Correction Of Leg Length Discrepancy Research Articles

Indications of sole lift and foot orthoses in the management of mild idiopathic scoliosis-a review.

[Purpose] Leg length discrepancy is common among patients with scoliosis. Some studies reported reduced functional scoliosis curves with correction of leg length discrepancy. Others, however, have shown that induced leg length discrepancy has little effects on spinal deformities. Also, small number of studies assessed the use of foot orthoses in patients with faulty foot biomechanics and their impact on idiopathic scoliosis. In this context, a review of the literature is needed to determine the current evidence for the appropriate use of sole lift and foot orthoses in a context of scoliosis. [Methods] A literature review was performed. [Results] It appeared that sole lifts are indicated for functional lumbar scoliosis when the level of the sacrum is parallel to that of the hips. Sole lifts may not be indicated for patients with structural scoliosis, seemingly inducing a compensatory curve. Custom foot orthoses were found to reduce spinal curves in juvenile patients with mild idiopathic scoliosis and concomitant abnormal foot biomechanics. [Conclusion] Sole lift appeared to be indicated in the presence of certain types of functional scoliosis. Custom foot orthoses can be considered in the management of mild idiopathic scoliosis in juvenile patients. Evidence, however, is low and quality studies are needed to validate these findings.

Lengthening Nails for Distraction Osteogenesis: A Review of Current Practice and Presentation of Extended Indications.

PurposeCircular frames have been the gold standard of treatment for complex deformity corrections and bone loss. However, despite the success of frames, patient satisfaction has been low, and complications are frequent. Most recently, lengthening nails have been used to correct leg length discrepancies. In this article, we review the current trends in deformity correction with emphasis on bone lengthening and present our case examples on the use of lengthening nails for management of complex malunions, non-unions, and a novel use in bone transport.Materials and methodsA nonsystematic literature review on the topic was performed. Four case examples from our institute, Brighton and Sussex University Hospitals, East Sussex, England, UK, were included.ResultsNew techniques based on intramedullary bone lengthening and deformity correction are replacing the conventional external frames. Introduction of lengthening and then nailing and lengthening over a nail techniques paved the way for popularization of the more recent lengthening nails. Lengthening nails have gone through evolution from the first mechanical nails to motorized nails and more recently the magnetic lengthening nails. Two case examples demonstrate successful use of lengthening nails for management of malunion, and two case examples describe novel use in management of non-unions, including the first report in the literature of plate-assisted bone segment transport for the longest defect successfully treated using this novel technique.ConclusionWith the significant advancement of intramedullary lengthening devices with lower complications rates and higher patient satisfaction, the era of the circular frame may be over.How to cite this articleBarakat AH, Sayani J, O'Dowd-Booth C, et al. Lengthening Nails for Distraction Osteogenesis: A Review of Current Practice and Presentation of Extended Indications. Strategies Trauma Limb Reconstr 2020;15(1):54–61.

The learning curve of robotic-arm assisted acetabular cup positioning during total hip arthroplasty.

Robotic-arm assisted surgery aims to reduce manual errors and improve the accuracy of implant positioning and orientation during total hip arthroplasty (THA). The objective of this study was to assess the surgical team's learning curve for robotic-arm assisted acetabular cup positioning during THA. This prospective cohort study included 100 patients with symptomatic hip osteoarthritis undergoing primary total THA performed by a single surgeon. This included 50 patients receiving conventional manual THA and 50 patients undergoing robotic-arm assisted acetabular cup positioning during THA. Independent observers recorded surrogate markers of the learning curve including operative times, confidence levels amongst the surgical team using the state-trait anxiety inventory (STAI) questionnaire, accuracy in restoring native hip biomechanics, acetabular cup positioning, leg-length discrepancy, and complications within 90 days of surgery. Cumulative summation (CUSUM) analysis revealed robotic-arm assisted acetabular cup positioning during THA was associated with a learning curve of 12 cases for achieving operative times (p < 0.001) and surgical team confidence levels (p < 0.001) comparable to conventional manual THA. There was no learning curve of robotic-arm assisted THA for accuracy of achieving the planned horizontal (p = 0.83) and vertical (p = 0.71) centres of rotation, combined offset (p = 0.67), cup inclination (p = 0.68), cup anteversion (p = 0.72), and correction of leg-length discrepancy (p = 0.61). There was no difference in postoperative complications between the two treatment groups. Integration of robotic-arm assisted acetabular cup positioning during THA was associated with a learning curve of 12 cases for operative times and surgical team confidence levels but there was no learning curve effect for accuracy in restoring native hip biomechanics or achieving planned acetabular cup positioning and orientation.

