[Stress fracture following femoral epiphysiodesis]

Growth guiding is currently widely practiced for deformity correction in the growing child. Different methods have been developed. In 2007 Stevens described a tension band device (8-plates) as a simple growth control method. Since then it has been widely used, e.g. in hemiepiphysiodesis to correct varus or valgus deformities or extension defect in the knee. Temporary epiphysiodesis can also be used to correct leg length discrepancy more accurately. Complications after treatment with 8-plates are well-described. Stress fracture after the usage of this device has to our knowledge not yet been described. We present a case with a fracture in the distal femur through 8-plates screw holes.

Valgus and flexion deformity after reconstruction of the anterior cruciate ligament in a skeletally immature patient

Anterior cruciate ligament reconstruction in children with open physes is still a topic of debate. We report a unique case of growth disturbance in valgus and flexion of the distal femoral epiphysis, after an ACL reconstruction in a 14.5-year-old boy. The Clocheville technique using the patellar tendon was performed. The femoral tunnel and tibial groove were both positioned above the growth plates. Eighteen months after ACL reconstruction, the patient had to be re-operated on for a valgus and flexion deformity of the femoral epiphysis. The clinical, radiological and aesthetic results were satisfactory. The angular deformity was caused by the fact that either the femoral tunnel was too close to the posterolateral femoral growth plate or an excessive eccentric traction of the graft in relation to the central point of the knee.

[Surf and Seymour's fractures]

The authors present four cases of Seymour-like juxtaepiphyseal fractures related to surf accidents. All four patients were novices at the sport, had the same fractures in identical circumstances. In all cases, reduction was achieved using an 'in-and-out' 1.2 K-wire serving as a 'joystick' which was then also used for fixation. The nail was fixed at the end.

Comparison of three surgical epiphysiodesis techniques for the treatment of lower limb length discrepancy

Three operative techniques for epiphysiodesis to correct lower limb length discrepancy (LLD) are compared: the Phemister technique, the percutaneous drilling-curettage technique and percutaneous epiphysiodesis using a transphyseal screw. Between 1987 and 2008, 92 patients with LLD were treated by surgical epiphysiodesis. Eighty patients were available for this retrospective study. No statistically significant difference was found between the three techniques concerning their efficiency in correction of lower limb length discrepancy. Percutaneous epiphysiodesis using a transphyseal screw appeared to be the best technique regarding mean operative time, mean hospitalisation time, postoperative pain and recovery of ambulation in the postoperative period. Complication rates were similar with the three techniques.

Drilled hole defects in mouse femur as models of intramembranous cortical and cancellous bone regeneration

In order to identify pertinent models of cortical and cancellous bone regeneration, we compared the kinetics and patterns of bone healing in mouse femur using two defect protocols. The first protocol consisted of a 0.9-mm-diameter through-and-through cortical hole drilled in the mid-diaphysis. The second protocol was a 0.9-mm-diameter, 1-mm-deep perforation in the distal epimetaphyseal region, which destroyed part of the growth plate and cancellous bone. Bone healing was analyzed by ex vivo micro-computerized X-ray tomography and histology. In the diaphysis, the cortical gap was bridged with woven bone within 2 weeks. This newly formed bone was rapidly remodeled into compact cortical bone, which showed characteristic parameters of intact cortex 4 weeks after surgery. In the epimetaphysis, bone formation was initiated at the deepest region of the defect and spread slowly toward the cortical gap. In this position, newly formed bone quickly adopted the characteristics of trabecular bone, whereas a thin compact wall was formed at its external border, which reached the density of intact cortical bone but failed to bridge the cortical gap even 13 weeks after surgery. This comparative study indicates that the diaphyseal defect is a model of cortical bone healing and that the epimetaphyseal defect is a model of cancellous bone repair. These models enable experimental genetics studies to investigate the cellular and molecular mechanisms of spontaneous cortical and cancellous bone repair and may be useful for pharmacological studies.

