Radiographic Determination of Skeletal Maturity Guides Optimal Timing of Bar Removal After Minimally Invasive Repair of Pectus Excavatum

Abstract

Background A small number of patients treated with minimally invasive correction of pectus excavatum recur after bar removal. This risk appears to be greater in younger children who continue to grow following bar removal. Methods We propose the use of wrist films to determine skeletal maturity and delay bar removal until it is completed. This is not possible in very young patients (less than 14 years of age) or necessary in patients older than 19. Results In the 14-year to 18-year age group, we have used wrist films to determine skeletal maturity in 25 patients. Ten patients (age 14-18) demonstrated full maturation, and their bars were removed at 2 years. Five patients had films that demonstrated nearly closed growth plates, and those bars were removed 6 months later (2.5 years post-insertion). Ten patients had 2 sets of films taken, initially at 2 years post-operation demonstrating open growth plates. Films 12 months later showed skeletal maturation. Their bars were removed at 3 years post-operation. There were no recurrences with an average follow-up of 3 years. Discussion Radiographic determination of skeletal maturity may be used as a guide to the timing of bar removal following the correction of pectus excavatum.