Intraoperative O-arm Use for Physeal Bar Excision

Abstract

Growth arrest caused by physeal bar formation in pediatric patients has posed a longstanding challenge in orthopedics. While growth arrest in pediatric distal radius fractures is relatively uncommon, its downstream consequences impact function, pain, and cosmesis. Physeal bar excision can be used to correct and prevent further growth arrest. The results of bar excision have been unreliable due to the difficulty of balancing complete bar resection while minimizing iatrogenic insult to the physis. In this article, we present a method utilizing intraoperative computed tomography O-arm for physeal bar excision. A 10-year-old boy sustained an open distal radius fracture that was initially stabilized with plates and screws. Two of these screws were transphyseal and resulted in physeal bars and growth arrest. Due to age and the central location of his bars, bar excision was performed with the addition of intraoperative computed tomography. This resulted in a successful outcome with restoration of longitudinal growth of his distal radius. This method offers improved localization of physeal bars intraoperatively and, subsequently, more precise bar excision while minimizing the risk of complications.