Dysplasia epiphysealis hemimelica: radiographic and magnetic resonance imaging features and clinical outcome of complete and incomplete resection

OBJECTIVES

The objectives of this communication were to discuss radiographic and magnetic resonance (MR) imaging manifestations and clinical outcome after complete and incomplete resection of the mass of dysplasia epiphysealis hemimelica (DEH).

MATERIALS AND METHODS

Clinical records, radiographs, and MR images of eight patients with DEH were retrospectively examined. Six patients were treated by complete excision of the lesional mass, and two patients were treated by incomplete resection at our University Hospitals during the period from 1980 to 2006.

RESULTS

We found that, unlike in osteochondroma, DEH was radiographically not clearly separable from the underlying or host bone with preserved cortical bone and marrow continuity. The finding in the talus distinguished DEH from (osteochondroma-like) parosteal osteosarcoma, in which a radiolucent demarcation line clearly separated the tumor from the host bone. The DEH mass had a well-defined low to intermediate signal intensity on T1-weighted images and an intermediate to high signal intensity on T2-weighted images, with irregularity of the articular surface. Simple excision was performed in all patients. The excision was complete in six patients and incomplete in two patients whose lesions was juxta-articular in the ankle and articular in the knee, respectively. The residual mass slowly absorbed and vanished, resulting in mild flaring of the affected portion of the epiphysis. No local recurrence or complication was seen in any of the eight patients.

CONCLUSIONS

Although the radiographic signs of DEH are characteristic, (osteochondroma-like) parosteal osteosarcoma should be differentiated from DEH when there is a radiolucent separation line between the mass and host bone in the talus. Simple excision was effective in the management of DEH if the deformity was not complicated. Incompletely excised masses resolved and vanished with time.

The epiphyseal scar as a radiographic landmark for retrograde femoral nail insertion

The purpose of this study was to examine the epiphyseal scar and its relationship to the intercondylar notch on anteroposterior (AP) radiographs of the knee and to establish its usefulness with retrograde femoral nail insertion. AP radiographs of 100 skeletally mature (50 male and 50 female) knees were used for measurements of the distance from the intercondylar notch to the epiphyseal scar. This data was correlated with intraoperative findings on 34 consecutive patients who underwent retrograde nail insertion. For men, the mean distance from the intercondylar notch to the epiphyseal scar on a "true" AP radiograph averaged 18.55 mm (range, 15.4-24.9 mm). For women, the mean distance measured 16.61 mm (range, 13.2-21.8 mm). Clinical intraoperative correlation revealed that all nails were inserted deep to the articular cartilage and that no intramedullary nails were prominent. The use of the epiphyseal scar on the AP fluoroscopic view as a landmark for the placement of the most distal interlocking screw of the nail ensures extra-articular nail placement. Good visualization of the epiphyseal scar and an understanding of nail geometry can assist in proper retrograde femoral intramedullary nail insertion without direct visualization of the entry site.

[Repair and reconstruction of traumatic defect of medial malleolus in children]

OBJECTIVE

To investigate the operative method and clinical effect of repairing and reconstructing the traumatic defect of medial malleolus in children with complex tissue flap of vascularized fibular head epiphysis.

METHODS

From July 2003 to December 2007, 8 children with defect of medial malleolus due to wheel injury were treated, including 5 boys and 3 girls aged 2-10 years old. The medial malleolus were completely defected (5 cases at left foot and 3 cases at right foot) and combined with the skin defect around the medial malleolus (4.0 cm x 2.0 cm - 9.5 cm x 5.5 cm). The time from injury to hospital admission was 6-8 hours in 2 cases, and 24-168 hours in 6 cases. The complex of vascularized fibular head epiphysis and tissue flap was adopted to repair the defect. The flap 4.5 cm x 2.5 cm - 10.0 cm x 6.0 cm in size and the fibular head epiphysis 2.5-3.0 cm in length were harvested. The donor site was sutured directly.

