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Principles of Surgical Management
Published in Alaaeldin (Alaa) Azmi Ahmad, Aakash Agarwal, Early-Onset Scoliosis, 2021
Epiphysiodesis has been extensively used in the management of limb-length discrepancies and angular deformities of long bones. Convex hemiepiphysiodesis remains one of the most used methods for scoliosis. This is a relatively easy procedure with a short learning curve [4,5]. These procedures address the curve by reducing growth on the convex side and continuing growth on the concave side, provided there is enough growth potential. Progression is prevented (with potential regression of the deformity) by slowing down the growth of the curve convexity by the destruction of the growth plate. Presently the most common indication is in children with multisegment congenital deformities in which fusion is undesirable (for fear of aggravating potential thoracic insufficiency syndrome through trunk shortening), particularly when the anomalies are hemivertebrae. However, it may be applied in idiopathic EOS in combination with growth-guiding instrumentation.
Beckwith–Wiedemann Syndrome
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Jirat Chenbhanich, Sirisak Chanprasert, Wisit Cheungpasitporn
Limb−leg discrepancy should be regularly followed by an orthopedic surgeon, and screening for secondary scoliosis is warranted. In the case of mild limb dysmetria (<2 cm), orthotics (shoe lifts) are usually prescribed to make the lower limbs achieve the same length. Significant discrepancy (>2 cm) requires surgical intervention. The patient's age, the degree of asymmetry, and the affected segment determine the optimal timing of the surgery. Epiphysiodesis refers to fusion of the epiphyseal plates to halt the overgrowth; the procedure is commonly performed in children with BWS via minimally invasive approach [47].
Orthopaedic operations
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Michael Whitehouse, David Warwick, Ashley Blom
The timing and technique of epiphysiodesis is important. If it is inaccurately timed, a difference in leg lengths will remain, and if improperly done, deformity may occur. Physeal arrest will create a loss of 10 mm of length a year from the distal femur and 6 mm a year from the proximal tibia. As the physes close naturally at 16 years of age in boys and 14 years in girls, a predicted length discrepancy at maturity of 45 mm can, for example, be addressed by both a distal femoral and proximal tibial physeal arrest performed about 3 years before skeletal maturity.
Surgical treatment of macrodactyly of the foot in children
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Lu Chen, Wei Huang, Wei Chen, Xiaofei Tian
Although many treatment options and surgical procedures have been reported [6], each has its respective indications and limitations. Soft tissue debulking on its own is insufficient in reducing the size of the foot [1]. First ray resection can not be performed, as the first toe contributes to weight-bearing and normal gait. Forefoot enlargement cannot be corrected by toe amputation [14]. Epiphysiodesis restricts longitudinal rather than appositional growth [13]. In the face of the diverse clinical manifestations of pedal macrodactyly, numerous treatment options, with various combinations of surgical procedures, are needed to achieve better results, as well as to reduce the number of operations. The single-stage procedure in our treatment algorithm is an individualized multi-technique procedure, incorporating numerous treatment option combinations. Using this method, foot size was effectively reduced, and good clinical outcomes were achieved.
Comparison of histomorphometric and radiographic effects of growth guidance with tension-band devices (eight-Plate and FlexTack) in a pig model
Published in Acta Orthopaedica, 2021
Julia Sattelberger, Hauke Hillebrand, Georg Gosheger, Andrea Laufer, Adrien Frommer, Sebastian Appelbaum, Ahmed Abdul-Hussein Abood, Martin Gottliebsen, Ole Rahbek, Bjarne Moller-Madsen, Robert Roedl, Bjoern Vogt
Deformity recurrence occurring after implant removal before skeletal maturity is a common problem in growth modulation treatment (Stevens et al. 1999, Burghardt and Herzenberg 2010, Farr et al. 2018, Leveille et al. 2019). The likelihood of relapse of the deformity is reportedly higher if THE is performed at a young age, in the correction of secondary axis deviations or an angular axis deviation over 20°, and in the case of a fast correction rate (Stevens and Klatt 2008, Park et al. 2016, Farr et al. 2018, Leveille et al. 2019). Nonetheless, the occurrence of rebound phenomenon shows a very variable incidence, as the physeal response after release of the epiphysiodesis is hardly predictable (Aykut et al. 2005, Leveille et al. 2019). Widening of the formerly arrested part of the physis after release of the physeal compression has been described by several authors, and has been linked to accelerated unilateral growth with consecutive relapse of the initial deformity (Gottliebsen et al. 2013b), Corominas-Frances et al. 2015, Ding et al. 2018).
Height matters: The experiences of very tall young British adults in relation to managing everyday occupations
Published in Journal of Occupational Science, 2019
Julie Booth, Tanya Rihtman, Sheila Leddington Wright, M. Clare Taylor, Michael Price
In addition to these occupational aspects, individual satisfaction with height has been investigated. For example, Lever, Frederick, Laird and Sadeghi-Azar (2007) found that over half of women at 6 ft 1″ (1.85 m) to 6 ft 3″ (1.90 m) were satisfied with their height, however no data were available for women over 6 ft 4″ (1.94 m) due to the small number of participants in this height bracket. More than half of the men in the study who were taller than 6 ft 8″ (2.03 m) were dissatisfied, but again data were not available for men over 6 ft 11″ (2.10 m). Lever et al. (2007) also acknowledged that “many tall women encounter negative social interactions as a result of their height” and suggested 6 ft (1.82 m) height is the indicator for intervention by paediatric endocrinologists (p. 194). Benyi et al. (2010) concurred with this final height prediction indictor for intervention to reduce height for females, and included a final height prediction indicator for men of 6 ft 5″ (1.95 m). Parental and young person concerns of becoming too tall and experiencing challenges with everyday life has led to the use of hormone treatment to reduce the overall height of adolescent and pre-adolescent young people since the 1950s (Benyi et al., 2010; Cohen & Cosgrove, 2009). A more recent surgical intervention has emerged, percutaneous epiphysiodesis, which involves permanent removal of growth plates around the knee (Benyi et al., 2010).