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 gives the short leg the opportunity 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 near-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 in order 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.
Performing Epiphysiodesis Surgery
Typically, the child/adolescent will undergo general anesthesia for about an hour for this minimally invasive surgery. 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’s length matches the corrected leg. A 1-inch (2.5-cm) incision occurs and the growth plate becomes fused. Temporary epiphysiodesis occurs with eight-Plates and screws.
Permanent epiphysiodesis is more common and is accomplished with surgical removal of the growth plate using a special drill. 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 surgeon will then cast the leg where it will remain in place until the bone completely heals. Doctors expect that the patient will stay in the hospital for a few days for close monitoring.
QUESTIONS AND ANSWERS
What is the epiphysiodesis procedure in children, and what benefit does it provide?
Epiphysiodesis, a surgical procedure that involves intentionally disrupting the growth plate, typically using screws or other methods, will 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.
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.
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 gets 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 end result of permanent epiphysiodesis. A bone bridge between the physis and metaphysis may develop as a result of the ablation to 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 totally 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 in order 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, and 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. There have been reports of screw breakage, screws not placed in the correct position, and implant-related problems such as screw loosening. Angular deformity and permanent damage were physical consequences. 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. In order to take extra precautions, surgeons need to recognize which patients are more vulnerable to difficulties during this treatment. In order 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, allowing 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:
National Institute of Health: Epiphysiodesis
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