The role of guided growth as it relates to limb lengthening
Identifieur interne : 008A70 ( Ncbi/Merge ); précédent : 008A69; suivant : 008A71The role of guided growth as it relates to limb lengthening
Auteurs : Peter M. Stevens [États-Unis]Source :
- Journal of Children's Orthopaedics [ 1863-2521 ] ; 2016.
Abstract
For decades, the classic indication for limb lengthening has been reserved for anisomelia that was expected to reach or exceed 5 cm at maturity. Epiphysiodesis was reserved for discrepancies in the 2–5 cm range. With the increasing sophistication of fixators, including rail, hexapod, and hybrid, complex deformities may be corrected simultaneously while moderate to extreme lengthening is achieved. More recently, iterations of telescoping intramedullary rods have further strengthened our armamentarium. Meanwhile, permanent epiphysiodesis techniques, both open and percutaneous, have yielded to more versatile and reversible tethering of one (angle) or both (length) sides of a physis. While the techniques of guided growth and callotasis seem to be diametrically opposed, they may be used in a tandem or complementary fashion, for the benefit of the patient. If treatment is undertaken during skeletal growth, one must be aware that issues remain regarding the accurate assessment of skeletal maturity and prediction of the ultimate outcome. Therefore, there is potential for over- or undercorrection. Reversible and serial guided growth now enable the surgeon to commence intervention at a comparatively young age, for the purpose of optimizing limb alignment and reducing the ultimate discrepancy. Frame application may be delayed or, in some cases, avoided altogether. With the limb properly aligned at the outset of lengthening, elective use of a telescoping intramedullary nail may now be favored over a frame accordingly.
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DOI: 10.1007/s11832-016-0779-8
PubMed: 27914027
PubMed Central: 5145829
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Stevens</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Utah</region></placeName><wicri:cityArea>Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City</wicri:cityArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27914027</idno><idno type="pmc">5145829</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5145829</idno><idno type="RBID">PMC:5145829</idno><idno type="doi">10.1007/s11832-016-0779-8</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000F59</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000F59</idno><idno type="wicri:Area/Pmc/Curation">000F58</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000F58</idno><idno type="wicri:Area/Pmc/Checkpoint">000514</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000514</idno><idno type="wicri:Area/Ncbi/Merge">008A70</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The role of guided growth as it relates to limb lengthening</title><author><name sortKey="Stevens, Peter M" sort="Stevens, Peter M" uniqKey="Stevens P" first="Peter M." last="Stevens">Peter M. Stevens</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Utah</region></placeName><wicri:cityArea>Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City</wicri:cityArea></affiliation></author></analytic><series><title level="j">Journal of Children's Orthopaedics</title><idno type="ISSN">1863-2521</idno><idno type="eISSN">1863-2548</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>For decades, the classic indication for limb lengthening has been reserved for anisomelia that was expected to reach or exceed 5 cm at maturity. Epiphysiodesis was reserved for discrepancies in the 2–5 cm range. With the increasing sophistication of fixators, including rail, hexapod, and hybrid, complex deformities may be corrected simultaneously while moderate to extreme lengthening is achieved. More recently, iterations of telescoping intramedullary rods have further strengthened our armamentarium. Meanwhile, permanent epiphysiodesis techniques, both open and percutaneous, have yielded to more versatile and reversible tethering of one (angle) or both (length) sides of a physis. While the techniques of guided growth and callotasis seem to be diametrically opposed, they may be used in a tandem or complementary fashion, for the benefit of the patient. If treatment is undertaken during skeletal growth, one must be aware that issues remain regarding the accurate assessment of skeletal maturity and prediction of the ultimate outcome. Therefore, there is potential for over- or undercorrection. Reversible and serial guided growth now enable the surgeon to commence intervention at a comparatively young age, for the purpose of optimizing limb alignment and reducing the ultimate discrepancy. Frame application may be delayed or, in some cases, avoided altogether. With the limb properly aligned at the outset of lengthening, elective use of a telescoping intramedullary nail may now be favored over a frame accordingly.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Machen, Ms" uniqKey="Machen M">MS Machen</name></author><author><name sortKey="Stevens, Pm" uniqKey="Stevens P">PM Stevens</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stevens, Pm" uniqKey="Stevens P">PM Stevens</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Phemister, Db" uniqKey="Phemister D">DB Phemister</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="White, Jw" uniqKey="White J">JW White</name></author><author><name sortKey="Stubbins, Sg" uniqKey="Stubbins S">SG Stubbins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bowen, Jr" uniqKey="Bowen J">JR 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Bertrand</name></author><author><name sortKey="Pasquier, P" uniqKey="Pasquier P">P Pasquier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stevens, Pm" uniqKey="Stevens P">PM Stevens</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stevens, Pm" uniqKey="Stevens P">PM Stevens</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pendleton, Am" uniqKey="Pendleton