Inhibition and stimulation of growth
Jansen, K.
Acta Orthopaedica Scandinavica 26(4): 296-308
1957
ISSN/ISBN: 0001-6470 PMID: 13443907 Document Number: 9184
Polio is the most frequent cause of discrepancy of leg length. The several other conditions causing overgrowth or shortening are surveyed. In treating unequal length of the legs three possibilities are at hand: 1) bandage, 2) osteotomy for correction by traction or by resection, 3) intervention on the rate of growth: inhibition or stimulation. An estimate of the several methods reported in the literature is discussed. Personal results reported have been obtained by epiphyseal arrest (46 cases) and by growth stimulation (68 cases). Epiphyseal arrest: Among the 46 cases no severe complications occurred, particularly no cases of deformity. One child had a transitory peroneal paralysis, and in two cases a slight flexion contracture of the knee joint. In five cases the staples loosened, and new staples were inserted. Overgrowth of the fibula was noted in one case due to insufficient block of the fibular epiphysis. In all cases the discrepancy has been reduced. The results obtained arc compared with the growth curve by Green and Anderson. The Phemister operation gave the most dependable effect (6 cases), hut even some eases treated by the Blount stapling were equal to the Phemister results. In spite of the preliminary results being satisfactory a complete equalisation was achieved in no case. Growth stimulation was attempted by the Pease operation, inserting one or two ivory screws in the metaphyses of the tibia and femur close to the knee. The obtained effect is minimal. The effect appears to occur in the first few months after the procedure. Later the gain is more or less reduced. According to Pease the effect should be estimated in relation to the expected increase of the inequality. Sympathectomy has not been considered an efficient method according to the literature. In two cases, however, when epiph;yseal arrest and ivory insertion were combined with sympathectomy the effect was more pronouncNI than any other result in the group .
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