legs can still develop unevenly if the operation to correct unequal bone length is performed at the wrong time. This could cause the patient to undergo the treatment once again.
Permanent Epiphysiodesis
A bone bridge that anchors the growth plate and stops further development provides the result of permanent epiphysiodesis. A bone bridge between the physis and metaphysis may develop as a result of the ablation of the medial and growth plate’s peripheral edges. Though it is frequently drilled in practice, the middle portion of the physis does not, in principle, need treatment because it will naturally close. Surgeons recommend this technique for projected 2 to 6-cm longer leg length disparities. Surgeons can conduct temporary epiphysiodesis, but permanent epiphysiodesis, which halts development at a specific physis, is more frequently used. The majority of lower extremity development takes place at the growth plate, closest to the knee.
Special Preparations
Epiphysiodesis is a common outpatient procedure with low morbidity. Before the procedure, your kid might need to abstain from food, beverages, or some medications. To confirm that the timing is appropriate and the infant appears as a strong candidate for epiphysiodesis, a variety of tests are necessary for advancement. For around 6 weeks following surgery, your child will be restricted from many activities.
Risk Factors
Epiphysiodesis error and complication rates are unknown because there hasn’t been a significant study of patients who have undergone the procedure. These issues can include infections, damage to the nerves, or an imperfect epiphysiodesis procedure, which frequently results in an angular deformity. A sizable patient group has been studied to obtain information regarding the frequency of complications and characteristics linked to them.
Potential side effects of epiphysiodesis include:
- Infection
- Hemorrhage
- Harm to the healthy limb
- Overcorrection of the disparity
- Undercorrection of the leg length discrepancy
Research also provides information that the temporary epiphysiodesis procedure frequently results in complications. Hemarthrosis, knee effusion, chronic knee discomfort, and wound infection have been reported as side effects of surgery.
Additional complications can arise from technical errors, such as:
- Screw breakage
- Screws not placed in the correct position
- Implant-related problems like screw loosening
Physical consequences include angular deformity and permanent damage. It was shown that 20% of cases using screws and up to 50% of cases using staples experienced an angular deformity. The risk variables for those patients who had problems were younger, congenital rather than acquired abnormalities, and higher leg length disparities at the time of the epiphysiodesis procedure.
Conclusion
However, these tendencies did not reach statistical significance. Other trends toward open curettage, epiphysiodesis involving the femoral growth plate, and male gender as risk factors were also present. To take extra precautions, surgeons need to recognize which patients are more vulnerable to difficulties during this treatment. For parents to make an informed decision, they should read about this treatment. Also, parents should know that there is a 5% chance of surgical complications and that there are other procedures to achieve a more exact and better result.
Why Choose Medical City Children’s Orthopedics and Spine Specialists
There are several reasons why parents should seek Epiphysiodesis treatment from the doctors at Medical City Children’s Orthopedics and Spine Specialists:
- Expertise: The doctors at Medical City Children’s Orthopedics and Spine Specialists are board-certified pediatric orthopedic surgeons with extensive experience in the treatment of Epiphysiodesis. They are highly skilled in performing the surgery and have a proven track record of success.
- Personalized care: The doctors at Medical City Children’s Orthopedics and Spine Specialists take the time to understand each child’s individual needs and develop a treatment plan tailored to the specific case. They work closely with families to ensure that they get the information they need and understand the treatment process.
- State-of-the-art facilities: The Medical Practice has state-of-the-art facilities and equipment, which allows the doctors to provide the best possible care for their patients.
- Comprehensive care: The Medical Practice offers a wide range of services for children with Epiphysiodesis. This includes diagnosis, treatment, and follow-up care. Therefore, it allows families to get everything they need for their child in one place.
In addition, Medical City Children’s Orthopedics and Spine Specialists is also a highly respected Dallas & Fort Worth medical practice. They are known for their commitment to providing excellent care for children with Epiphysiodesis and other orthopedic conditions.
If you are considering Epiphysiodesis treatment or limb lengthening for your child, we encourage you to schedule a consultation with the doctors at Medical City Children’s Orthopedics and Spine Specialists. We have offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX. The doctors will answer your questions and help you determine if choosing the Epiphysiodesis treatment option makes sense.
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Footnote:
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