We describe a new technique of percutaneous epiphysiodesis using transphyseal screws (PETS) and our experience with it in 32 cases of limb-length inequality and nine angular knee deformities. A subgroup of 18 patients with postfracture limb overgrowth formed a clinical model for study of the real efficacy of PETS. It proved a reliable method with few complications and many advantages such as simplicity of technique, short operating time, rapid postoperative rehabilitation, and reversibility. Bone-length inequality decreased from a preepiphysiodesis average of 2.47 cm (range, 1.5-4.6) to 0.51 cm at skeletal maturity. The tibiofemoral angle reduced from a preoperative average of 7.66 degrees to 0.86 degrees at maturity. The screws began to exert significant growth inhibition within 6 months of insertion, slowing down the distal femoral and upper tibial physes by 68 and 56%, respectively. They achieved maximum growth retardation over the ensuing 12 months, slowing down the distal femoral physis by 89% and the proximal tibial physis by 95%. At skeletal maturity, total femoral growth was 45% and total tibial growth was 52% that of the normal side. Key
We propose that MWD is much more common than previously reported and did not find conditions of extreme environmental stress or poverty in our patients. We advocate surgical management of the condition by triple arthrodesis and extend it to include a naviculocuneiform fusion whenever indicated according to CT findings.
Most studies report little or no problem with union following intramedullary nailing of fractured forearm bones in children. The bone involved in the occasional delayed union is not mentioned except for one delayed union of the ulna following an open fracture. The present paper specifically highlights problems with union of the ulna following nailing in children. It reports two cases of delayed union and one non-union following nailing of closed fractures of both forearm bones. In all cases, the radius united in good time. We discuss the anatomical reasons and surgical techniques that predispose the ulna bone to delayed union and non-union and recommend surgical precautions to avoid this.
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