PATIENT-SPECIFIC 3D-PRINTED GUIDES FOR CENTRAL PHYSEAL BAR RESECTION: ENHANCING PRECISION AND OUTCOMES IN PAEDIATRIC LOWER EXTREMITY SURGERY

Physeal bar formation in the lower extremities after injury to the growth plate often results in angular deformities and leg length discrepancies, presenting significant challenges for pediatric patients. Traditional physeal bar resection techniques, while effective in some cases, may lack the precision required to ensure complete removal of the bony bridges, and without compromising the surrounding healthy physis. Advances in 3D printing have introduced patient-specific guides as a promising tool to enhance surgical accuracy and clinical outcomes. This study evaluates a novel approach to central physeal bar resection in the lower extremities using patient-specific 3D-printed surgical guides and rigid bone reamers, focusing on precision, safety, and clinical outcomes. Methods Five pediatric patients (mean age: 11.5 years; range: 10.5–12.5 years) with centrally located physeal bars affecting less than 40% of the physeal area and with at least two years of remaining growth were included. The cohort comprised three boys and two girls, with two cases in the distal femur, two in the distal tibia, and one in the proximal tibia. CT scans were used to delineate the physeal bar, and digital simulations guided the creation of patient-specific 3D-printed surgical guides. These guides enabled precise reaming through a single cortical entry point. Outcomes were assessed using postoperative CT scans, long-standing axis radiographs, and clinical evaluations. Results Complete removal of physeal bars was confirmed in all cases via postoperative CT scans, with no recurrences during follow-up. In the two distal femur cases, near-normal longitudinal growth was observed, with significant spontaneous correction of angular deviations. In the tibial cases (two distal, one proximal), no further increase of deformities developed. The results highlight the potential of patient-specific 3D-printed guides to enhance the precision of physeal bar resections compared to traditional methods, which show high compolication rates. The ability to pre-plan resection and employ custom-designed guides allows for complete removal of the bar and minimizes damage to surrounding growth cartilage, which is critical for preserving growth potential and correcting angular deformities. These findings align with emerging evidence supporting 3D-printed surgical tools as a transformative approach in orthopedics. However, further studies with larger cohorts and long-term follow-up are necessary to validate these preliminary results. Patient-specific 3D-printed guides represent an innovative and effective solution for managing physeal bars in pediatric patients, providing enhanced surgical precision and improved clinical outcomes.