RESULTS

All wounds healed by first intention, all the composite tissue flap survived with good blood circulation, all the epiphysis of medial malleolus healed within 6-9 weeks, and all the donor sites healed well. All the child patients were followed up for 1-5 year. The color and elasticity of the flaps were good, without cicatricial contracture. The patients had no inversion of ankle joint, with satisfying loading and walking function. Six cases had normal flexion and extension of the ankle and 2 cases were limited slightly (dorsiflexion 10-20 degrees, plantarflexion 35 degrees). Talus has no inner move and ankle joint had no eversion. Seven cases were graded as excellent and 1 as good according to the standard of American Orthopaedic Foot & Ankle Society. For the medial malleolus, no premature closure of epiphysis occurred, and the center of ossification grew gradually and well developed like the contralateral side. The donor knee joint had normal flexion and extension function, without inversion and instability.

CONCLUSION

The complex of vascularized fibular head epiphysis and tissue flap can repair the epiphysis and soft tissue defect of medial malleolus in children at one stage, and the reconstructed medial malleolus can develop with the growth of children. It is a satisfactory method of reconstructing the traumatic defect of medial malleolus in children.

[The false equivalent Galeazzi in children]

We report the case of a false Galeazzi equivalent in children. This injury is characterised by an epiphyseal detachment of the distal extremity of the ulna rather than a distal radio-ulnar dislocation. A 16-year-old patient was injured in a fall from a bike. Radiographs showed a fracture of the radial shaft with anterior angulation, together with a type II Salter-Harris epiphyseal injury at the level of the distal ulna. We were unable to perform a closed reduction under general anesthesia due to interposition of periosteum at the fracture site. Thus surgical management was the only option, which consisted of removing the offending periosteum and performing osteosynthesis of the radial shaft fracture with a plate, and the epiphyseal detachment with pins. After 10 months, we noted no bone growth disturbance, or any reduced mobility of the wrist. We will continue the follow-up to monitor bone growth disturbance of the distal extremity of the ulna.

[Epiphyseal fracture of the proximal tibia: review of the literature and report of simultaneous bilateral fractures in a 13-year-old boy]

Proximal tibial epiphyseal injury is a rare finding in adolescents. We report the case of a 13-year-old boy with simultaneous epiphyseal fractures of both proximal tibiae to illustrate appropriate diagnosis and treatment of this condition. The injury occurred while performing a long jump: a Salter-Harris type II fracture of the right proximal tibia was sustained at take-off and a Salter-Harris type III avulsion fracture of the left tibial tuberosity upon landing. Closed reduction and internal fixation using K-wires were performed on the right side, whereas open reduction and internal fixation were done on the left side, using a lag screw and additional McLaughlin wiring.

[Surgical treatment of patients with fractures of distal metaepiphysis of the radial bone]

Traumatologic emergency to patients with primary unstable, comminuted, intraarticular fractures of distal metaepiphysis of the radial bone (DMRB) should be provided in steady-state conditions, using reliable methods of reposition and retention of the fixed bone fragments. The strategy of treatments of fractures of DMRB first consisting in closed reposition and in surgery in case of failure or secondary displacement is thought to be outdated. In patients with symptoms of unstable fractures active surgical strategy should be used before complications appear.

Unilateral pedicle screw epiphysiodesis of the neurocentral synchondrosis. Production of idiopathic-like scoliosis in an immature animal model

BACKGROUND

The neurocentral synchondrosis plays a role in the growth of the spine. The goal of this study was to determine whether asymmetric epiphysiodesis of this synchondrosis creates a scoliotic deformity in a growing-animal model and to correlate curve magnitude with the degree of closure of the synchondrosis.

