Name of the Procedure:

Arrest, epiphyseal (epiphysiodesis), open; distal tibia

Summary

An epiphysiodesis is a surgical procedure to halt growth in one of the long bones. The specific procedure on the distal tibia aims to stop or slow down growth at the end of the tibia to help manage leg length discrepancies.

Purpose

The procedure is designed to correct or manage leg length discrepancies. By arresting growth in the longer leg, it allows the shorter leg to "catch up" and thus equalize the length of both legs. This can improve balance, gait, and overall mobility.

Indications

• Significant leg length discrepancy expected to cause functional problems or discomfort
• Conditions such as congenital limb disorders, trauma, or diseases affecting bone growth like epiphyseal dysplasia
• Patient generally nearing end of growth but with some growth remaining

Preparation

• Patients usually need to fast for several hours before surgery.
• A pre-operative assessment, including blood tests and imaging studies (X-rays or MRI), is often required.
• Medication adjustments may be necessary, especially if the patient is on blood thinners or has other chronic conditions.

Procedure Description

1. The patient is administered anesthesia, typically general anesthesia.
2. An incision is made over the distal tibia.
3. Surgical instruments are used to reach the growth plate (epiphysis) at the end of the tibia.
4. The growth plate is damaged or removed to stop bone growth.
5. The incision is closed with sutures or staples.
6. Sterile dressings are applied.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and the patient's specific condition.

Setting

The procedure is usually performed in a hospital or a specialized surgical center, often on an inpatient basis.

Personnel

The team generally includes:

• An orthopedic surgeon
• An anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Blood clots
• Damage to surrounding tissues or nerves
• Uneven limb growth if procedure timing is not accurate
• Pain or discomfort post-surgery

Benefits

• Correction of leg length discrepancies
• Improved gait and balance
• Alleviation of discomfort due to uneven leg length
• Enhanced overall mobility

Improvements are usually noticeable within a few months as the shorter leg catches up.

Recovery

• Initial recovery typically involves a hospital stay of 1-2 days.
• Pain management with medications as prescribed.
• Avoiding weight-bearing activities on the operated leg for several weeks.
• Physical therapy may be needed to regain strength and mobility.
• Full recovery and return to normal activities may take several months.
• Follow-up appointments are necessary to monitor progress and assess leg growth.

Alternatives

• Non-surgical options like shoe lifts or orthotic devices, though these don't fix the underlying issue
• Other surgical procedures such as limb lengthening, which involves gradually lengthening the shorter bone
• Each alternative has its own advantages, disadvantages, and suitability depending on the specific case.

Patient Experience

During the procedure, the patient will be under general anesthesia and won’t feel anything. Post-procedure, some pain or discomfort is expected, which will be managed with medications. Swelling and bruising around the surgical area are common. Gradual improvement in leg length discrepancy will be observed over time with proper follow-up and care.