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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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    Heterotopic ossification following hip osteotomies in cerebral palsy: Incidence and risk factors
    (Lippincott Williams & Wilkins, 2006) Inan, Muharrem; Chan, Gilbert; Dabney, Kirk; Miller, Freeman
    The aims Of this Study are, first, to determine the incidence of heterotopic ossification (HO) in patients with cerebral palsy (CP) who have undergone pelvic and/or proximal femoral osteotomies and, second, to identify any risk factors that may, contribute to its development in this patient population. The radiographs of 219 consecutive patients with CP who underwent proximal femoral osteotomies with or without pelvic osteotomies were reviewed. Risk factors including gender, age, and degree of involvement, ambulatory status, previous hip operations, bilateral hip surgery, capsular release, concomitant pelvic osteotomy. infection, and history of exuberant callus were evaluated. Thirty-five (16%) patients were diagnosed with HO and the 5 factors that cause HO were identified, which are degree of involvement (quadriplegic), ambulatory status, capsular release, infection, and previous hip operations. Based on logistic regression analysis. if a patient had quadriplegic type of CP, then they have 17.5 times more risk for HO than a patient with hemiplegic type, and capsular release increases the risk 237 times. Although HO Occurred in 16% of patients treated with bony procedures in the hip, in a small group (2%) of children it had a clinically significant limitation requiring surgical resection. In this Study, clear risk factors were presented for the development of HO; however, none of these risk factors can be altered in ways that will reduce the risk for HO. These risk factors might be used to define a high-risk group in whom attempts at prophylactic treatment lot, prevention of HO Could be initiated.