METHODS

Two-month-old pigs were assigned to three groups. In the control group, two animals received a sham operation without pedicle screw fixation; in the single-screw group, three animals were treated with a single right transpedicular screw placed across the neurocentral synchondrosis from T7 to T14; and in the double-screw group, three animals were treated in the same way as the previous group except that two screws were placed in each pedicle. The animals were killed at six months, and radiographs and axial computed tomography images of the spine were obtained. Histomorphometric analyses were performed to grade the synchondrosis at each level.

RESULTS

A scoliotic curve was seen in none of the animals in the control group, in one of the three in the single-screw group, and in all three in the double-screw group (30 degrees, 42 degrees, and 42 degrees). Vertebral rotation in the axial plane occurred toward the screw side and was significantly greater in the double-screw group (mean, 15.2 degrees) than in the single-screw (mean, 6.1 degrees) and control (0 degrees) groups (p < 0.001). There was no difference in morphology between the left and right pedicles in the control group. The left pedicle was 9% longer than the right (screw-treated) pedicle in the single-screw group, and it was 22% longer than the right pedicle in the double-screw group. Closure of the neurocentral synchondrosis was greatest in the double-screw group (>75% closure) compared with the single-screw group (<50% closure) (p < 0.0001) and the control group (no closure) (p < 0.0001), and closure correlated with the magnitude of the coronal curve (p = 0.001).

CONCLUSIONS

Unilateral transpedicular screw fixation that traverses the neurocentral synchondrosis in a growing-pig model can produce asymmetric growth of the synchondrosis to create scoliosis with the convexity on the side of the screw fixation. Double pedicle screws provided a greater epiphysiodesis effect on the neurocentral synchondrosis, which correlated with a greater degree of scoliosis.

[Bilateral upper femoral physis injury in a case of epilepsy in a young child]

Detachment of the proximal epiphyseal plate of the femur is a rare observation in infants. The context usually involves obstetrical injury or child abuse. There is however a high risk in certain children with epilepsy. Fractures and dislocations can occur during hypertonic seizures in a context of iatrogenic bone weakening due to drug treatments. Emergency reduction is required and requires a double fixation with osteosynthesis and plaster cast in order to reduce the risk of secondary displacement in this particular context. The risk of major impact on growth requires prolonged radiographic and clinical follow-up.

[A secondary bleeding false aneurysm of the superomedial genicular artery after distal femoral epiphysiodesis: a case report]

A 16-year-old male developed a false aneurysm of the superomedial genicular artery five weeks after medial distal femoral epiphysiodesis. The aneurysm was revealed by inexhaustible bleeding from the medial aspect of the knee and the presence of acute hemorrhage which resolved spontaneously. Physical examination disclosed disunion of the surgical wound at the apex of a pulsatory tumefaction over the medial aspect of the knee. AngioCT enabled the diagnosis of a false aneurysm of the superomedial genicular artery. Emergency surgery was undertaken to drain the hematoma and exclude the false aneurysm by ligating the superomedial genicular artery.

Allograft reconstruction of segmental defects of the humeral head associated with posterior dislocations of the shoulder

Six men underwent operative management of defects of the humeral head involving at least 40% of the articular surface, following posterior dislocation of the humeral head. The cause of dislocation was a grand mal seizure in three and a fall in three cases. In five cases the dislocation was reduced under general anaesthesia, and in all the posterior dislocation recurred early. Time between dislocation and surgery ranged from 7 to 8 weeks. The defect in the head, revealed by CT, was filled with an allogeneic segment of humeral head contoured to restore the spherical shape. All the patients returned to their occupation 4 months later. The mean duration of follow-up was 62.6 (60-68) months. At discharge, four of the men had no complaints of pain, instability, clicking or catching; two had pain, clicking, catching and stiffness. Radiographs and CT revealed no failures of fixation or of incorporation of the allograft. In four cases the contour and volume of the graft were maintained, but in the two with a bad clinical result, flattening and collapse of the graft and osteoarthrosis were observed. If the procedure fails, prosthetic reconstruction should be simple because the skeletal anatomy has not been distorted.

