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Each bone has an area where the bone primarily grows for length. This area is always near the ends of the bone and is called the growth plate or “physis.” On an X-ray, it appears as a dark gray stripe or band across the bone. While a child is still growing, this band can be seen. During rapid growth, the band is wider. As a child enters his or her teen years and growth starts to slow, the band narrows. Once bone crosses the cartilage growth plate, the growth stops.
This gives us an opportunity to fix problems early. If one leg is longer than the other, a surgical procedure called epiphysiodesis can be done to stop the growth of the longer side and allow the short side to catch up. By scraping out the cartilage of the growth plate and allowing it to heal with bone, we can stop growth. Sometimes it is hard to be absolutely sure we want to stop growth, so another option is guided growth.
We use a metal plate and screws covering the growth plate to briefly or permanently tether the area. A plate is placed on both sides of the bone to prevent it from growing further. By using guided growth, if the outcome your child needs is reached after months or years, the plate can be removed, and growth often resumes.
Guided growth with a plate can be used for other corrections, such as helping a crooked bone become straight. In this way, a plate and screws are placed on the convex side, restricting it while the concave side grows. With time, the bone straightens.
Your health care provider can help you and your child make the decision about when the time is right. Surgeons usually aim to do surgery a year or two before the end of growth. That reduces the risk of overcorrection and, if timed right, growing is complete and the hardware doesn’t need to be removed.
The surgery is generally outpatient, but some may require an overnight stay. The incision is about 1 ½ inches, and surgery takes about 20 minutes for each plate.
Your doctor will work with you on the follow-up treatment plan. Usually there are no limitations after surgery. It is moderately painful, since it is right over a joint. Some can kids return to sports within a week; others need weeks of physical therapy to return to normal walking.
We will plan for your child to be inactive for about two weeks, but you should know it could be less or more. The most common location for the surgery is at the knee. A neoprene knee sleeve can maintain gentle compression after the surgery to help with swelling and pain.