25450 Epiphyseal arrest by epiphysiodesis or stapling; distal radius OR ulna

Name of the Procedure:

Epiphyseal arrest by epiphysiodesis or stapling of the distal radius or ulna.

Summary

Epiphyseal arrest, also referred to as epiphysiodesis, is a surgical procedure aimed at halting the growth of the distal radius or ulna by affecting the growth plate (epiphysis). This can be done using staples or other surgical techniques.

Purpose

This procedure is used to address limb length discrepancies in the forearm, where one bone (radius or ulna) is growing longer or faster than the other. The goal is to equalize the length and prevent further discrepancy, helping to improve limb function and appearance.

Indications

• Marked limb length discrepancy between the radius and ulna
• Conditions such as congenital limb deformities, skeletal dysplasia, or trauma
• Significant growth potential remaining which allows for the correction of discrepancies

Preparation

• The patient is often required to undergo preoperative imaging studies such as X-rays or MRI to assess the growth plates and bone structure.
• Patients may need to fast for a certain period before the procedure.
• Adjustment or cessation of certain medications, as advised by the doctor, to prepare for anesthesia.

Procedure Description

1. The patient is typically administered general anesthesia.
2. A small incision is made at the distal end of the affected bone (radius or ulna).
3. The growth plate (epiphysis) is located with the aid of imaging techniques.
4. Surgical staples or other devices are used to arrest the growth of the epiphysis.
5. The incision is closed with sutures or surgical glue.
6. A cast or splint may be applied to protect the area post-surgery.

Duration

The procedure usually takes between 1 to 2 hours.

Setting

Epiphyseal arrest is typically performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Radiologic technologist (for intraoperative imaging)

Risks and Complications

• Infection at the surgical site
• Damage to surrounding tissues or nerves
• Over or under arrest leading to continued growth discrepancies
• Potential need for further surgeries
• Blood clots or adverse reactions to anesthesia

Benefits

• Correction of limb length discrepancies
• Improved limb function and appearance
• Enhanced quality of life with balanced limb lengths

Recovery

• The patient may be required to stay in the hospital for a short period for observation.
• Pain management may include prescribed pain relievers and anti-inflammatory medications.
• Instructions will be given for keeping the surgical area clean and dry.
• Follow-up appointments to monitor healing and assess limb growth.
• Full recovery can vary but generally spans several weeks to months, with limited physical activities initially.

Alternatives

• Limb lengthening procedures
• Shoe lifts or orthotic devices if the discrepancy is minor
• Non-surgical interventions might include physical therapy

Patient Experience

Patients may experience discomfort or pain post-surgery, which is managed with medications. The sensation of immobilization in a cast or splint can be uncomfortable but is necessary for proper healing. Patients are encouraged to follow their surgeon’s instructions closely to promote the best outcomes.