Transphyseal Resection of Post-Traumatic Linear Physeal Bars of the Distal Tibia Using a Large-Diameter Trephine: A Report of Two Cases

Background: Physeal fractures of the distal tibia may result in persistent growth arrest and physeal bar formation. An asymmetrical bar, combined with continued skeletal growth, leads to progressive ankle deformity. Physeal bar resection is a standard procedure for local growth plate damage. However, linear bars that traverse the entire sagittal plane from the anterior to the posterior cortex are technically challenging to curette. Methods: Two clinical cases of pediatric patients with posttraumatic linear distal tibia bars are presented. Both patients underwent resection using a large-diameter trephine and bone wax. Temporary hemiepiphysiodesis with an 8-plate was also performed, although this proved technically unsuccessful in one case. Results: Both patients underwent transphyseal resection of a linear physeal bar of the distal tibia using a 12 mm trephine, followed by temporary hemiepiphysiodesis. One patient experienced proximal migration of the epiphyseal screw and plate displacement, which was managed conservatively. At final follow-up, joint axis was restored (MDTA improved from 72° to 92° in Patient 1 and from 75° to 91° in Patient 2 at 4.5 and 4 years after surgery, respectively). Conclusions: Our findings demonstrate that transphyseal bar resection of post-traumatic linear physeal bars of the distal tibia using a large-diameter trephine can serve as the technical option for correction of varus ankle deformity in growing children. In both patients, correction of varus ankle deformity was observed after the combined procedure—trephine resection with bone-wax interposition and temporary lateral hemiepiphysiodesis. Because both patients underwent concomitant guided growth, the relative contribution of bar resection and hemiepiphysiodesis cannot be determined from these two cases.