A Critical Evaluation of a Method of Epiphyseal Stimulation

¹ Department of Orthopaedic Surgery, Medical College of Virginia, and Crippled Children's Hospital, Richmond

On the basis of the results obtained by this method of epiphyseal stimulation, it is apparent that while some increase in growth was obtained in twenty-six of the thirty

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patients, the amounts of this increased growth was not sufficient to justify the procedure. However, while it is true that in 70 per cent of the cases, the maximum gain was only one-eighth to one-quarter of an inch, it is also worthy of note that many of the patients were below the age at which a limb-shortening or epiphyseal-arrest procedure could be done. Furthermore, although the gain was negligible, the stimulating procedure did prevent the inequality in length from becoming greater and in several instances it reduced the inequality to a small amount. For this reason the authors feel that this procedure has some merit in a few isolated instances, such as in a child below the age of six with a discrepancy of one and one-half inches or more and with a flail extremity secondary to poliomyelitis. According to the authors' observations, this method of epiphyseal stimulation very possibly will prevent the discrepancy from becoming greater before such time as a growth-arrest or limb-shortening procedure might be indicated. They also believe that in a child with a discrepancy of one inch or more who had to undergo surgical relaxation of a tight iliotibial band, a stimulating procedure can be carried out through the same operative incision with little additional trauma or operative time.

This study has been a disappointment for the results have demonstrated that the use of intramedullary ivory implants in the distal end of the femur and proximal end of the tibia will not produce a sufficient increase in growth to justify the procedure. The authors have been stimulated themselves, however, to further study this problem in the hopes of finding a method of growth stimulation which will have sound clinical application.

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