A">AM Pendleton</name></author><author><name sortKey="Stevens, Pm" uniqKey="Stevens P">PM Stevens</name></author><author><name sortKey="Hung, M" uniqKey="Hung M">M Hung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eastwood, Dm" uniqKey="Eastwood D">DM Eastwood</name></author><author><name sortKey="Sanghrajka, Ap" uniqKey="Sanghrajka A">AP Sanghrajka</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gottliebsen, M" uniqKey="Gottliebsen M">M Gottliebsen</name></author><author><name sortKey="M Ller Madsen, B" uniqKey="M Ller Madsen B">B Møller-Madsen</name></author><author><name sortKey="St Dkilde J Rgensen, H" uniqKey="St Dkilde J Rgensen H">H Stødkilde-Jørgensen</name></author><author><name sortKey="Rahbek, O" uniqKey="Rahbek O">O Rahbek</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ilharreborde, B" uniqKey="Ilharreborde B">B Ilharreborde</name></author><author><name sortKey="Gaumetou, E" uniqKey="Gaumetou E">E Gaumetou</name></author><author><name sortKey="Souchet, P" uniqKey="Souchet P">P Souchet</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Villemure, I" uniqKey="Villemure I">I Villemure</name></author><author><name sortKey="Stokes, Ia" uniqKey="Stokes I">IA Stokes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stevens, Pm" uniqKey="Stevens P">PM Stevens</name></author><author><name sortKey="Arms, D" uniqKey="Arms D">D Arms</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Corominas Frances, L" uniqKey="Corominas Frances L">L Corominas-Frances</name></author><author><name sortKey="Sanpera, I" uniqKey="Sanpera I">I Sanpera</name></author><author><name sortKey="Saus Sarrias, C" uniqKey="Saus Sarrias C">C Saus-Sarrias</name></author><author><name sortKey="Tejada Gavela, S" uniqKey="Tejada Gavela S">S Tejada-Gavela</name></author><author><name sortKey="Sanpera Iglesias, J" uniqKey="Sanpera Iglesias J">J Sanpera-Iglesias</name></author><author><name sortKey="Frontera Juan, G" uniqKey="Frontera Juan G">G Frontera-Juan</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Child Orthop</journal-id><journal-id journal-id-type="iso-abbrev">J Child Orthop</journal-id><journal-title-group><journal-title>Journal of Children's Orthopaedics</journal-title></journal-title-group><issn pub-type="ppub">1863-2521</issn><issn pub-type="epub">1863-2548</issn><publisher><publisher-name>Springer Berlin Heidelberg</publisher-name><publisher-loc>Berlin/Heidelberg</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27914027</article-id><article-id pub-id-type="pmc">5145829</article-id><article-id pub-id-type="publisher-id">779</article-id><article-id pub-id-type="doi">10.1007/s11832-016-0779-8</article-id><article-categories><subj-group subj-group-type="heading"><subject>Current Concept Review</subject></subj-group></article-categories><title-group><article-title>The role of guided growth as it relates to limb lengthening</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Stevens</surname><given-names>Peter M.</given-names></name><address><email>peter.stevens@me.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><aff id="Aff1">Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT USA</aff></contrib-group><pub-date pub-type="epub"><day>2</day><month>12</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>2</day><month>12</month><year>2016</year></pub-date><pub-date pub-type="ppub"><month>12</month><year>2016</year></pub-date><volume>10</volume><issue>6</issue><fpage>479</fpage><lpage>486</lpage><history><date date-type="received"><day>19</day><month>10</month><year>2016</year></date><date date-type="accepted"><day>19</day><month>10</month><year>2016</year></date></history><permissions><copyright-statement>© The Author(s) 2016</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.</license-p></license></permissions><abstract id="Abs1"><p>For decades, the classic indication for limb lengthening has been reserved for anisomelia that was expected to reach or exceed 5 cm at maturity. Epiphysiodesis was reserved for discrepancies in the 2–5 cm range. With the increasing sophistication of fixators, including rail, hexapod, and hybrid, complex deformities may be corrected simultaneously while moderate to extreme lengthening is achieved. More recently, iterations of telescoping intramedullary rods have further strengthened our armamentarium. Meanwhile, permanent epiphysiodesis techniques, both open and percutaneous, have yielded to more versatile and reversible tethering of one (angle) or both (length) sides of a physis. While the techniques of guided growth and callotasis seem to be diametrically opposed, they may be used in a tandem or complementary fashion, for the benefit of the patient. If treatment is undertaken during skeletal growth, one must be aware that issues remain regarding the accurate assessment of skeletal maturity and prediction of the ultimate outcome. Therefore, there is potential for over- or undercorrection. Reversible and serial guided growth now enable the surgeon to commence intervention at a comparatively young age, for the purpose of optimizing limb alignment and reducing the ultimate discrepancy. Frame application may be delayed or, in some cases, avoided altogether. With the limb properly aligned at the outset of lengthening, elective use of a telescoping intramedullary nail may now be favored over a frame accordingly.</p></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Epiphysiodesis</kwd><kwd>Guided growth</kwd><kwd>Limb lengthening</kwd><kwd>Anisomelia</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2016</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc><affiliations><list><country><li>États-Unis</li></country><region><li>Utah</li></region></list><tree><country name="États-Unis"><region name="Utah"><name sortKey="Stevens, Peter M" sort="Stevens, Peter M" uniqKey="Stevens P" first="Peter M." last="Stevens">Peter M. Stevens</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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