Post traumatic bar in a 9 ys old boy on distal tibia

[Vincenzo de Rosa]

Hi,

I've a patient, 9ys of age.

in 2007 ankle fracture Mc Farland.

I've seen him for the first time now.

He has distal tibia bar.

Clinically he has not varus deviation of the ankle.

On MRI (I don't have yet images) radiologist told me that the bar is small (<50%).

I would like to go forward on surgery : escision of the physeal bar by Langeskiöld-Peterson technique.

Do you agree?

What do you would put inside (fat, silastic, ciment)?

Thank you for your help.

V. de Rosa

Pediatric orthopedic surgeon

Bellinzona

Switzerland

[Sandeep Vaidya]

Dear Dr de Rosa,

 

Radiologically, the child already has an ankle varus deformity due to the distal tibial physeal bar though it may not be visible clinically. Hence, my choice of surgery would be as physeal bar excision + supramalleolar distal tibial osteotomy. The osteotomy would be necessary as bar excision may prevent progression of the deformity but will not correct the existing deformity. Of course, accurate localisation of the ber by pre-op MRI / CT would be mandatory. You can fill the void with either fat or silastic or cement, all are effecrtive.

 

Do keep us posted on the results.

Thanks.

 

_Sandeep.

 

--
Dr Sandeep V Vaidya
MS, MRCSEd (UK), DNB, D'Ortho.
Fellow ped ortho NUH, Singapore
Fellow ped ortho KUMC, Korea

Consultant Pediatric Orthopaedic Surgeon.
Jupiter Hospital, Thane
SL Raheja Fortis Hospital, Mahim, Mumbai
Mobile:9833285817.
Tel: 21718695.

[Krunoslav Margić]

Dear colleague!

I have a limited experience in the treatment of epiphysiodeses with the central epiphyseal bar. Based on standard x-rays and MRI it's easy to calculate the position of bar, but it can be difficult to precisely locate it during operation. To make my life easier under fluoroscopic control I pin one hypodermic needle through soft tissue at each side of the bar. Then with chisel and between the needles I open vertical tunnel supposing to be at the borders of normal epiphysis. I use operative microscope and fine bur to free surrounding epiphyseal margins and to refresh the bar area. I have tried to interpose local vascularized fat grafts bat at the end they were not more than free fat grafts. The rest of the tunnel is filled with previously removed bone. Corrective or lengthening osteotomy is part of planned operative procedure.

Good luck!

Krunoslav Margic

 

 

Prim.dr. Krunoslav Margic, dr.med

Department of Plastic and Reconstructive Surgery

General Hospital

SI-5290 Sempeter pri Gorici

Slovenia