Post infective physeal bar sequelae around knee: Natural history and coronal plane deformities

Abstract

Backgroundand methodology: The presented retrospective study is a report of 17 children (18 limbs) with post infective physeal bars around the knee. Minimum 2 years follow up post sepsis follow up was available. ObservationsThe mean follow up post infection was 6.9 years. The bar formation manifested mean 22.6 months post sepsis. The angular deformity progressed at the mean monthly rate of 0.84, 0.1, 0.26° for peripheral, central and extensive bars respectively. Peripheral bars underwent early intervention. Balancing of physeal growth using contralateral ‘8’ plate was useful for partial bars. For extensive bars and older patients, complete epiphyseodesis and limb length equalization was used. Articular abnormalities (cupping, flattening, small epiphysis) were associated in 80% bars. Neonatal infections were often multifocal and had articular abnormalities. ConclusionsThe 3 bar types presented with different characteristics. Peripheral bars produced most angular deformities and required early intervention. Articular abnormalities were associated with physeal bars in large number of patients especially those with neonatal infections. Overall unhealthy physis beside bar, delayed manifestations, and limb length discrepancy should be accounted for while planning treatment.