[Surgical treatment of acute coronoid process fractures]

OBJECTIVES

This study was designed to assess the results of surgical treatment for type 2-3 coronoid process fractures and to identify factors that might influence the outcome.

METHODS

Thirteen male patients (mean age 35 years; range 17 to 53 years) were treated with open reduction and internal fixation for displaced coronoid fractures. According to the Regan-Morrey classification, the fractures were type 2 in nine patients (69.2%), and type 3 in four patients (30.8%). Nine patients had associated injuries (elbow dislocation, radial head or olecranon fractures, and/or ligamentous injuries). The mean duration to treatment was 2.3 days (range 1 to 7 days). Functional results were assessed according to the Mayo elbow performance score (MEPS), and signs of arthritis were assessed according to the Broberg-Morrey criteria. The mean follow-up was 41.1 months (range 12 to 96 months).

RESULTS

A functional range of motion of the elbow joint was achieved in 10 patients (76.9%). The mean elbow range of motion was 110.7 degrees (range 85 degrees to 130 degrees ) and the mean forearm rotation was 134.2 degrees (range 120 degrees to 155 degrees ). Three patients who had comminuted fractures and associated elbow injuries had decreased range of motion. None of the patients exhibited signs of instability. The mean MEPS was 86.5 (range 75 to 100). The results were excellent in four patients (30.8%; the mean MEPS 98.8) having isolated or noncomminuted coronoid fractures, and good in nine patients (69.2%) with comminuted fractures and/or associated bone or ligament injuries. Post-traumatic arthritis was detected in seven patients (53.9%) whose mean MEPS was 81.4. Patients with an excellent functional result did not develop arthritis. All the patients returned to preinjury activity levels.

CONCLUSION

Coronoid fractures are the most important component of complex elbow injuries. The presence of comminuted fractures, associated bone and ligament injuries, and post-traumatic arthritis affect the outcome adversely.

Juvenile hallux valgus deformity: surgical management by lateral hemiepiphyseodesis of the great toe metatarsal

Surgical correction of juvenile hallux valgus (JHV) by soft tissue balancing or skeletal realignment is associated with a high rate of recurrence of the deformity. An alternative treatment strategy for the management of symptomatic or progressive JHV, consisting of lateral hemiepiphyseodesis of the great toe metatarsal physis, has been used at our institution since 1996. A review of these cases was performed to determine the outcomes in the technical and patient satisfaction domains. Preoperative and follow-up radiographs of the foot were analyzed to measure the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the proximal metatarsal articular angle (PMAA), and the metatarsal length ratio. Repeated measures of the radiographs were performed to determine intraobserver reliability. The medical records were reviewed to determine the children's age at presentation, chief complaints, age at surgery, tourniquet time of the surgical procedure, length of follow-up, the need for subsequent foot surgeries, and complications. Follow-up clinic or telephone interviews were performed to determine patient satisfaction. Seven children with 11 feet treated for JHV were available for study. Mean age at the time of the index surgery was 10 years 4 months (range, 9 years 7 months-11 years 1 month). Mean follow up after surgery was 4 years 2 months (range, 1 year 7 months-7 years 6 months). The mean improvement in the IMA was 2.32 degrees (range, 0-5 degrees; P < 0.0001). The mean improvement in the HVA was 3.45 degrees (range, 0-9 degrees; P = 0.027). Significant correction of both the IMA and the HVA was achieved in 6 (55%) of 11 of the feet. In no case did either of the measures worsen. The mean change in the PMAA in the anteroposterior plane was 5.09 degrees (range, 0-11 degrees; P = 0.001). The mean change in the PMAA in the lateral plane was 1.00 degree (range, 0-3 degrees; P = 0.008). The mean change in the metatarsal length ratio was 0.01 (range, 0.07-0.11), which was not statistically significant (P = 0.65). Lateral hemiepiphyseodesis of the great toe metatarsal was effective at halting the progression of the JHV deformity in all cases and achieved significant correction of both the IMA and the HVA in more than 50% of the feet. Lateral hemiepiphyseodesis of the great toe metatarsal is a reasonable alternative for the management of symptomatic or progressive JHV, given the high recurrence rate associated with other soft tissue and skeletal surgical procedures.

