-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
1/37
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
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
2/37
Physeal Distraction
Prof. JosProf. Jos CaCaadelladell
Universidad de Nava rraUniversidad de Nava rra
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
3/37
Physeal Distraction
AgendaAgenda ConceptConcept
TechniqueTechniqueApplications/IndicationsApplications/Indications
DrawbacksDrawbacks
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
4/37
Physeal Distraction
ConceptConcept
Physis:Physis:Locus minoris resistentiaeLocus minoris
resistentiae
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
5/37
Physeal Distraction
PhysealPhyseal
DistractionDistraction
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
6/37
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
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
7/37
Physeal Distraction
TechniqueTechnique
No osteotomyNo osteotomy No delayNo delay
Device:Device:Orthogonal configurationOrthogonal
configuration
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
8/37
Physeal Distraction
ApplicationsApplications
LL DLL Discrepanciesiscrepancies
Angular deformitiesAngular deformities
Tumor reconstructionTumor reconstruction
Immature Patients OnlyImmature Patients Only
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
9/37
Physeal Distraction
11+811+86+96+9
Congenital
short femurPhyseal distractio
13+113+1
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
10/37
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
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
11/37
Physeal Distraction
pre 18 m.post
PreviousPrevious
MCC sepsisMCC sepsisand DICand DICGirl 12 yoGirl 12 yo
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
12/37
Physeal Distraction
IndicationsIndications ((ii))Angula r deformityAngula r
deformity
Physeal def.Physeal def.
Associated shorteningAssociated shortening
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
13/37
Physeal Distraction
imm. postop.imm. postop. 12 m. postop.12 m. postop.
Adolescent BlountAdolescent Blounts diseases diseaseBoy, 14
y.o.Boy, 14 y.o.
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
14/37
Physeal Distraction
pre-op. 1 y. post-op.
AdolescentAdolescentBlountBlountss
diseasediseaseBoy, 14 y.o.Boy, 14 y.o.
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
15/37
Physeal Distraction
IndicationsIndications ((iiii))Angula r deformityAngula r
deformity
PostraumaPostrauma Mal/nonMal/non--unionunion
Physeal bridgesPhyseal bridges
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
16/37
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
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
17/37
Physeal Distraction
Distal tibial nonDistal tibial non--union.union. Boy, 10
y.o.Boy, 10 y.o.
1y postPreop
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
18/37
Physeal Distraction
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
19/37
Physeal Distraction
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
20/37
Physeal Distraction
Tibia varaTibia varaPhyseal BridgePhyseal BridgeBoy, 13 a.Boy,
13 a.
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
21/37
Physeal Distraction
22
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
22/37
Physeal Distraction
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
23/37
Physeal Distraction
+10 m
+20 m
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
24/37
Physeal Distraction
DrawbacksDrawbacks ofof
Physeal DistractionPhyseal Distraction
Technically trickyTechnically tricky Septic arthritisSeptic
arthritis
Physeal ClosurePhyseal Closure
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
25/37
Physeal Distraction
Physeal DistractionPhyseal Distraction
distal tibiadistal tibiaPin insertionPin insertion
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
26/37
Physeal Distraction
Distal femoral physeal distractionDistal femoral physeal
distraction
Location of the epiphyseal pinsLocation of the epiphyseal
pins
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
27/37
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
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
28/37
Physeal Distraction
prepre 18 m post18 m post
18 m postop18 m postop
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
29/37
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.
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
30/37
Physeal Distraction
34 m po11+9
27 mm27 mm
6 m po9+5
9 mmmm
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
31/37
Physeal Distraction
Importance ot premature physeal closureImportance ot premature
physeal closure
after physeal distractionafter physeal distraction
Important:Important: Young & NormalYoung & Normal
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
32/37
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
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
33/37
Physeal Distraction.Physeal Distraction. Girl, 13 y.o.Girl, 13
y.o.
6 m. Postop.6 m. Postop.
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
34/37
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
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
35/37
Physeal Distraction
Imm. postop.
Postraumatic physeal arrestPostraumatic physeal arrest
Boy, 13 y.o.Boy, 13 y.o.
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
36/37
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.
-
8/6/2019 Physeal Distraction. Lengthening & Angular
correction. Julio de Pablos
37/37
Physeal Distraction
Physeal Distraction
Summary
Useful toolUseful tool
Specific indicationsSpecific indications Learning curveLearning
curve
Aware of drawbacksAware of drawbacks
