RESUMEN
BACKGROUND: The Green-Anderson (GA) leg-length data remain the gold standard for the age-based assessment of leg lengths in children despite their methodologic weaknesses. We aimed to summarize current growth trends among a cross-sectional cohort of modern U.S. children using quantile regression methods and to compare the median femoral and tibial lengths of the modern U.S. children with those of the GA cohort. METHODS: A retrospective review of scanograms and upright slot-scanning radiographs obtained in otherwise healthy children between 2008 and 2020 was completed. A search of a radiology registry revealed 3,508 unique patients between the ages of 2 and 18 years for whom a standard-of-care scanogram or slot-scanning radiograph had been made. All patients with systemic illness, genetic conditions, or generalized diseases that may affect height were excluded. Measurements from a single leg at a single time point per subject were included, and the latest available time point was used for children who had multiple scanograms made. Quantile regression analysis was used to fit the lengths of the tibia and femur and overall leg length separately for male patients and female patients. RESULTS: Seven hundred patients (328 female and 372 male) met the inclusion criteria. On average, the reported 50th percentile tibial lengths from the GA study at each time point were shorter than the lengths in this study by 2.2 cm (range, 1.4 to 3.3 cm) for boys and 2 cm (range, 1.1 to 3.1 cm) for girls. The reported 50th percentile femoral lengths from the GA study at each time point were shorter than the lengths in this study by 1.8 cm (range, 1.1 to 2.5 cm) for boys and 1.7 cm (range, 0.8 to 2.3 cm) shorter for girls. CONCLUSIONS: This study developed new growth charts for femoral and tibial lengths in a modern U.S. population of children. The new femoral and tibial lengths at nearly all time points are 1 to 3 cm longer than traditional GA data. The use of GA data for epiphysiodesis could result in underestimation of expected childhood growth. LEVEL OF EVIDENCE: Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Fémur , Diferencia de Longitud de las Piernas , Humanos , Masculino , Niño , Femenino , Preescolar , Adolescente , Estudios Transversales , Fémur/diagnóstico por imagen , Tibia/diagnóstico por imagen , Extremidad InferiorRESUMEN
OBJECTIVE: In the 50 years since a premature partial physeal arrest (a physeal bar) was first excised from an epiphysis there have been no large in-depth studies reporting the results in patients followed to skeletal maturity. This paper reports the results of physeal bar resection surgery in a group of patients followed to skeletal maturity, documenting the restored growth of the affected physis, the affected bone, and the final limb-length discrepancy. METHODS: Forty-eight patients underwent physeal bar resection of the distal femur (21), proximal tibia (9), and distal tibia (18) by 1 surgeon (H.A.P.) from 1968 through 1996, and were followed prospectively to skeletal maturity with clinical and radiologic examinations. Factors such as sex, age at time of injury, etiology of the bar, physeal bar location and size, age at time of bar excision, interposition material, and additional surgical procedures were analyzed with respect to physis, bone, and limb growth following bar resection. RESULTS: The mean growth for the entire bone following physeal bar excision was 7.6 cm for the distal femur, 4.7 cm for the proximal tibia, and 7.5 cm for the distal tibia, compared with growth in the contralateral control bone of 6.8 cm in the femur, 5.0 cm in the proximal tibia, and 7.8 cm in the distal tibia. The maximum bone growth following bar excision in a single patient was 21.3 cm for the distal femur, 10.3 cm for the proximal tibia, and 18.6 cm for the distal tibia. The mean limb-length discrepancy at maturity was -1.7 cm for the distal femur, -1.3 cm for the proximal tibia, and -1.1 cm for the distal tibia (all sites combined -1.4 cm). Fourteen patients (29%) had only the 1 bar excision with no other accompanying or subsequent surgery. Thirty-four patients (71%) had 1 to 4 accompanying or subsequent leg length or angular correcting procedures. CONCLUSIONS: Physeal bar excision to restore growth when applied to the appropriate patient is a useful, rewarding procedure, reducing the number of surgical limb length equalizing procedures. It is a demanding surgical procedure and requires diligent and careful follow-up until maturity. Additional limb length equalizing surgery is frequently needed. LEVEL OF EVIDENCE: Case series, level IV.
