CONTROL OF BONE GROWTH BY EPIPHYSEAL STAPLING

Abstract

1. Efficient stapling of the distal femoral and proximal tibial epiphyses stops the elongation of bone at these epiphyses immediately and almost completely. 2. The operation is less extensive and the risk of complication is less than with other operative methods of controlling bone growth. 3. Angular deformity may be corrected during the growth period. Knock-knee, bowleg, back-knee, flexion deformity, or combinations of these deformities are rapidly overcome. 4. The occasional complicating irregularities of growth following stapling should be detected clinically and corrected immediately by rearrangement of the staples. 5. After removal of the staples, growth at the epiphysis is resumed at about the same rate as would be expected on the other side, if both sides were normal. It is sometimes faster and sometimes slower. The variations in rate are usually caused by factors other than staples. 6. The best proof of the normal rate of growth after removal of staples is the persistence of a straight extremity after correction of an idiopathic knock-knee. 7. Several important questions are being studied further: A. What is the ideal size and design of staples? B. For what length of time and for what ages is it safe to leave staples in place? C. What are the factors influencing epiphyseal closure? D. What is the rate of growth after removal of staples which were inserted for various conditions?