Management of LLD Physeal bar with no angulation (This means complete or central)?
CT scan to evaluate size
< 40% central Bar ➔ Consider resection
> 40% ➔ No point resecting. Manage as per LLD
‣
Management of Angular Physeal Bar?
Need to address both angulation and LLD
Dependant on skeletal age andsize of bar
CT scan to evaluate extent of bar
If mature, regardless of size of bar
no more opportunity for remodelling ➔ Plan for definitive osteotomy to correct angulation
If immature, we look at size of bar:
If < 40% and immature = consider resection with interposition with concomittant hemiepiphsiodesis
Langenskoild technique with metaphyseal cortical window with interpositional graft (fat/ bone wax/ PMMA)
If > 40% = Hemiepiphysiodesis; no need to excise the bar
May need subsequent lengthening.
‣
Epiphysis vs Apophysis?
Epiphysis contributes to longitudinal growth
Apophysis are growth plates that does not contribute to longitudinal growth. Stes of tendon or ligament attachments e.g. tibial tubercle, medial epicondyle