Browsing by Subject "Epiphyses"
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Item Assessing Complications of Epiphysiodesis for Leg Length Discrepancy(2014-02-04) Terrill, Tyler A.; Dunn, Samuel H.; Birch, John; Makarov, MarinaINTRODUCTION: Leg length discrepancy in children and adolescents is a serious orthopedic problem that can cause leg and back problems due to abnormal gait. This condition may be congenital or caused by disease or trauma. One method to correct leg length discrepancies in children is to perform an epiphysiodesis. This surgical procedure removes one or more growth plates from the femur, tibia, or fibula. This operation slows down the growth of the long leg to allow the shorter leg to catch up, or at least prevent the discrepancy from increasing. As there has been no large study of epiphysiodesis patients in the literature, the rates for surgical complications and errors associated with this surgery are not well known. These complications may include infections, nerve damage, and incomplete epiphysiodesis, which often results in an angular deformity. Because of the lack of understanding for rate of complications and characteristics associated with these, we studied a large patient population to gain insight into these aspects of the procedure. METHODS: The patient population at Texas Scottish Rite Hospital for Children undergoing epiphysiodesis for the treatment of leg length discrepancy from 1980 to 2008 was examined by a retrospective review of both charts and radiographs, with a total of 755 patients included in the study. The information recorded in the study included the extent of leg length discrepancy, angular measurements of the joints, method of epiphysiodesis, postoperative development of angular deformities, underlying etiology, length correction prediction, and other clinical features. RESULTS: Of the 755 patients examined, 38 had surgical complications, (5%). Of these patients, 27 had incomplete epiphysiodesis, 6 had neurological problems, 3 had overcorrection of the leg length discrepancy, and 2 had other complications not specific to this procedure. Patients incurring complications had statistically significant risk factors that include greater leg length discrepancies at the time of epiphysiodesis, congenital defects instead of acquired ones, and younger age. There were also trends towards open curettage method, epiphysiodesis involving the femoral growth plate, and male gender as risk factors, though these did not achieve statistical significance. DISCUSSION: It is important that surgeons understand which populations of patients are at greater risk for complications during this procedure, so that extra caution may be taken to prevent harm. Also, parents should be aware that there is a 5% risk of surgical complication, so that they may be fully informed before committing to the procedure.Item The Results of Epiphysiodesis for Treatment of Limb Length Discrepancy(2015-01-26) Jackson, Taylor; Smith, Connor; Birch, John; Makarov, Marina; Jo, ChanheeBACKGROUND: Epiphysiodesis is a pediatric surgical procedure often used to correct a 2-5 cm limb length discrepancy (LLD) by surgically arresting physeal growth of the longer limb. OBJECTIVE: The purpose of the study is to compare three models commonly used to calculate expected LLD in patients who have undergone an epiphysiodesis to determine which most accurately predict the patient outcomes. METHODS: Out of 469 patients who have undergone an epiphysiodesis for LLD at the Texas Scottish Rite Hospital for Children between1991-2011, 84 patients were selected for the study. The inclusion criteria were availability of three pre-operative x-rays and skeletal age data before the surgery, with at least a six months interval between scans. Each patient must have been followed to skeletal maturity with limb length measurements at that time and must not have suffered growth arrest of traumatic etiology or had postoperative complications. Using radiographic limb measurements, we compared the accuracy of the growth remaining methods by assessing predicted limb lengths and predicted LLD with White-Menelaus, Moseley/Rotterdam, and Green-Anderson methods or their variants. Where applicable, the predictions were made with and without accounting for growth inhibition rate (GIR), which is a quantification of the retarded rate of growth in the shorter leg. The differences across methods were assessed with one-way repeated measures ANOVA and reliability measures using intraclass correlation coefficients (ICC). A p-value < 0.05 indicated statistical significance. RESULTS: Analysis comparing the mean absolute difference between the predicted and actual outcomes for each method demonstrates a similar efficacy. CONCLUSION: The White-Menelaus, Moseley/Rotterdam, and Green-Anderson methods of prediction are nearly indistinguishable, with the White-Menelaus being slightly more accurate. Modifying the existing models to include GIR did not improve the accuracy of the predictions. We advocate that the White-Menelaus be the preferred method as it is as accurate as the others and, from the clinical perspective, has the advantage of simplicity: requiring only one measurement and the patient's chronological age, as opposed to skeletal age. It also does not require the physician to create graphs or consult growth charts.