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 method of Menalaus assumes that boys close their growth plates at an average age of 16 while girls close their growth plates at an average age of 14. Assuming 1.0 cm of growth per year from the distal femur and 0.6 cm per year from the proximal tibia, the magnitude of the final discrepancy at skeletal maturity can be predicted and therefore the appropriate timing of the epiphysiodesis determined. The Moseley straight-line graph helps determine the estimated lengths of the long and short bones at maturity, the discrepancy at maturity, and when the best equalization procedure should be performed. Although the Moseley graph is believed to be much more accurate in cases of significant growth inhibition, it is simply a logarithmic representation of the Green and Anderson chart. The child’s skeletal age, which is determined by comparing the left hand to the Greulich and Pyle Radiographic Atlas, is used to determine the appropriate time for equalization procedures.
Regular follow-up is necessary to determine if the discrepancy is progressive and whether conservative measures (e.g., orthoses, prostheses) or surgery are the best methods of correction.
Surgical procedures for leg-length discrepancy include (1) shortening of the long side by arresting or retarding epiphyseal growth or resecting a segment of bone; (2) femoral, tibial, or transiliac lengthening of the short side; (3) combined shortening of the long side and lengthening of the short side; and (4) prosthetic fitting.
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