The current role of robotics in total hip arthroplasty.

Robotic total hip arthroplasty (THA) improves accuracy in achieving the planned acetabular cup positioning compared to conventional manual THA.Robotic THA improves precision and reduces outliers in restoring the planned centre of hip rotation compared to conventional manual THA.Improved accuracy in restoring hip biomechanics and acetabular cup positioning in robotic THA have not translated to any differences in early functional outcomes, correction of leg-length discrepancy, or postoperative complications compared to conventional manual THA.Limitations of robotic THA include substantive installation costs, additional radiation exposure, steep learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs.Further higher quality studies are required to compare differences in conventional versus robotic THA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness.Cite this article: EFORT Open Rev 2019;4:618-625. DOI: 10.1302/2058-5241.4.180088

Limb Salvage Using Non-hinged Endoprosthesis and Staged Correction of Leg-length Discrepancy for Children with Distal Femoral Malignant Tumors.

ObjectiveLimb salvage in pediatric patients remains a challenge. We describe a staged strategy. The procedure includes: (i) tumor removal and non‐hinged static endoprosthesis reconstruction; (ii) leg length discrepancy (LLD) correction by shoe lift or distraction osteogenesis; and (iii) maturity reconstruction by regular endoprosthesis. The aim of the study was to investigate the results of non‐hinged static megaprosthesis reconstruction and staged LLD correction in the treatment of malignant tumors in the distal femur in children.MethodsNon‐hinged megaprostheses were implanted in 12 pediatric patients with osteosarcoma in the distal femur. The prosthesis consists of a femoral component with constrained condylar knee (CCK) design, and a tibial component with a small‐diameter press‐fit stem and derotation fins. A posterior stabilizing polyethylene component is fixed on the tibial component. The cases were prospectively followed up with focus on the growth rate of adjacent uninvolved bone in the salvaged limb, joint stability, knee stability, function outcome, length discrepancy, and surgery‐related complications.ResultsThere were five girls and seven boys included in the study, with an average age at the time of primary surgery of 10.0 years (range, 8–12 years). All the tumors were located in the distal femur. The average follow up was 76.3 months (range, 24–139 months). The Ligament Augmentation and Reconstruction System (LARS) ligament was used in two patients to enhance the soft tissue reattachment and reconstruct medial collateral ligament (MCL). Ten patients were alive at the final follow‐up and two had died of lung metastases. Expected LLD was 6.7 cm (range, 3.0–13.2 cm) at initial surgery. At the final follow‐up, nine patients reached skeletal maturity and the actual LLD at the femur was 5.3 cm (range, 3.0–10.1 cm), excluding 1 cm correction at initial surgery by endoprosthesis. The proximal tibia physis showed an average of 86.7% (range, 56.5%–100%) growth of the contralateral side. The mean reduction in tibial length was 1.2 cm (range, 0.5–4.7 cm). Six patients received distraction osteogenesis at a mean length of 5.4 cm (range, 3.0–9.1 cm). Range of knee movement was between 85° and 125°, with an average of 102.5°. The Musculoskeletal Tumor Society 93 score of patients alive was 80.6 (range, 60–90).ConclusionNon‐hinged static megaprosthesis followed by LLD correction with shoe lift or staged distraction osteogenesis appears to be an alternative option to treat children with malignant bone tumors around the knee.

