The efficacy of physeal bar resection with guided growth in the treatment of physeal arrest with angular limb deformity

Abstract

Premature physeal arrest can cause progressive deformities and functional disabilities of the lower limbs. This study addressed the outcomes after physeal bar resection with or without guided growth (temporary hemiepiphysiodesis) for the treatment of angular limb deformities. We retrospectively analyzed 27 patients (mean 9 years; range, 3-12 years) who underwent physeal bar resection of the distal femur (15 patients), proximal tibia (3 patients), and distal tibia (9 patients) between 2002 and 2020. Fifteen patients underwent physeal bar resection only (Group A), and the other twelve underwent simultaneous guided growth (Group B). The correction angle (angle change between the preoperative and last follow-up values) was compared and analyzed. The overall mean correction angle was 2.9 degrees (range, - 9 to 18.3 degrees). A total of 12 (45%) patients had a>5 degrees angular deformity improvement (mean, 9.6 degrees; range, 5-18.3 degrees), 9 (33%) had a<5 degrees angular change; and 6 (22%) had a>5 degrees worsening of the angular deformity (mean, 6.7 degrees; range, 5.2-9 degrees). The correction angle in Group B (mean 7.6 degrees +/- 6.2) was significantly higher than that in Group A (mean - 0.77 degrees +/- 6.3) (P=0.01). We found six (40%) and zero patients with a>5 degrees angular deformity increase in Groups A and B, respectively (P<0.047). The group that underwent physeal bar resection with guided growth showed significantly higher correction angles than the group that underwent physeal bar resection alone. Additionally, none of the patients in the guided growth group experienced an increased angular deformity. Therefore, combining guided growth with physeal bar resection may lead to better outcomes in the treatment of growth arrest with angular deformities.