Excision of the central physeal bar: a modification of Langenskiöld's procedure.

In the growing child a central bone bridge fusing epiphysis to metaphysis will lead to progressive shortening and deformity. Provided that its size does not exceed half the cross-sectional area of the physis normal growth can be restored by resecting the bridge, and ifiling the defect with fat (Langenskiold 1981 ; Peterson 1984). Furthermore, as growth resumes, minor deformities will correct spontaneously. Accurate mapping of the defect and operative planning are the keys to the success of this difficult surgery and biplanar tomograms or oblique CT scans are most helpful. The conventional surgical approach is through a metaphyseal window. Considerable stereotactic skill is required and there may be difficulties with irrigation, suction, illumination, magnification, and introducing dental mirrors and cutting instruments. The use ofthe arthroscope has recently been advocated in this context (Stricker 1992). Operative technique. A modified approach was developed