A new and simple intraoperative method for correction of leg-length discrepancy in total hip arthroplasty

Total hip arthroplasty (THA) can eliminate pain caused by hip joint destruction and correct leg-length discrepancies (LLD). We present a short and simple intraoperative method for LLD correction in THA. We performed 55 primary THAs using this technique. The measurement error was 1.86 ± 1.4 mm, which was within 3 mm in 49 of 55 cases (89%) and within 5 mm in 54 of 55 cases (98%). This method is simple and does not require specialized devices, making it versatile to be used anywhere. No new skin incisions or extra costs are required, which will likely make it attractive to surgeons.

The Delta of Correction: a novel, more reliable variable than limb-length discrepancy at predicting outcome after total hip arthroplasty.

Leg-length discrepancy (LLD) is a frequent and recurring issue after total hip arthroplasty (THA). It can lead to discomfort and litigation due to the patient's perception of this inequality. The aim of this study was to evaluate the functional impact of postoperative LLD and length correction in patients after primary THA. We hypothesised that clinical outcomes are inversely correlated to length correction and residual discrepancy. In a prospective cohort, we included 121 patients undergoing unilateral primary THA. Patients were categorised into 3 groups based on their residual LLD using routine EOS imaging; Shorter (<-5 mm); Equal (-5 mm to +5 mm); and Longer (>+5 mm). Delta of Correction (DC) was defined as the difference between pre- and postoperative discrepancy measured on EOS imaging. Functional scores (HHS, Postel Merle d'Aubigné, and WOMAC) were measured preoperatively and at last follow-up. The average follow-up was 24 months. We evaluated the clinical and radiographic outcomes regarding the residual LLD and DC. All patients had improvement in their functional scores at last follow-up. There was no difference in clinical outcomes, regardless of preoperative or residual LLD. The highest scores were found in the population with the smallest variations (DC -5 to +5 mm, HHS 96). Conversely, poorer results were found in shortened patients (DC <-5 mm), HHS 86, and lengthened patients, corrected by > 15 mm, with HHS of 83, p < 0.005. Patient perception of postoperative LLD correlated with the DC (p = 0.004). The DC measurement is a more effective assessment than arthroplasty.

Correction of leg-length discrepancy among meat cutters with low back pain: a randomized controlled trial

BackgroundThe etiology of non-specific low back pain (LBP) is complex and not well understood. LBP is common and causes a remarkable health burden worldwide. Leg-length discrepancy (LLD) is potentially a risk factor for development of LBP, although this relationship has been questioned. Yet only one randomized controlled study (RCT) has been performed. The objective of our study was to evaluate the effect of insoles with leg-length discrepancy (LLD) correction compared to insoles without LLD correction among meat cutters in a RCT-design.MethodsThe study population consisted 387 meat cutters who were over 35 years old and had been working 10 years or more. The LLD measurement was done by a laser ultrasound technique. All workers with an LLD of at least 5 mm and an LBP intensity of at least 2 on a 10-cm Visual Analog Scale were eligible. The LLD of all the participants in the intervention group was corrected 70%, which means that if the LLD was for example 10 mm the correction was 7 mm. The insoles were used at work for eight hours per day. The control group had insoles without LLD correction. The primary outcome was between-group difference in LBP intensity. Secondary outcomes included sciatic pain intensity, disability (Roland Morris), RAND-36, the Oswestry Disability Index, physician visits and days on sick leave over the first year. We used a repeated measures regression analysis with adjustments for age, gender and BMI. The hurdle model was used for days on sick leave.ResultsIn all, 169 workers were invited and 114 (67%) responded. Of them, 42 were eligible and were randomized to the intervention (n = 20) or control group (n = 22). The workers in the intervention group had a higher improvement in LBP intensity (− 2.6; 95% confidence intervals − 3.7 – − 1.4), intensity of sciatic pain (− 2.3; − 3.4 – − 1.07) and RAND-36 physical functioning (9.6; 1.6–17.6) and a lesser likelihood of sick leaves (OR -3.7; − 7.2 - -0.2).ConclusionsCorrection of LLD with insoles was an effective intervention among workers with LBP and a standing job.Trial registrationISRCTN11898558. Registration date 11. Feb 2011. BioMed Central Ltd.

