Physeal bar resection by modified arthroscopically assisted surgery in a closed osteocavity

Han Xiao; Miao Li; Qian Tan; Weihua Ye; Jiangyan Wu; Haibo Mei; Guanghui Zhu; An Yan

doi:10.3389/fped.2023.1157192

Physeal bar resection by modified arthroscopically assisted surgery in a closed osteocavity

Front Pediatr. 2023 Oct 17:11:1157192. doi: 10.3389/fped.2023.1157192. eCollection 2023.

Authors

Han Xiao^{1

2

3}, Miao Li^{1

2

3}, Qian Tan^{1

2

3}, Weihua Ye^{1

2

3}, Jiangyan Wu^{1

2

3}, Haibo Mei^{1

2

3}, Guanghui Zhu^{1

2

3}, An Yan^{1

2

3}

Affiliations

¹ Department of Pediatric Orthopedics, Hunan Children's Hospital, Changsha, China.
² The School of Pediatrics, Hengyang Medical School, University of South China, Changsha, China.
³ Hunan Provincial Key Laboratory of Pediatric Orthopedics, Hunan Children's Hospital, Hunan, China.

Abstract

Background: Physeal bar resection has been used for partial growth arrest treatment for a decade while removing the bony bar minimally invasively and accurately is challenging. This research aims to illustrate a modified arthroscopically assisted surgery, by which all the procedure was under all-inside visualization, without the constant exchange between burring under fluoroscopy, followed by irrigation, suction, and arthroscopy of the canal.

Methods: We retrospectively reviewed the patients who sustained physeal bar resection under direct all-inside visualization of the arthroscope during 2016-2021. Patients who underwent physeal bar resection with the aid of an arthroscope for identifying the physeal cartilage but not resecting and visualizing the physeal bar simultaneously were excluded from this study.

Results: In total, nine patients with ten related joints were included in this study. All the patients were followed up for at least two years. The average following time was 28.5 ± 6.7 months. Eight patients with nine related joints had an improvement of angular deformity, averaging 8.3 ± 6.9 degrees, and one had a worsening of the angular deformity. All the patients had a leg length discrepancy improvement, while four patients still had LLD >1 cm. The surgery time was 3.1 ± 0.7 h. There were no postoperative fractures, infections, or intraoperative complications such as neurovascular injury.

Conclusions: Using clamps to form a closed osteocavity could make physeal bar resection under all-inside arthroscopic visualization feasible, which is minimally invasive, accurate, and safe.

Keywords: all-inside; arthroscopy; closed osteocavity; direct visualization; physeal bar.

Grants and funding

This work was supported by the Key Research and Development Program of Hunan Province (2020SK21139), the Clinical Research Center for Limb Deformity of Children in Hunan Province (2019SK4006), Major science and technology projects for collaborative prevention and control of congenital disabilities in Hunan Province (2019SK1010), Clinical medical technology innovation guidance project of Hunan Province (2020SK50518), National Key Clinical Specialty Construction Project—Pediatric Surgery of Hunan Children's Hospital (XWYF [2022] No. 2).