A 9-year-old boy has a post-traumatic peripheral physeal bar of the distal femur causing progressive genu valgum. MRI shows the bar occupies approximately 30 percent of the physis. At least 4 years of growth remain. The most appropriate treatment is:

• A Corrective osteotomy alone without addressing the bar
• B Completion epiphysiodesis of the whole physis
• C Contralateral physeal arrest now
• D Physeal bar excision with interposition fat grafting ✓

Explanation

Physeal bar resection with interposition of fat, cartilage or methylmethacrylate is indicated when the bar involves less than 50 percent of the physeal area and sufficient growth potential remains, classically more than 2 years. This child meets both criteria, so excision can restore longitudinal growth and correct deformity. Completion epiphysiodesis sacrifices all remaining growth, contralateral arrest is reserved for untreatable bars near maturity, and osteotomy alone leaves the causative bar active so deformity recurs.

Reference: Tachdjian's Pediatric Orthopaedics, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.