Postoperative Growth Rate Research Articles

Severe Tibial Growth Retardation in Total Fibular Hemimelia After Limb Lengthening

Summary Seven patients with total fibular hemimelia who underwent limb-lengthening procedures prior to skeletal maturity were evaluated for tibial and femoral growth after lengthening. The average preoperative follow-up was 6.5 years and all patients were followed to skeletal maturity. Thirteen segments (eight tibiae and five femora) were lengthened by three methods (Wagner, Ilizarov, and modified Ilizarov). The average preoperative limb-length discrepancy was 9.7 cm, and the average projected limb-length discrepancy at skeletal maturity was 12.5 cm. The average tibial lengthening was 6.7 cm (range, 5.3-10) with an average percentage of lengthening of 26% (range, 19-40%). The average postoperative growth rate of the tibia was 80% (range, 70-100%) and of the femur, 83% (range, 70-90%) of the normal side. Five tibiae showed a decrease in the average preoperative growth rate from 82.5% (range, 70-100%) to 39% (range, 26-54%) of the normal side. Two tibiae had no longitudinal growth after lengthening. The average postoperative growth rate of the femur decreased from 83% (range, 70-90%) to 61% (range, 26-125%). In one patient there was an increase in the rate of growth of the femur. These findings suggest that limb lengthening in skeletally immature children with total fibular hemimelia results in severe growth retardation of the tibia after lengthening. The subsequent growth of the tibia after lengthening in patients with total fibular hemimelia is unpredictable.

A formula for diaphyseal limb lengthening

Calculation of the expected limb length discrepancy at maturity plays an important part in the timing of operations designed to equalise length. Present methods assume similar pre-operative and postoperative rates of bone growth in limbs undergoing diaphysea! lengthening procedures. Moseley (1977) conceived a straight line graph to predict the optimal timing ofsurgery to lengthen the shorter limb, or to slow growth in the longer one. Recently Shapiro (1987) has calculated more precise growth rates after diaphysea! lengthening ; he defined different pre-operative and postoperative longitudinal growth rates in femora and tibiae. Before operation the rate of growth of congenitally short femora was, on average, 82% of that on the normal side ; after operation the figure was 90%. An average of 88% pre-operatively and 64% postoperatively was found in congenitally short tibiae and in tibiae which were short secondary to O!!ier’s disease, poliomyelitis and haemangioma. These rates of growth may vary according to the disease process. Method. A simple formula for predicting the length of a normal bone at maturity is proposed. It combines the differential growth rates found by Shapiro, with the standard charts produced by Anderson and Green (1948), Anderson, Messner and Green (1964) and by Maresh (1955). This formula should allow the amount of lengthening required for equalisation to be predicted with greater accuracy. If SAP is the length of the shorter bone at presentation, LAP is the length of the longer bone at presentation, LAM is the length of the longer bone at maturity, and PLN is the predicted lengthening necessary, then the formula is: PLN = (!-x)LAM + xLAP-SAP. For the femur where x = 0.9, PLN = 0. 1 LAM + 0.9 LAP-SAP. For the tibia where x = 0.64, PLN = 0.36 LAM + 0.64 LAP- SAP. Derivation of the formula. Growth of the affected bone after operation can be expressed as a percentage of the growth of the normal bone from surgery to maturity : this percentage is the factor ‘x’. This concept can be expressed

Preoperative and postoperative growth rates in acoustic neuromas documented with CT scanning.

Sequential computerized tomography (CT) allows us to determine the growth rate of acoustic neuromas. Prior to CT scanning, a variability in tumor growth rates was recognized on the basis of clinical signs. After incomplete tumor removal, some patients experienced rapid recurrence, whereas others lived many years without recurrence. We used CT scanning to study tumor growth rates in a heterogeneous group of 21 patients. Thirteen elderly patients were given annual scans after incomplete tumor removal, while eight patients who had not had surgery are likewise being followed up. Early detection and complete tumor removal with preservation of hearing and facial function remain the goal in vigorous and healthy patients. However, a large number of older, infirm patients with acoustic neuromas may not require surgery or be candidates for incomplete tumor removal. Because rapid tumor growth may necessitate total tumor removal even in older patients, a better understanding of the growth rates may permit us to take a more scientific approach in planning these patients' management.

Influence of Preoperative Parenteral Alimentation on Postoperative Growth in Adolescent Crohn's Disease

The postoperative growth rates achieved in eight early pubertal adolescent males with Crohn's disease undergoing surgery for obstructive complications is reported as a function of the use of 1 month's preoperative central venous alimentation. All patients had ileal strictures with ileocolitis, bone ages less than 13, Tanner stages 1 or 2, and growth velocities below the 3rd percentile for age. During a 3‐year follow‐up, those receiving preoperative venous alimentation demonstrated greater oral caloric intake (significant for 1 year) and greater postoperative growth velocity (significant for 2 years) in comparison to those patients who did not receive preoperative venous alimentation. There was no significant difference between the two groups of patients in postoperative weight gain, sexual development, and 3‐year disease control.

Influence of preoperative parenteral alimentation on postoperative growth in adolescent Crohn's disease.

The postoperative growth rates achieved in eight early pubertal adolescent males with Crohn's disease undergoing surgery for obstructive complications is reported as a function of the use of 1 month's preoperative central venous alimentation. All patients had ileal strictures with ileocolitis, bone ages less than 13, Tanner stages 1 or 2, and growth velocities below the 3rd percentile for age. During a 3-year follow-up, those receiving preoperative venous alimentation demonstrated greater oral caloric intake (significant for 1 year) and greater postoperative growth velocity (significant for 2 years) in comparison to those patients who did not receive preoperative venous alimentation. There was no significant difference between the two groups of patients in postoperative weight gain, sexual development, and 3-year disease control.

Prolactin and somatomedin in hypopituitary patients with "catch up" growth following operations for craniopharyngioma.

Four patients had insufficiency of hGH, TSH, ACTH, and ADH following surgery for craniopharyngiomas. Despite hypopituitarism, and without hGH therapy, all showed “catch-up” growth during post-operative follow up. Prolactin, determined by RAI was normal in every patient, and therefore cannot be responsible for the increase in post-operative growth rate. Their prolactin values were similar to those of a large series of children with idiopathic hypopituitarism. In determined by bioassay and was normal. An additional patient who showed a normal growth rate (without “catch-up”) postoperatively also had normal somatomedin in the absence of growth hormone response to provocative tests. While the mechanism for catch-up growth in the patients remains enigmatic, the possibility cannot be excluded that hyperinsulinism could play a role, inasmuch as these patients are generally obese secondary to voracious appetites.