Surgical Treatment of Partial Closure of Growth Plate - Physeal Bar Resection and Free Fat Graft -

Abstract

Purpose: To evaluate the results of physeal bar resection and free fat graft as a treatment method for partial epiphyseal closure. Materials and Methods: Thirteen cases of partial epiphyseal closure (4 of the distal femur, 8 of the distal tibia and one of the distal radius) were subjected to physeal bar resection. All of the cases were caused by trauma. The physeal bar was central in 3 cases, peripheral in 9, and mixed (central-peripheral) in 1. Mean patient age at surgery was 10.7 years and mean follow-up period was 47 months. Final results were evaluated by a modified Williamson-Staheli classification. Results: Results at final follow-up were as follows: 6 satisfactory (3 excellent and 3 good) and 7 unsatisfactory (5 fair and 2 poor). Satisfactory results according to location and region of the physeal bar were as follows: distal tibia, 5 of 8 cases; distal femur, 1 of 4; central, 1 of 3; peripheral, 4 of 9; and mixed, 1 of 1. When considered by areal extent, physeal bars occupying 30% or less of the bone's cross-sectional area showed satisfactory results in 5 of 7 cases, while in 6 cases with the physeal bar over 30%, 5 were unsatisfactory. Conclusion: Accurate preoperative evaluation of the size and type of the physeal bar, and meticulous surgical technique, are important predictors of satisfactory outcome of physeal bar resection. Cases where the physeal bar extent exceeded 30% had mostly unsatisfactory results.