Faculty Bibliography

Nine patients have undergone percutaneous epiphysiodesis using a 4.5-mm drill and image intensification fluoroscopy. The minimal surgical exposure resulted in minimal postoperative discomfort, excellent cosmesis, and complete closure of the physis in all patients in three to five months. No complications were encountered. The procedure is easy to perform and reliable.

An angle within the femoral arch is defined, and its line is described in selecting the osteotomy site and the position of the fixation device in performing a femoral varus osteotomy. This neck metaphyseal angle was measured with varying degrees of rotation on seven pediatric femurs; it was also studied on 283 randomly selected hip radiographs. The angle varied 25-40 degrees in 90% of the patients and was not age related. The angle is stable within 5 degrees as long as the landmarks, base of the great trochanter, and medial metaphysis of the femoral neck are definable (0-30 degrees of rotation).

An atypical case of nonossifying fibroma involving the femoral neck of a 7-year-old white male is presented. The radiographic characteristics of the lesion were consistent with this diagnosis, although the location is rare. The differential diagnosis included fibrous dysplasia, unicameral bone cyst, chondroblastoma, and eosinophilic granuloma. A final diagnosis was obtained through tissue biopsy and histopathologic review.

A case of medial subtalar dislocation associated with a calcaneonavicular coalition is presented. The trauma of the dislocation resulted in fracture of the coalition.

Twenty-nine reoperated clubfeet were reviewed. The age range of the patients at the time of the revision surgery was 1-12 years. The average follow-up period was 30 months (range 9-36 months). The surgical procedure used most often in the revision surgery was complete soft tissue release alone or combined with plantar release, calcaneocuboid fusion, and capsulotomies of the navicular first-cuneiform joint and the first-cuneiform first-metatarsal joint. In 27 of 29 feet the results were considered acceptable (19 of 29 were rated excellent or good). An algorithm that suggests surgical solutions to a variety of clubfoot deformities in different age groups has been developed, as well as an objective functional rating system to evaluate long-term results in revision clubfoot surgery.

Fifteen deformed limbs in 10 patients with neuromuscular problems were treated by the Ilizarov technique. Five patients with cerebral palsy had, respectively, two deformities, two tight hamstrings and knee flexion contractures, and one bilateral external tibial torsion; two patients with spina bifida (L5-S1) had foot deformities; one arthrogrypotic patient had flexion contractures of both knees; one poliomyelitis patient had flexion contractures of both knees and equinovarus deformities of the feet; and one patient with Poland's syndrome had a 90 degree flexion contracture of the wrist. Complications were few, and none compromised full correction which was achieved in nine patients. The Ilizarov method is a new and efficient tool which can be successfully applied in the treatment of neuromuscular patients.

Sixty patients (eighty hips) who had slipped capital femoral epiphysis were treated by epiphyseodesis with a cannulated-screw technique. Forty-nine patients (sixty-seven hips) were available for follow-up, forty-four (sixty hips) of whom were followed for a minimum of two years. Thirty-five patients (forty-six hips) were followed until the hardware was removed. Of seventy-two hips in which contrast medium was injected, arthrographic results were obtained in three. In these three hips, there was evidence of pre-existing narrowing of the joint space. Four patients (six hips) who did not have evidence of penetration by a screw or guide-wire had evidence of either pre-existing chondrolysis or osteoarthrosis. Chondrolysis did not develop postoperatively in any patient who had no evidence of it preoperatively

Rotational displacement of the distal tibial physis occurred in a 12-year-old boy. A review of the literature indicates that long-term follow-up is necessary to determine whether premature physeal closure will occur