Asunto(s)
Epífisis/cirugía , Fémur/cirugía , Diferencia de Longitud de las Piernas/cirugía , Tibia/cirugía , Adolescente , Desarrollo Óseo , Niño , Preescolar , Epífisis/diagnóstico por imagen , Epífisis/crecimiento & desarrollo , Femenino , Fémur/diagnóstico por imagen , Fémur/crecimiento & desarrollo , Humanos , Lactante , Recién Nacido , Diferencia de Longitud de las Piernas/diagnóstico por imagen , Estudios Longitudinales , Masculino , Tibia/diagnóstico por imagen , Tibia/crecimiento & desarrolloRESUMEN
Premature partial physeal arrest without the formation of an osseous bar - physeal bar equivalent (PBE) - is uncommon. Four children with a PBE had an infection near the distal femoral physis before the age of 11 months. Some growth was achieved after resection of the PBE in each case. Of two cases diagnosed and treated early, one required only contralateral physeal arrests to achieve limb-length equality at maturity. The other, currently 8 years and 4 months old, has a 1.1-cm limb-length discrepancy 6 years after PBE resection and will require observation until maturity. Of two cases diagnosed and treated late, one required ipsilateral femoral lengthening and contralateral femoral shortening and physeal arrests to treat the limb-length discrepancy and angular deformity. The other, currently 7 years and 1 month old, has a 4.8-cm discrepancy and will need future surgical limb-length equalization. Early recognition and treatment of PBE is required to avoid severe limb-length inequality and angular deformity.
Asunto(s)
Artritis Infecciosa/diagnóstico , Placa de Crecimiento/cirugía , Diferencia de Longitud de las Piernas/cirugía , Osteomielitis/diagnóstico , Niño , Femenino , Fémur/diagnóstico por imagen , Fémur/cirugía , Placa de Crecimiento/anomalías , Placa de Crecimiento/crecimiento & desarrollo , Humanos , Lactante , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Diferencia de Longitud de las Piernas/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Osteogénesis , Radiografía , Staphylococcus aureus/aislamiento & purificación , Tibia/diagnóstico por imagen , Tibia/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: The indications for prophylactic pinning of the contralateral hip after unilateral slipped capital femoral epiphysis (SCFE) remain controversial in part because the natural history of the contralateral hip is unclear. QUESTIONS/PURPOSES: We therefore determined (1) the incidence of contralateral slips in patients with unilateral SCFE, (2) the rate of subsequent corrective surgery, and (3) the Harris hip score (HHS) and VAS pain score for hips that sustained a contralateral slip after unilateral pinning. METHODS: We retrospectively reviewed 226 patients with unilateral SCFE at initial presentation between 1965 and 2005; of these, 133 met our inclusion criteria and were followed at least 2 years. Latest followup included examination and radiographs for 52 patients and HHS (without radiographs) and VAS pain score for 81 hips. Minimum followup was 2 years (median, 13 years; range, 2-43 years). RESULTS: Of the 133 patients at risk for a subsequent slip, 20 patients developed a contralateral slip (15%). One patient developed avascular necrosis requiring arthroplasty, and another patient had a mild contralateral slip with disabling pain. For the 15 patients with contralateral slips and scores available, the mean HHS was 90 (range, 49-100) and the mean VAS pain score was 20 of 100. Six found the contralateral hip painful. CONCLUSIONS: The contralateral slip sustained by the majority of patients was for the most part mild. However, nearly 1/3 of the contralateral slipped hips were painful. One patient has severe pain, and a second required THA for avascular necrosis after an unstable slip. These may have been preventable by prophylactic pinning. LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Tornillos Óseos , Articulación de la Cadera/cirugía , Procedimientos Ortopédicos/instrumentación , Complicaciones Posoperatorias/etiología , Epífisis Desprendida de Cabeza Femoral/cirugía , Adolescente , Adulto , Artroplastia de Reemplazo de Cadera , Fenómenos Biomecánicos , Distribución de Chi-Cuadrado , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Necrosis de la Cabeza Femoral/etiología , Necrosis de la Cabeza Femoral/cirugía , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Humanos , Masculino , Procedimientos Ortopédicos/efectos adversos , Osteotomía , Dimensión del Dolor , Dolor Postoperatorio/etiología , Dolor Postoperatorio/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Radiografía , Rango del Movimiento Articular , Reoperación , Estudios Retrospectivos , Epífisis Desprendida de Cabeza Femoral/diagnóstico por imagen , Epífisis Desprendida de Cabeza Femoral/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenAsunto(s)
Fracturas del Fémur/cirugía , Procedimientos Ortopédicos/métodos , Fracturas de Salter-Harris , Preescolar , Progresión de la Enfermedad , Estudios de Seguimiento , Placa de Crecimiento/cirugía , Humanos , Diferencia de Longitud de las Piernas/etiología , Diferencia de Longitud de las Piernas/cirugía , MasculinoRESUMEN
The incidence of slipped capital femoral epiphysis (SCFE) remains controversial. A population-based database was used to identify all residents of a Midwestern American county treated for a new diagnosis of SCFE. Between 1965 and 2005, 49 patients (aged 9-16 years) underwent treatment of SCFE. This represents an annual incidence of 8.3 unilateral cases and 0.5 bilateral cases per 100,000 children. In patients with unilateral disease, mild slips developed in nine contralateral hips (19%) at a mean of 166 days (range: 6-432 days). As all contralateral slips were mild, we recommend careful follow-up rather than prophylactic pinning of the contralateral hip.
