27479 Arrest, epiphyseal, any method (eg, epiphysiodesis); combined distal femur, proximal tibia and fibula

Name of the Procedure:

Arrest, epiphyseal, any method (e.g., epiphysiodesis); combined distal femur, proximal tibia and fibula. Commonly referred to as Epiphysiodesis for Combined Distal Femur, Proximal Tibia, and Fibula Growth Plate Arrest.

Summary

Epiphysiodesis is a surgical procedure aimed at halting the growth of specific bones by closing the growth plates (epiphyses). This particular type involves the distal femur, proximal tibia, and fibula, typically performed to correct leg length discrepancies or deformities.

Purpose

The procedure addresses:

• Medical Condition or Problem: It treats discrepancies in leg length and angular deformities often resulting from unequal growth rates.
• Goals/Expected Outcomes: Achieving balanced leg lengths or correcting angular deformities to improve gait and reduce discomfort.

Indications

• Symptoms/Conditions: Significant leg length discrepancy, angular deformities in the legs.
• Patient Criteria: Growth remaining in the affected bones, skeletal immaturity, the disparity in leg lengths projected to cause functional issues.

Preparation

• Pre-procedure Instructions: Fasting typically required if under general anesthesia; pausing certain medications like blood thinners.
• Diagnostic Tests/Assessments: X-rays, MRI, or CT scans to assess growth plates, overall health checks, and pre-surgical consultations.

Procedure Description

1. Anesthesia: Administration of general anesthesia.
2. Incision: Small incisions made to access the growth plates.
3. Method: Use of various techniques (e.g., drilling or mechanical devices) to ablate or compress the growth plate, preventing further growth.
4. Closure: Incisions are closed with sutures or staples, and dressings are applied.

• Tools/Equipment: Specialized surgical instruments like drills, ablation tools, imaging gadgets (e.g., intraoperative X-rays).
• Sedation Details: General anesthesia to ensure the patient is asleep and pain-free during the procedure.

Duration

The procedure typically takes about 1-2 hours.

Setting

Performed in a hospital or surgical center.

Personnel

• Healthcare Professionals Involved:
  • Orthopedic Surgeon
  • Anesthesiologist
  • Surgical Nurses
  • Radiologic Technologist (for intraoperative imaging)

Risks and Complications

• Common Risks: Infection, bleeding, pain at the surgical site.
• Rare Risks: Nerve damage, incomplete arrest of the growth plate, under-correction or over-correction requiring further intervention.

Benefits

• Expected Benefits: Corrected leg length discrepancy, improved gait and functionality.
• Realization Time: Benefits typically noticed as the patient grows, with adjustments monitored over months to years.

Recovery

• Post-procedure Care: Wound care, pain management, physical therapy.
• Expected Recovery Time: Initial recovery in 1-2 weeks, with activity restrictions. Full recovery and outcome assessment over several months.
• Restrictions/Follow-ups: Regular follow-ups with X-rays to monitor bone growth and alignment.

Alternatives

• Other Treatment Options: Shoe lifts, physical therapy, other forms of corrective surgery.
• Pros and Cons: Shoe lifts are non-invasive but may not fully correct the issue. Other surgeries might be more comprehensive but come with increased risks.

Patient Experience

• During Procedure: Patient is under general anesthesia, hence unconscious and pain-free.
• After Procedure: Initial soreness and limited mobility, managed with pain medication and physical therapy to aid in recovery.