Name of the Procedure:

Arrest, Hemiepiphyseal, Distal Femur or Proximal Tibia or Fibula (e.g., Genu Varus or Valgus)

Summary

Arrest, hemiepiphyseal, is a surgical procedure aimed at correcting bone growth abnormalities in children, specifically in the distal femur or proximal tibia or fibula. This procedure is often performed to address conditions like genu varus (bow-leggedness) or genu valgus (knock-knees).

Purpose

This procedure is conducted to correct abnormal angulation or growth of the lower extremities. The goals are to guide proper bone growth, improve alignment, and prevent future joint problems and pain.

Indications

• Significant genu varus (bow-leggedness) or genu valgus (knock-knees)
• Discrepancy in leg length due to abnormal bone growth
• Progressive deformity with adverse effect on mobility or function
• Non-responsive to conservative treatments such as bracing or physiotherapy

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to current medications may be necessary.
• Pre-procedure imaging tests, like X-rays or MRI scans, will be performed to plan the surgery.
• Blood tests and a general health check may also be required.

Procedure Description

1. The patient is administered general anesthesia.
2. A small incision is made near the affected bone.
3. The surgeon places a small device (e.g., staples, screws, plates) across the growth plate (physis) to partially stop growth on one side of the bone.
4. This causes the opposite side to grow normally, thereby correcting the angulation over time.
5. The incision is then closed with sutures.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is performed in a hospital operating room or surgical center.

Personnel

• Orthopedic surgeons specialized in pediatric surgery
• Anesthesiologists to manage anesthesia
• Surgical nurses and assistants

Risks and Complications

• Infection at the surgical site
• Damage to growth plate or surrounding structures
• Incomplete correction or overcorrection of the deformity
• Blood clots or bleeding
• Anesthetic risks

Benefits

• Improved alignment of the legs
• Enhanced mobility and function
• Prevention of future joint and bone problems
• Benefits can be seen progressively as the child grows

Recovery

• Post-procedure care might include pain management and wound care.
• The child may need to use crutches temporarily.
• Physical activity might be limited for a few weeks.
• Follow-up appointments will be necessary to monitor bone growth and healing.

Alternatives

• Physical therapy and bracing, which may be less effective for severe deformities
• Osteotomy, a more invasive surgical procedure involving cutting and realigning the bone
• Observation, especially if the deformity is mild and expected to correct itself over time

Patient Experience

The patient may experience discomfort and swelling at the incision site. Pain is usually managed with medications. There will be some restrictions on physical activities, but most children resume normal activities within a few weeks. Follow-up care is critical to ensure successful outcomes.