Timeline to Complete Healing After Epiphysiodesis Surgery
Danielle A Hogarth, BS, Masahiro Iwamoto, DDS, PhD, Motomi Enomoto-Iwamoto, DDS, PhD, Casey M Codd, BA and Joshua M Abzug, MD, University of Maryland School of Medicine, Baltimore, MD
Growth plate injuries are common in pediatric patients and can result in premature physeal arrest. When needed, epiphysiodesis has demonstrated successful rates of uniform, complete physeal closure. Postoperatively, the recommended length of immobilization and frequency of post-operative radiographs are dictated by a surgeon's experience, however, to our knowledge there is no known study that has quantified the time to physeal closure following an epiphyseiodesis. The purpose of this study was to establish a postoperative healing timeline to quantifiably determine time to complete physeal closure following an epiphysiodesis procedure which may aid in determining when radiographs should be obtained to confirm physeal closure has occurred.
Materials & Methods
A retrospective review was performed to assess time to complete physeal closure following an epiphysiodesis procedure. Patients were excluded if they did not return for follow-up radiographs within 1 year. Complete physeal closure was defined by a pediatric orthopaedic surgeon after blindly reviewing plain radiographs. Partial closing on radiographs was not considered as complete closure. For bilateral procedures, complete closure was defined as the timepoint when all treated physes were closed.
Fourteen patients (8 male, 6 female) were included in the analysis. The average age at the time of surgery was 13.4 years (SD=1.7, range: 10.7- 15.7 years). An epiphyseiodesis of the distal radius and distal ulna (64.3%, 9/14) occurred most often followed by an isolated distal ulna epiphyseiodesis (28.6%, 4/14), and an isolated distal radius epiphyseiodesis (7.1%, 1/14). Patients underwent bilateral procedures 28.6% of the time (4/14). The average time to complete physeal closure was 3.49 months (SD=1.66 months, range: 1.6-7.16), with the majority of patients only immobilized for 2-3 weeks.
Epiphysiodesis is sometimes needed for patients with premature physeal arrest. The approximate time to complete physeal closure was found to be 3-4 months post-operatively. These quantifiable data can be used to reduce exposure to radiation by avoiding radiographs prior to this time.
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