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    Correction of angular deformities of the knee by percutaneous hemiepiphysiodesis
    (Lippincott Williams & Wilkins, 2007) Inan, Muharrem; Chan, Gilbert; Bowen, J. Richard
    Predicting patients' remaining angular growth and timing for hemiepiphysiodesis are crucial for correcting coronal plane knee deformities in children. We asked whether the Angular Deformity Versus Growth Remaining Chart predicted correction of coronal angular deformities of the knee in children. Serial orthoroentgenograms and the predictive chart were used to time percutaneous hemiepiphysiodesis, and the children were followed until skeletal maturity. Twenty-rive consecutive children (35 extremities) with a mean skeletal age of 13 years (range, 9.6-16 years) had percutaneous hemiepiphysiodeses as described by Bowen and Johnson, and were followed up until skeletal maturity. At skeletal maturity, correction of varus and valgus coronal plane deformities were within 2 degrees (range, 0 degrees-6 degrees) of the predicted value. The maximum limb-length discrepancy resulting from the procedure was 1.5 cm. The only complication was failure of a physeal bar formation hemiepiphysiodesis; this was treated successfully with a repeat percutaneous hemiepiphysiodesis. The percutaneous hemiepiphysiodesis is effective and has a low complication rate. Angular correction and timing for hemiepiphysiodesis can be predicted by using the Angular Deformity Versus Growth Remaining Chart in children with coronal plain knee deformities.
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    Epiphysiodesis in a patient with osteopetrosis
    (Lippincott Williams & Wilkins, 2006) Inan, Muharrem; Chan, Gilbert; Bowen, J. Richard
    We describe a 14-year-old girl with intermediate-type osteopetrosis who presented with a 4.8-cm leg-length discrepancy secondary to premature distal femoral growth plate closure. She had a projected leg-length discrepancy of 7 cm at maturity, which was predicted using Moseley charts. The patient was treated successfully with an epiphysiodesis. Her remaining growth was predicted by Moseley charts. A percutaneous epiphysiodesis can treat leg-length discrepancies in patients with osteopetrosis.
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    Knee arthritis in congenital short femur after Wagner lengthening
    (Springer, 2006) Jeong, Changhoon; Inan, Muharrem; Riddle, Eric C.; Gabos, Peter G.; Bowen, J. Richard
    Knee anomalies are common in patients with congenital short femurs who require lengthening to correct limb-length discrepancies. We retrospectively reviewed the incidence of knee arthritis and the factors influencing its occurrence after femoral lengthening using the Wagner method. Twenty-three patients with congenital short femurs treated with the Wagner method were followed up until skeletal maturity (minimum, 5 years postoperatively). The mean age of the patients at lengthening was 10.8 years (range, 8.4-14.5 years). The mean leg-length discrepancy at the time of surgery was 9.7 cm (femur, 7.6 +/- 3.7 cm; tibia, 2.1 +/- 1.8 cm). Femoral lengthening (mean, 7.9 cm) was performed in 17 patients. Femoral lengthening and tibial lengthening were performed simultaneously in six patents (mean, 11.8 cm). The mean age of the patients at the last followup was 16.8 years (range, 14-20.3 years). Eighteen patients had arthritis at followup. Nine patients had severe arthritis develop, seven of whom had knee instability preoperatively and temporary subluxation during the lengthening procedure. Seventy-eight percent of patients had arthritis develop in the knee after lower-limb lengthening using the Wagner method for congenital short femurs. Patients who had an unstable knee before surgery had temporary knee subluxation develop during the lengthening procedure, and patients who had simultaneous lengthening of the femur and tibia had a high association with degenerative arthritis changes in the knee.