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PhysealPhysealDistractionDistractionLengthening &Lengthening &
Angular correctionAngular correction
Julio de PablosJulio de PablosHospital de NavarraHospital de Navarra
Hospital San Juan de DiosHospital San Juan de DiosPamplonaPamplona
RECOA/Evora, 2009
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Physeal Distraction
Prof. JosProf. Jos CaCaadelladell
Universidad de Nava rraUniversidad de Nava rra
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Physeal Distraction
AgendaAgenda ConceptConcept
TechniqueTechniqueApplications/IndicationsApplications/Indications
DrawbacksDrawbacks
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Physeal Distraction
ConceptConcept
Physis:Physis:Locus minoris resistentiaeLocus minoris resistentiae
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Physeal Distraction
PhysealPhyseal
DistractionDistraction
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Physeal Distraction
Short femur. Hip septic arthritis.Short femur. Hip septic arthritis.Boy, 9 yearsBoy, 9 years
9+2 9+3 9+5 9+89+8
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Physeal Distraction
TechniqueTechnique
No osteotomyNo osteotomy No delayNo delay
Device:Device:Orthogonal configurationOrthogonal configuration
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Physeal Distraction
ApplicationsApplications
LL DLL Discrepanciesiscrepancies
Angular deformitiesAngular deformities
Tumor reconstructionTumor reconstruction
Immature Patients OnlyImmature Patients Only
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Physeal Distraction
11+811+86+96+9
Congenital
short femurPhyseal distractio
13+113+1
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Physeal Distraction
Advantages in AADDAdvantages in AADD
No osteotomy
Acts on site of deformityActs on site of deformity
It can correct & lengthenIt can correct & lengthen
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Physeal Distraction
pre 18 m.post
PreviousPrevious
MCC sepsisMCC sepsisand DICand DICGirl 12 yoGirl 12 yo
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Physeal Distraction
IndicationsIndications ((ii))Angula r deformityAngula r deformity
Physeal def.Physeal def.
Associated shorteningAssociated shortening
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Physeal Distraction
imm. postop.imm. postop. 12 m. postop.12 m. postop.
Adolescent BlountAdolescent Blounts diseases diseaseBoy, 14 y.o.Boy, 14 y.o.
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Physeal Distraction
pre-op. 1 y. post-op.
AdolescentAdolescentBlountBlountss
diseasediseaseBoy, 14 y.o.Boy, 14 y.o.
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Physeal Distraction
IndicationsIndications ((iiii))Angula r deformityAngula r deformity
PostraumaPostrauma Mal/nonMal/non--unionunion
Physeal bridgesPhyseal bridges
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Physeal Distraction
Distal tibial nonDistal tibial non--union.union.Boy, 10 y.o.Boy, 10 y.o.
+50 d.
+4 m.
Bridge:Bridge: NoNo
Strategy:Strategy: II
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Physeal Distraction
Distal tibial nonDistal tibial non--union.union. Boy, 10 y.o.Boy, 10 y.o.
1y postPreop
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Physeal Distraction
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Physeal Distraction
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Physeal Distraction
Tibia varaTibia varaPhyseal BridgePhyseal BridgeBoy, 13 a.Boy, 13 a.
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Physeal Distraction
22
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Physeal Distraction
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Physeal Distraction
+10 m
+20 m
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Physeal Distraction
DrawbacksDrawbacks ofof
Physeal DistractionPhyseal Distraction
Technically trickyTechnically tricky Septic arthritisSeptic arthritis
Physeal ClosurePhyseal Closure
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Physeal Distraction
Physeal DistractionPhyseal Distraction
distal tibiadistal tibiaPin insertionPin insertion
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Physeal Distraction
Distal femoral physeal distractionDistal femoral physeal distraction
Location of the epiphyseal pinsLocation of the epiphyseal pins
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Physeal Distraction
Factors with influence on the viability ofFactors with influence on the viability of
the growth plate after physeal distrationthe growth plate after physeal distration
Rate of distractionRate of distraction
AgeAge
Previous physeal conditionPrevious physeal condition
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Physeal Distraction
prepre 18 m post18 m post
18 m postop18 m postop
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Physeal Distraction
+5 d.+5 d. +22 d.+22 d. +25 d.+25 d. +20 m.+20 m.
Aneurismal Bone CystAneurismal Bone CystBoy, 9 y.o.Boy, 9 y.o.
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Physeal Distraction
34 m po11+9
27 mm27 mm
6 m po9+5
9 mmmm
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Physeal Distraction
Importance ot premature physeal closureImportance ot premature physeal closure
after physeal distractionafter physeal distraction
Important:Important: Young & NormalYoung & Normal
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Physeal Distraction
Importance ot premature physeal closureImportance ot premature physeal closure
after physeal distractionafter physeal distraction
Less important: OlderLess important: Older
Important:Important: Young & NormalYoung & Normal
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Physeal Distraction.Physeal Distraction. Girl, 13 y.o.Girl, 13 y.o.
6 m. Postop.6 m. Postop.
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Physeal Distraction
Importance ot premature physeal closureImportance ot premature physeal closure
after physeal distractionafter physeal distraction
Desired:Desired: Recurrent def.Recurrent def.
Less important: OlderLess important: Older
Important:Important: Young & NormalYoung & Normal
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Physeal Distraction
Imm. postop.
Postraumatic physeal arrestPostraumatic physeal arrest
Boy, 13 y.o.Boy, 13 y.o.
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Physeal Distraction
Imm. postop.Imm. postop. +10 d. +60 d. +13 m.
Postraumatic physeal arrestPostraumatic physeal arrestBoy, 13 y.o.Boy, 13 y.o.
+120 d.
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Physeal Distraction
Physeal Distraction
Summary
Useful toolUseful tool
Specific indicationsSpecific indications Learning curveLearning curve
Aware of drawbacksAware of drawbacks