Growth Factors
The growth and development of the limbs are controlled by specific genes. At the tip of each limb bud is a collection of ectodermal cells called the apical ectodermal ridge…
Ilizarov and De Bastiani Techniques for Limb Lengthening
Chondrodiastasis, or symmetric distraction of the growth plate, can be considered when the leg-length discrepancy is small. The procedure stimulates closure of the growth plate; however, its use is limited…
Growth Arrest
Lengthening is appropriate to consider in children 8 to 12 years of age who have a predicted leg-length discrepancy at maturity of 5 cm or more. The discrepancy in a…
Charts for Timing Growth Arrest and Determining Amount of Limb Lengthening to Achieve Limb-Length Equality at Maturity
The advent of improved clarity of intraoperative radiographic image intensification has facilitated the use of a closed technique, percutaneous epiphysiodesis. A very small incision is made over a Steinmann pin…
Evaluation of Leg-Length Discrepancy
The Green and Anderson growth-remaining chart is used to estimate the effects of an epiphyseal arrest procedure on the distal femur and proximal tibia at various skeletal ages. The arithmetic…
Clinical Manifestations
• Congenital and developmental anomalies with terminal limb deficiencies (see Plate 3-32): hemihypertrophy or hemiatrophy, Klippel-Trénaunay-Weber syndrome, Maffucci syndrome, posterior bowing of the tibia, proximal femoral focal deficiency, congenital short…
Congenital Bowing of the Tibia
Posteromedial bowing spontaneously and markedly corrects in the first 6 months of life, with essentially normal tibial angulation noted by the age of 2 years. Surgical deformity correction is rarely…
Congenital Pseudoarthrosis of the Tibia and Dislocation of the Knee
The etiology of CPT is unclear. Approximately 55% of affected children with anterolateral bowing subsequently develop clinical findings of neurofibromatosis, although only 6% of patients with NF1 have anterolateral tibial…
Madelung Deformity
Madelung deformity is bilateral in two thirds of the patients. Rarely, a reversed Madelung deformity may occur in which the articular surface of the distal radius is angulated dorsally and…
Congenital Elevation of Scapula, Absence of Clavicle, and Pseudarthrosis of Clavicle
Associated malformations are almost always present with a Sprengel deformity. These can include anomalies in the cervicothoracic vertebrae or the thoracic rib cage. The most common anomalies are absent or…
