Name of the Procedure:

Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula; and distal femur

Summary

Epiphysiodesis is a surgical procedure to arrest or stop the growth of specific bone growth plates. This procedure is performed on the proximal and distal regions of the tibia and fibula, as well as the distal femur, typically to treat leg length discrepancies in growing children.

Purpose

The primary purpose of epiphysiodesis is to address significant differences in leg length, which can cause pain, difficulty walking, and other orthopedic issues. The goal is to equalize leg lengths by halting growth in the longer limb.

Indications

• Significant leg length discrepancy
• Functional impairment due to unequal leg lengths
• Progressive worsening of leg length difference not responsive to conservative treatments

Preparation

• Patients may need to fast for a certain period before surgery.
• Adjustments to medications may be required.
• Pre-operative diagnostic tests may include X-rays, MRI, or CT scans to determine the exact growth plate locations.

Procedure Description

1. Anesthesia is administered, typically general anesthesia to ensure the patient is asleep and pain-free.
2. Small incisions are made near the targeted growth plates in the proximal tibia and fibula, distal tibia and fibula, and distal femur.
3. The surgeon uses specialized tools to either drill, scrape, or apply other methods to damage the growth plates and arrest their function.
4. The incisions are closed with sutures or surgical staples.
5. A dressing is applied to the incision sites.

Duration

The procedure typically takes 1 to 2 hours, depending on the number of growth plates being treated.

Setting

Epiphysiodesis is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses and assistants

Risks and Complications

• Infection at the surgical site
• Damage to surrounding tissues or bones
• Blood clots
• Adverse reactions to anesthesia
• Incomplete arrest of growth leading to continued discrepancies

Benefits

• Corrects leg length discrepancy, improving overall function and mobility
• Reduces pain and discomfort associated with unequal leg lengths
• Long-term benefits include improved gait and reduced risk of further orthopedic problems

Recovery

• Pain management with prescribed medications
• Limited weight-bearing on the operated leg(s) for a specified period
• Follow-up appointments to monitor healing and the effectiveness of the procedure
• Physical therapy may be recommended to regain strength and mobility
• Full recovery can take several weeks to a few months depending on the extent of the surgery and patient adherence to post-operative instructions

Alternatives

• Non-surgical options like shoe lifts or orthotic devices
• Limb lengthening procedures
• Pros of epiphysiodesis: shorter recovery time and less invasive than limb lengthening
• Cons of epiphysiodesis: timing is critical, as the procedure depends on the patient's growth potential

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-operatively, patients may experience moderate pain, managed with medications. They should expect a recovery period with limited activity, as per surgeon's instructions, and gradual return to normal activities with potential follow-up therapies for optimal results.