The purpose of this study was to evaluate the effectiveness and complication rate of guided growth for the treatment of patients with a moderate leg-length discrepancy. The authors retrospectively reviewed all patients treated with guided growth for a moderate leg-length discrepancy at their institution between October 2004 and December 2010. Thirty-four patients met the inclusion criteria from an initial cohort of 105 patients. All patients were followed until screw removal or maturity occurred. Nine patients had a developmental leg-length discrepancy, and 25 had a congenital leg-length discrepancy. Average age was 12.6 years (range, 7-16 years). Average leg-length discrepancies, as measured on standing long-leg radiographs from the top of the pelvis, the top of the femoral heads, and the center of the ankle to the top of the femoral heads, were 22, 19, and 17 mm, respectively. Average discrepancies at screw removal or maturity were 13, 10, and 11 mm, respectively. Twenty of 33 patients had a leg-length discrepancy of less than 1 cm at maturity or screw removal. The leg-length discrepancy change in patients who underwent guided growth of the tibia was minimal. Leg-length discrepancies in patients who underwent guided growth of the femur or both the femur and the tibia changed by an average of 10 mm. One patient had a mechanical axis change greater than 1 zone, and 1 patient required treatment for angular deformity after being treated for a leg-length discrepancy. Guided growth is a safe and effective technique for treating moderate leg-length discrepancies.

Factors the hospital can control to reduce LOS include time to surgery, time for physical therapy evaluation, and radiology delays (for spine clearance radiographs). Physical therapy availability within 24 hours of surgery is important and should include weekends and holidays. Early evaluation of social factors including homelessness or obstacles to independent living may reduce time to find placement. LOS reduction after femur fractures will decrease the cost of trauma to the hospital. In addition, LOS reduction will possibly increase bed availability and minimize the time spent on diversion yielding greater revenues and increasing patient satisfaction.

Methicillin-resistant Staphylococcus aureus has been a clinically significant pathogen in orthopaedics for more than a decade. Research shows that these infections are more virulent and that treatment requires greater use of hospital resources. A multidisciplinary approach involving emergency department physicians, radiologists, interventional radiologists, MRI technicians, pediatricians, infectious disease specialists, anesthesiologists, and orthopaedic surgeons is necessary to optimize outcomes and minimize costs. Early use of MRI helps delineate the extent of infection, aids in the consideration of surgery, and provides valuable information for surgical planning. Healthcare providers need to stay vigilant during the course of the disease to detect other sites of infection or complications of methicillin-resistant S aureus, such as deep vein thrombosis and septic pulmonary emboli. Patients with infections near growth centers require long-term monitoring to ensure the absence of growth disturbances. Physicians should help educate patients and families on prevention strategies and be aware of guidelines for students to return to school and athletes to return to play.

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