Name of the Procedure:

Epiphyseal Arrest, Any Method (e.g., Epiphysiodesis); Tibia and Fibula, Proximal

Summary

Epiphyseal arrest, also known as epiphysiodesis, is a surgical procedure aimed at halting the growth of the growth plate in the tibia and fibula bones near the knee. This procedure is used to correct or manage leg length discrepancies in children and adolescents.

Purpose

The primary purpose of this procedure is to adjust or even out limb length discrepancies, where one leg is significantly shorter or longer than the other. The goal is to achieve more symmetrical growth, ensuring proper alignment and function of the legs as the child continues to grow.

Indications

• Significant leg length discrepancy (LLD) typically greater than 2 centimeters.
• Progressive LLD that is expected to worsen.
• Discomfort or functional issues due to leg length difference.
• Suitable bone age and growth plate status, generally in children and adolescents still experiencing growth.

Preparation

• Pre-operative assessment including X-rays and possibly MRI to measure bone growth and evaluate growth plates.
• Fasting for specific hours prior to surgery.
• Adjustment or temporary discontinuation of certain medications (as advised by the doctor).
• General health evaluation and medical history review.

Procedure Description

1. Anesthesia: General anesthesia is administered to the patient.
2. Incision: A small incision is made near the proximal end of the tibia and fibula.
3. Arrest Mechanism: The growth plates (epiphyseal plates) in the tibia and fibula are either drilled, scraped, or treated with screws or implants that stop the growth of these bones.
4. Closure: The incision is closed with sutures or surgical glue.
5. Dressing: Sterile dressing is applied to the site.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Damage to surrounding tissues or nerves
• Overcorrection or undercorrection of the leg length
• Growth plate damage
• Anesthetic risks
• Blood clots

Benefits

• Improved leg length symmetry
• Better alignment and function of the legs
• Prevention of further complications related to leg length discrepancy
• Enhanced mobility and reduced discomfort

Recovery

• Post-operative pain management with medications.
• Instructions on wound care and hygiene.
• Use of crutches or a walker if needed, to avoid putting weight on the leg initially.
• Physical therapy to restore strength and mobility.
• Follow-up appointments for X-rays and to monitor healing.

Alternatives

• Epiphyseodesis on the longer leg to slow its growth.
• Limb lengthening procedures for the shorter leg, which involve a more complex and prolonged treatment course.
• Use of orthotic devices or shoe lifts to manage symptoms without surgery.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel pain or discomfort.
• Post-surgery, some pain, and swelling can be expected, which are managed with medications.
• Gradual improvement in walking and posture as healing progresses.
• Adherence to follow-up care and physical therapy to ensure optimal outcomes.