Asunto(s)
Epífisis Desprendida/diagnóstico , Epífisis Desprendida/epidemiología , Cabeza Femoral/patología , Adolescente , Niño , Epífisis Desprendida/terapia , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Minnesota/epidemiología , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: The surgical making of a one-bone lower leg is, in a way, an operation of necessity or last resort. It has been attempted for many conditions and by many techniques. METHODS: This is a review of the literature and a case report of transferring a congenitally pseudarthritic fibula to replace an ipsilateral pseudarthritic tibial diaphysis without exposing the fibular vascular pedicle, or using microvascular techniques, and with the specific aim of purposely creating a true one-bone lower leg, the tibula. RESULTS AND CONCLUSION: The concept and surgical technique used here leave the contralateral leg undisturbed and are less demanding, time consuming, and costly than a vascularized pedicle graft or bone transport. This procedure is new and can also be applied when the fibula is normal and to repair tibial diaphyseal deficiency from any cause in both children and adults.
Asunto(s)
Alargamiento Óseo/métodos , Peroné/trasplante , Diferencia de Longitud de las Piernas/cirugía , Seudoartrosis/cirugía , Tibia/cirugía , Estudios de Seguimiento , Humanos , Recién Nacido , Diferencia de Longitud de las Piernas/diagnóstico por imagen , Diferencia de Longitud de las Piernas/etiología , Masculino , Seudoartrosis/complicaciones , Seudoartrosis/congénito , Radiografía , Tibia/diagnóstico por imagen , Factores de TiempoRESUMEN
Surgical creation of a one-bone forearm is appropriately utilized for a variety of underlying conditions. It functions best when the proximal ulna and distal radius are available for use. A variety of surgical techniques have been utilized. This report reviews the pediatric literature and presents four personal cases, each with a different underlying abnormality. The rotational position of forearm fusion is discussed.
Asunto(s)
Antebrazo/anomalías , Radio (Anatomía)/anomalías , Cúbito/anomalías , Adolescente , Niño , Condroma/complicaciones , Condroma/cirugía , Exostosis Múltiple Hereditaria/complicaciones , Exostosis Múltiple Hereditaria/cirugía , Femenino , Antebrazo/cirugía , Humanos , Masculino , Radio (Anatomía)/cirugía , Sarcoma de Ewing/complicaciones , Sarcoma de Ewing/cirugía , Neoplasias de los Tejidos Blandos/complicaciones , Neoplasias de los Tejidos Blandos/cirugía , Cúbito/cirugíaRESUMEN
PURPOSE: Type 6 is an open fracture in which part of the physis is missing. It is the least common physeal fracture, but has the highest rate of complications, particularly the formation of a physeal bar. Without preemptive treatment, a physeal bar always forms, producing growth retardation and angular deformity, and excision of these physeal bars has been uniformly unsuccessful. The distal medial malleolus is a common site for the fracture. METHODS: Strategies for the treatment of two varieties of acute medial malleolar type-6 fractures and two types of late deformities following type-6 fracture are given. The acute fractures were treated with either fat or cartilage applied to the exposed physis. The late deformities were treated with corrective iliac bone grafting. RESULTS: The acute fractures were prevented from forming physeal bars and the two late deformities were fully corrected with good outcomes. CONCLUSION: Fat applied to an acute type-6 physeal fracture has a good chance of preventing bar formation. Ankle deformities due to bars can be corrected by means of iliac bone grafting.
RESUMEN
The indications for removing metal that was implanted in children and the practice of removing it have changed dramatically during the past century, but this subject is rarely discussed in publications, oral presentations, or resident training curricula. Thus, during their training, residents learn about the topic only sporadically from evaluating patients. This article presents the cases for and against metallic implant removal and identifies situations in which removal is appropriate and situations in which it is not.