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Physeal Bone-Bridge

- Discussion:
    - bone bridge obliterates growth-plate cartilage & prevents growth;
    - peripheral bone bridges predispose patient to angular deformities;
    - most common sites of growth arrest include the distal tibiadistal femoral and distal ulnar physis;
    - much less common sites include distal radius and proximal humerus;
- Radiology:
    - extent of bone bridge is demonstrated by CT scanning and tomograms;

- Indications for Bone Bridge Resection:
    - resection is indicated if less than 1/3 to 1/2 of growth plate is involved;
    - younger children tend to have a better prognosis w/ resection than older children;
          - less than 2 years of remaining growth is a relative contra-indication for bone bridge resection;
    - central bars are more amenable to resection than peripheral bars;
    - ischemic or septic related bone bars have a poor prognosis w/ resection;

- Technical Pearls:
    - interposition of fat is easiest and most commonly used agent to prevent bone bridge formation (alternatives include
           silastic, methyl  methacrylate, or free epiphysis)

Partial physeal growth arrest: treatment by bridge resection and fat interposition.

Surgical treatment of partial closure of the growth plate.     

Partial growth plate arrest and its treatment.     

Operative correction of partial epiphyseal plate closure by osseous bridge resection and silicone rubber implant.  An experimental study in dogs.

An operation for partial closure of an epiphyseal plate in children, and its experimental basis.  

Secondary Tethers After Physeal Bar Resection: A Common Source of Failure?

Physeal bridge resection.

Patterns of premature physeal arrest: MR imaging of 111 children.

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