27732 Arrest, epiphyseal (epiphysiodesis), open; distal fibula

Name of the Procedure:

Arrest, epiphyseal (epiphysiodesis), open; distal fibula

Summary

Epiphysiodesis of the distal fibula is a surgical procedure aimed at halting the growth of the growth plate in the lower leg bone (fibula) near the ankle. This is done to ensure even growth of the leg bones when one leg is longer or growing faster than the other.

Purpose

The primary goal of this procedure is to correct or prevent limb length discrepancies in growing children. By stopping the growth in the distal fibula, the procedure aims to harmonize the growth rate with the tibia and the unaffected leg.

Indications

• Significant limb length discrepancy due to unequal growth rates.
• Conditions such as growth plate injuries, congenital limb length discrepancies, or certain neurological or muscular conditions.
• Patients typically are growing children or adolescents nearing skeletal maturity who are expected to benefit from growth modulation.

Preparation

• Patients may need to fast for several hours prior to the procedure.
• Adjustments to current medications (e.g., blood thinners) might be required.
• Preoperative imaging studies, such as X-rays or MRI, to assess growth plates and overall leg length.

Procedure Description

1. The patient is brought into the operating room and administered general anesthesia to ensure they are asleep and pain-free.
2. An incision is made over the distal end of the fibula near the ankle.
3. The growth plate (epiphysis) is identified.
4. Surgical tools are used to remove or damage the growth plate to cease its activity.
5. The incision is closed with sutures or staples, and a sterile dressing is applied.
6. The procedure is carefully monitored using imaging techniques to confirm correct placement and effectiveness.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Possibly radiologic technicians for intraoperative imaging

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Damage to surrounding tissues or nerves
• Incomplete fusion of the growth plate leading to residual growth
• Potential for over or under correction of limb length discrepancy

Benefits

• Correction of limb length discrepancies, leading to improved function and gait.
• Reduction in the potential for long-term joint problems or uneven wear on joints.

Recovery

• After the procedure, patients may need to wear a cast or brace.
• Pain management will include medications for pain relief.
• Avoidance of weight-bearing on the affected leg for a specified period.
• Follow-up appointments for removal of sutures and monitoring of healing.
• Physical therapy may be recommended to regain strength and mobility.
• Full recovery can take several weeks to months.

Alternatives

• Limb lengthening procedures, which involve gradual stretching of the bone.
• Shoe lifts or orthotic devices to compensate for length discrepancies.
• The pros of epiphysiodesis include a relatively simple and quick procedure with shorter recovery times compared to limb lengthening. Cons may include the need for precise timing to match the patient’s growth phases.

Patient Experience

Patients will not feel pain during the procedure due to general anesthesia. Post-surgery, the affected leg may be sore and swollen. Pain management and rest will be crucial during the recovery period. Physical therapy and follow-up care are essential components of the healing process.