A new technique for correction of leg length discrepancies in combination with complex axis deformities of the lower limb using a lengthening nail and a locking plate.

:PurposeIntramedullary lengthening nails are an accepted alternative to external fixators but are limited by anatomical preconditions. Therefore, to date the use of external fixators is sometimes inevitable. We report on a new technique for correction of combined limb length discrepancies and complex axis deformities using solely internal devices - a lengthening nail and a locking plate.MethodsBetween October 2008 and November 2011 five patients (two femora, three tibias) with a mean leg length discrepancy of 36 mm (25 to 50) and a complex angular deformity were treated with a fully implantable motorized lengthening nail (Fitbone) and a locking plate. All patients were evaluated with regards to the pre- and postoperative leg length as well as axis alignment, functional outcome, lengthening indices and complications.ResultsA successful leg length equalization was achieved in all cases and physiological joint orientation angles in all but one case. The mean distraction index was 1.2 mm/day, the maturation index 24 days/cm and the consolidation index 35 days/cm. The functional outcome was very encouraging in all cases with bilateral free range of movement. In total, two complications were observed, one nonunion and one loss of leg length after an early locking bolt removal in a peripheral hospital.ConclusionThe combination of a fully implantable motorized lengthening nail and a locking plate is a valuable alternative option for treating selected cases with limb length discrepancies in combination with a complex deformity of the lower leg. However, the reported technique puts high demands on the preoperative planning, operative technique as well as surgeon’s skills.Level of evidenceIV (retrospective series)

A comparison of screw versus drill and curettage epiphysiodesis to correct leg-length discrepancy.

:PurposeTo compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) versus cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates.MethodsA retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted. Characteristics including age at surgery, gender, epiphysiodesis location, side, operative time, LOS and hardware removal were compared across treatment groups. LLD, expected growth remaining (EGR) and bone age were determined preoperatively and at most-recent visit. The correction ratio (change in EGR) was calculated along with a 95% confidence interval (CI) to assess if correction in leg length was achieved.ResultsA total of 115 patients underwent epiphysiodesis in the femur (53%), tibia (24%) or a combination (24%). The cohort was 47% male, with a mean age of 12.6 years (7.7 to 17.7) at surgery. Median follow-up was 3.7 years (2.0 to 12.7). In all, 23 patients underwent PETS and 92 patients had PDED. Both treatment groups achieved expected LLD correction. There was no significant difference in median operative time, complication rates or LOS. PETS patients returned to activity at a mean 1.4 months (interquartile range (IQR) 0.7 to 2.1) while PDED patients returned at a mean 2.4 months (IQR 1.7 to 3) (p < 0.001).ConclusionEffectiveness in achieving expected correction, LOS and operative time are similar between screw and drill/curettage epiphysiodesis. Patients undergoing PETS demonstrated a faster return to baseline activity than patients with PDED.Level of Evidence:III

Timing of Epiphysiodesis to Correct Leg-Length Discrepancy: A Comparison of Prediction Methods.