Treatment of acute salmonella epiphyseal osteomyelitis using computed tomography-guided drainage in a child without sickle cell disease

Salmonella osteomyelitis occurs infrequently in children without sickle cell disease. Similarly, acute osteomyelitis of the epiphysis has been rarely reported. We present a case of primary epiphyseal osteomyelitis caused by Salmonella in the distal femur of an otherwise healthy 17-month-old child. Before isolating an organism, parenteral nafcillin provided ineffective clinical, radiographic, and laboratory responses. Repeated fluoroscopic-guided percutaneous surgical drainages allowed for identification of the Salmonella, but did not resolve the epiphyseal infection, as the infection focus was missed. In the effort to eradicate the infection yet minimize further trauma to the epiphysis, computed tomography-guided drainage was performed and the infection subsequently resolved. Owing to its greater localization accuracy and minimal invasiveness, the computed tomography-guided intervention allowed for precise drainage without compromising the contiguous growth plate. At latest follow-up, the patient was ambulating well, had a normal knee examination, and had no evidence of leg length discrepancy or growth disturbance.

Avascular necrosis in acute and acute-on-chronic slipped capital femoral epiphysis

This study reviews the factors affecting the development of avascular necrosis (AVN) after slipped capital femoral epiphysis. Seventy-three patients (n=73) with ninety-two (n=92) hips were included in the study. Out of these 92, 16 were acute, 43 acute-on-chronic, 29 chronic, and four were preslips. Postoperative radiographs showed a reduction in 18 (19.5%) slips. The mean preoperative slip angle was 32 degrees (range 9-76) compared with the postoperative slip angle of 29.9 degrees (range 10-75 degrees ) (P=0.004). Four patients developed AVN. Our results showed that intraoperative reduction of the slip (P<0.001) was significantly related to the development of AVN and was also associated with poor functional outcome.

[In situ pinning with Kirschner wires for chronic juvenile slipped capital femoral epiphysis]

Fixation in situis the most common method of management for different degrees of slip of the proximal capital femoral epiphysis. The aim of our study is to retrospectively analyze final results and complications after in situ pinning with Kirschner wires for stabile slipped capital femoral epiphysis. We retrospectively reviewed clinical records and radiographs of 61 children (17 girls and 33 boys) at the average age of 11.8 years. The average follow-up period was 7.4 years, minimum 3 years. In slips 300 and less (38 hips) vast majority of patients had very good and good subjective results (pain and function), 5% and 8% has satisfactory objective (limping and range of motion) and radiological results respectively. In slips between 30-60 degrees (23 hips) 75%, 60% and 70% had satisfactory subjective, objective and radiological results respectively. One child had chodrolysis that resolved at later follow up. There was no case of AVN. In 6 cases wires migration was found. In situ spinning with Kirschnerwires is simple safe and gives satisfactory results. This method of treatment especially recommended in younger, skeletally immature children with remaining growth of femoral neck.

Correction of deformity and shortening due to post traumatic epiphyseal arrest by distraction osteogenesis

Growth arrest in the epiphyseal plate during childhood often causes both periarticular deformities and limb length discrepancy, leading to compartmental osteoarthrosis and gait disturbance or spinal disorders, respectively. Distraction osteogenesis using external fixators with hinge systems appears to be useful for the simultaneous correction of deformity and shortening. In this paper, we evaluated cases of lower limbs with periarticular deformities and limb length discrepancy after epiphyseal plate injury that has been treated by distraction osteogenesis using external fixators. This is the first report regarding the outcomes of distraction osteogenesis for a group of patients having deformity and limb length discrepancy due to traumatic arrest of the physis. Successful outcomes may promise the use of this method as the first choice for the treatment of growth disorders after the arrest of the epiphyseal plate in the lower limbs. However, treatment under 20 years of age may provide a better outcome with a lower incidence of complications.

