Surgical anatomy of selected physes

Area of Science:

• Pediatric Orthopedics
• Surgical Anatomy
• Growth Plate Research

Background:

• Partial physeal arrest in children requires precise surgical intervention.
• Damaged physes result from trauma, infection, or irradiation.
• Knowledge of physeal anatomy is vital for successful bony bar excision.

Purpose of the Study:

• To assess the surgical accessibility of pediatric physes and adjacent metaphyses.
• To identify anatomical landmarks for physeal bar resection.
• To evaluate the relationship between physes and surrounding joint structures.

Main Methods:

• Dissection of a pediatric cadaver (5-year-old child).
• Focus on distal radius, distal femur, proximal tibia, and distal tibia/fibula physes.
• Emphasis on surgical accessibility and relationship to overlying structures.

Main Results:

• Distal radius physis is entirely extracapsular.
• Distal femur physis accessibility is influenced by the suprapatellar pouch and capsular attachments.
• Proximal tibia physis is extracapsular, with posterolateral aspects obscured by the popliteus muscle.
• Distal tibial physis is extracapsular, with intra-articular components at the distal fibula.

Conclusions:

• Detailed anatomical understanding is essential for surgical correction of physeal arrest.
• Specific anatomical features dictate the surgical approach and accessibility of different physes.
• This cadaveric study provides critical insights for pediatric orthopedic surgeons.