The purpose of this study was to compare the accuracy of different methods used to predict ultimate leg lengths and residual leg-length discrepancy in a group of patients treated with epiphysiodesis at our institution. Seventy-seven patients with adequate preoperative radiographs, no postoperative complications, and follow-up to skeletal maturity composed the study group. We compared the predicted lengths of both legs and residual leg-length discrepancy at maturity with actual outcomes using the White-Menelaus, Anderson-Green, Moseley, and multiplier methods. Skeletal age varied >1 year from chronological age in 61 (26%) of 231 observations, including 19 patients (25%) whose average skeletal age from 3 determinations differed by >1 year from chronological age. The prediction accuracy of each method was improved by using skeletal, rather than chronological, age. Error in prediction of the length of the short leg varied from a mean (and standard deviation) of 1.8 ± 1.2 cm for the straight-line graph to 2.5 ± 2.0 cm for the multiplier method. Prediction error for the long leg (after epiphysiodesis) varied from a mean of 1.2 ± 1.1 cm for the straight-line graph to 1.7 ± 1.5 cm for the multiplier method. Leg-length-discrepancy prediction error ranged from a mean of 0.7 ± 0.6 cm for the White-Menelaus method incorporating a growth inhibition factor to 1.1 ± 0.9 cm for the multiplier method. The multiplier method was the least accurate of all. All differences were significant. Determination of skeletal age is clinically relevant in patients being considered for epiphysiodesis to manage leg-length inequality. The multiplier method was the least accurate of the prediction methods in this patient population, which may have implications in calculating the appropriate timing of epiphysiodesis.

A Comparison of Screw versus Drill and Curettage Epiphysiodesis to Correct Leg Length Discrepancy

A Comparison of Screw versus Drill and Curettage Epiphysiodesis to Correct Leg Length Discrepancy

CT-based analysis of muscle volume and degeneration of gluteus medius in patients with unilateral hip osteoarthritis

BackgroundThe gluteus medius (GMED) affects hip function as an abductor. We evaluated muscle volume and degeneration of the GMED by using CT-based analysis and assessed factors that affect hip abductor strength in patients with unilateral hip osteoarthritis (OA).MethodsWe examined clinical and imaging findings associated with hip abductor strength in consecutive 50 patients with unilateral hip OA. Hip abductor muscle strength and Harris hip score (HHS) were assessed. Leg length discrepancy (LLD) and femoral offset were assessed using X-ray; CT assessment was employed for volumetric and qualitative GMED analysis. Volumetric analysis involved measurement of cross sectional area (CSA) and three-dimensional (3D) muscle volume. CT density was measured for the qualitative assessment of GMED degeneration with or without adjustment using a bone mineral reference phantom.ResultsHip abductor muscle strength on the affected side was significantly lower than that on the contralateral healthy side and positively correlated with overall score and score for limping of gait of HHS, demonstrating the importance of hip abductor strength for normal hip function. A significant correlation was found between CSA and 3D muscle volume, unadjusted CT density and adjusted CT density, and hip abductor strength and these CT measurements. Multiple linear regression analysis demonstrated that 3D muscle volume, adjusted CT density, and LLD are independent factors affecting hip abduction.Conclusions3D measurement of muscle volume and adjusted CT density more accurately reflect quantity and the GMED quality than do conventional assessments. Increase in muscle volume, recovery of muscle degeneration, and correction of LLD are important for improving limping in patients with hip OA.

Cementless Total Hip Arthroplasty Involving Trochanteric Osteotomy without Subtrochanteric Shortening for High Hip Dislocation.