Longitudinal epiphyseal bracket

A longitudinal epiphyseal bracket (LEB) is a defect of the tubular bones and has been primarily described in the hands and feet, especially the proximal phalanges, metacarpals, and metatarsals. The LEB results from a defective C-shaped secondary ossification center that brackets the diaphysis and metaphysis, causing restricted longitudinal growth in these bones with resultant shortening and angular deformities. Deformities associated with metatarsal epiphyseal bracket include a short, broad metatarsal and medial deviation of the metatarsophalangeal joint (hallux varus deformity). Excision of the cartilaginous LEB has been proposed to prevent future soft tissue contractures and osseous deformities. The LEB has been associated with numerous syndromes including Rubinstein-Taybi syndrome, Cenani-Lenz syndactyly, isolated oligosyndactyly, and Nievergelt syndrome. We describe a two-month-old patient in whom plain film and MR imaging demonstrated bilateral bracketed first metatarsals with associated hallux varus deformities. Bilateral bracket excision was performed with excellent clinical results.

Results of screw epiphysiodesis for the treatment of limb length discrepancy and angular deformity

The purpose of this study was to evaluate the technique of screw epiphysiodesis for effectiveness, predictability, and reversibility. We reviewed the cases of our first 60 patients (105 physes) treated with percutaneous screw epiphysiodesis or hemiepiphysiodesis. All cases were followed up to maturity or screw removal if growth remained after full correction. A total of 30 patients underwent the procedure for limb length inequality. Final inequality was compared with the predicted epiphysiodesis effect. A total of 30 patients (66 physes) underwent screw hemiepiphysiodesis for the correction of angular deformity. The degree of correction per month was calculated, the reversibility of the procedure was analyzed, and complications were evaluated. In the length group, at the end of treatment, the final limb length difference in the femur averaged 0.15 cm (SD, +/-0.37 cm) from the epiphysiodesis effect predicted by using the multiplier method. In the tibia, this difference was 0.05 cm (SD, +/-0.57 cm). In the angular group, the average correction in the distal femur was 6.91 degrees (SD, +/-3.75 degrees) or 0.75 degrees per month (SD, +/-0.45 degrees per month). In the proximal tibia, the average correction was 3.88 degrees (SD, +/-3.57 degrees) or 0.37 degrees per month (SD, +/-0.34 degrees per month). In all 13 cases where the screws were removed at the time of angular correction with significant growth remaining, growth resumed. Complications were minor and were related to incorrect placement of screws or minor hardware irritation. Percutaneous screw epiphysiodesis is a reliable, minimally invasive method with reliable results in both length and angular correction, with minimal morbidity, and with an acceptable complication rate.

Arthroscopic assisted fixation of juvenile intra-articular epiphyseal ankle fractures

The purpose of this study was to present the long-term follow-up of a case series of arthroscopically assisted fixation of juvenile intraarticular epiphyseal ankle fractures. The functional and radiographic outcomes of 6 patients with a range of follow-up of 1 to 5 years were evaluated. Five of the 6 patients had triplane injuries, whereas the remaining patient sustained a juvenile Tillaux fracture. All of the patients returned to full activity within 14 weeks of surgery, and none of the patients had any restriction in the ankle range of motion at the time of last follow-up. The results of this small series of patients suggest that arthroscopic-assisted, percutaneous fixation of intraarticular juvenile epiphyseal ankle fractures is an effective, less invasive surgical technique. Several surgical maneuvers that are helpful in the consistent execution of this technique are also mentioned.