Minimally invasive physeal bar resection using 3D image guidance successfully corrects deformity following partial physeal arrest.

Abstract

In pediatric orthopedics, the physis functions as an ally, allowing for remodeling of fractures. However, when physeal bars occur, they can cause leg length discrepancy (LLD) and malalignment. 3D guided techniques can be used to guide the treatment of those physeal bars to achieve a precise resection while protecting the surrounding tissues, allowing growth to resume, and correcting angular deformity. The objective is to describe a 3D imaging-guided technique for excision of partial physeal bars and to report the results of a series of patients who have undergone this procedure. This is a retrospective chart review of five patients treated at a level 1 pediatric tertiary care center by a fellowship-trained pediatric orthopedic surgeon. Inclusion criteria were: (1) Pediatric patients aged 2-18 diagnosed with a partial physeal arrest with resulting deformity, (2) treatment with partial physeal excision using 3D imaging guidance between January 2008 and December 2022, and (3) appropriate radiographic follow-up of at least 6 months. Preoperative 3D imaging demonstrated physeal bar size and location for each patient and was utilized for operative planning. Descriptive statistics were used. The use of 3D imaging guidance for physeal bar excision resulted in improved radiographic angular deformities and LLD. Our cohort had an average physeal bar size of 6.7 ± 3.6% of the physis with no complications reported. A 3D guidance system can help achieve a precise and safe physeal bar resection and is a valuable tool to consider.