BackgroundTotal hip arthroplasty with subtrochanteric shortening osteotomy is widely performed for high hip dislocation. However, suboptimal leg length discrepancy correction and nonunion of the osteotomy site remain concerns. Although total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy was introduced, cemented implants have been more commonly used than contemporary cementless implants in this procedure. We evaluated the long-term results of cementless total hip arthroplasty with trochanteric osteotomy without subtrochanteric osteotomy for high hip dislocation.MethodsFrom 1990 to 2002, 27 cementless total hip arthroplasties using trochanteric osteotomy without subtrochanteric osteotomy were performed in 26 patients with Crowe III or IV high hip dislocation and a mean age of 36.4 ± 12.9 years. Seven ceramic-on-ceramic, 8 ceramic-on-polyethylene, 10 metal-on-polyethylene, and 2 metal-on-metal bearings were inserted. Mean follow-up was 15.1 ± 3.7 years. We retrospectively reviewed medical records and radiographic data and evaluated the clinical and radiological results including the Harris hip score, implant survival, correction of leg length discrepancy, and occurrence of complications.ResultsThe mean Harris hip score and leg length discrepancy improved significantly from 73.3 to 94.9 points and from 4.3 cm to 1.0 cm, respectively. With revision for loosening set as the end point, implant survival rates at 10 and 15 years postoperatively were 96.0% and 90.9% for stems and 74.1% and 52.3% for cups. In 8 of 10 hips with the metal-on-polyethylene bearing and 4 of 8 hips with the ceramic-on-polyethylene bearing, revision surgery was performed for aseptic loosening. However, no revision was performed in hips with the ceramic-on-ceramic bearing or the metal-on-metal bearing. Implant survival was significantly different by the type of bearing surface. Two permanent neurologic complications occurred in patients with a limb lengthening over 3.5 cm.ConclusionsWith proper selection of the bearing surface coupled with adjustment of lengthening, cementless total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy might be a favorable treatment option for high hip dislocation.

Femoral lengthening during hip resurfacing arthroplasty: A new surgical procedure

Correction of leg length discrepancy during hip arthroplasty is a technical challenge. Although resurfacing proposed to young subjects presents a number of advantages (stability, bone stock, etc.), it does not correct leg length discrepancy. We propose an original femoral lengthening technique concomitant to resurfacing performed through the same approach, consisting in a Z-shaped subtrochanteric osteotomy. Resurfacing was performed first and the femoral and acetabular reaming material was used for autografting. The series comprised five cases followed for a mean 42.2 months (range, 33–64 months). The mean surgical time was 100min (range, 76–124min). Weightbearing was authorized in all cases at the 8th week. The mean lengthening was 32mm (range, 25–40mm). Healing was observed in all cases. This surgical technique, reserved for very young subjects who accept an 8-week postoperative period without weightbearing, can be proposed in cases with substantial preoperative leg length discrepancy.

A Report on Three Consecutive Cases using Computer Tomography 3D Preoperative Planning for Conversion of Arthrodesed Hips to Total Hip Replacements.

Conversion of an arthrodesed hip to a total hip arthroplasty (THA) is a technically demanding procedure with high complication rates. One important issue is that determining the amount of correction for a leg length discrepancy (LLD) can be difficult at the planning stage. The aim of this study is to assess the reliable use of computer tomography (CT)-based three-dimensional (3D) preoperative planning for the conversion of arthrodesed hips to THAs. CT-based preoperative 3D planning was used to convert three arthrodesed hips to THAs. The efficacy of the planning was evaluated with postoperative radiographic measurements involving the amount of correction for LLD, position of components, difference between targeted and actual values, and ratio of the moment arms. The clinical assessment was performed with the Japanese Orthopaedic Association (JOA) hip score before and after THA. The mean amount of LLD correction and median LLD after THA were 16mm (range, 15-17mm) and 4mm (range, 1-10mm), respectively. The components were implanted close to the positions recommended by the preoperative simulation. The ratio of the moment arms indicated that the converted hips were reconstructed in a biomechanically correct manner. The implants for the conversion to THA were successfully positioned with respect to anatomy and functional outcome. The median JOA hip score improved from 50 points (range, 30-66 points) preoperatively to 79 points (range, 72-86 points) at the latest follow-up. CT-based preoperative 3D planning could be a powerful guidance tool for conversion of arthrodesed hips to THAs.

Correction of Leg-Length Discrepancies by Ilizarov Technique

The management of leg-length discrepancies is one of the most challenging problems that the surgeon confronts in his daily practice. We are presenting here the use of Ilizarov apparatus-external ring device in a series of 86 patients for the limb lengthening. 66 patients are male & 20 female; the patients are 17 post polio shortening; 25 post-traumatic shortening; 5 gun short shortening; 10 congenital pseudoathrotic shortening, 24 congenital idiopathic shortening, shortening due to osteomyelitis-5. Among the complications 9 pin track infections were observed from which all responded positively to local care. Among the 86 patients, 3 admitted with the gun shot injury with 13 cm shortening, 39 admitted with the shortening of 7 cm, 18 with 5 cm & 26 with 3.5 cm. Lengthening & sound union was achieved according to Ilizarov’s technique. The Ilizarov apparatus & technique represents a useful method for the successful lengthening of the limbs.

Percutaneous Epiphysiodesis Using Transphyseal Screws in the Management of Leg Length Discrepancy

Percutaneous epiphysiodesis using transphyseal screws (PETS) has been used to manage leg length discrepancy (LLD) in growing children. The purposes of this study were to analyze effects of PETS on LLD, its associated complications, to determine optimal operation timing, and find ways of preventing complications. The data of 59 patients obtained up to screw removal or at skeletal maturity were retrospectively analyzed. Retrospective growth calculations were done using multiplier method. The efficacy of LLD correction was calculated, and the predicted segment length with the index operation was compared with the final measured length and final LLD was measured. The screw insertion angle in 3-dimension was calculated, and it was correlated with the efficacy. Complications associated with screw design and the techniques used were analyzed. The LLD correction efficacy averaged 75.5% (5.0 to 114.0) at the distal femur and 78.9% (11.0 to 111.0) at the proximal tibia. However, mean final LLD was 3.0 mm (range, -10.0 to 16.7 mm), presumably because operations were performed on average 1.3 years earlier than estimated by growth calculation. Three-dimensional screw insertion angle was positively correlated with LLD correction efficacy. Complications were closely related to the screw design and the implantation techniques. PETS provides a minimally invasive and effective means of LLD correction. In view of its delayed effect, we recommend that PETS be performed at least 1 year earlier than estimated optimal epiphysiodesis timing. The careful selection of screw design and length and accurate screw placement are the keys to successful results. Level IV prognostic studies.

Surgical Correction and Osteosynthesis for Cranial Displaced Pelvic Nonunion: Technical Note and Two Cases Report Regarding Anterior Correction and Osteosynthesis Following Posterior Release

Nonunion of an unstable pelvic fracture with cranial displacement pelvic surgery is technically difficult due to a large amount of bleeding and the risk of nerve damage. In addition, surgical correction of leg length discrepancy by reduction of a dislocated sacroiliac joint is in high demand. Nevertheless, when a patient is strongly disabled by a pelvic deformity, surgical correction may be necessary. Two patients with pelvic deformity were treated successfully by surgical correction and osteosynthesis.

Disease severity and functional factors associated with walking performance in polyostotic fibrous dysplasia

The purpose of this study was to determine the association between measures of disease severity, impairment, and ambulation ability in persons with polyostotic fibrous dysplasia (PFD). A cross-sectional sample of 81 patients (ages 5–57) with polyostotic fibrous dysplasia was evaluated as part of an ongoing study. Subjects were scored on the Skeletal Disease Burden Score (SDBS), completed a 9-minute walk test (9MW), manual muscle testing (MMT), and measurements of range of motion (ROM). Correlations between continuous variables were calculated using the Pearson correlation coefficient and ordinal variables by Spearman correlation coefficient. It was found that subjects with more severe disease walked slower than those with less skeletal disease, with the exception of the youngest subjects. Walking velocity was faster in subjects with better hip strength and range of motion and slower in those with bilateral coxa vara. Those subjects with more severe disease had less range of motion, were weaker at the hips, and more likely to have leg length discrepancy. Skeletal disease severity was associated with hip weakness, leg length discrepancy, and loss of range of motion. In most cases, findings did not differ in the presence or absence of associated endocrinopathies. Skeletal disease severity, MMT and ROM each has an impact on walking efficiency in persons with PFD. These findings suggest that treatment focused on strategies to improve or, at least, maintain hip strength and range of motion, correct leg length discrepancies and hip malalignment may help preserve ambulation ability in persons with PFD and that treatment should begin at a young age.