Anderson, Green, and Messner followed 100 children with annual orthoroentgenographic measurements through skeletal maturity. The study quantifies how much growth remains in the distal femur and proximal tibia at each skeletal age level. It asks: which predictor — skeletal age or chronological age — most precisely estimates remaining lower-extremity growth for surgical planning?
Every child with limb length discrepancy who walks into your clinic is asking: 'How much bigger will this gap get, and when should you operate?' Before this paper, the answer was based on chronological age — a predictor so imprecise during adolescence that two 12-year-old boys could have growth estimates differing by several centimeters.
This paper is why you order a bone age radiograph at every evaluation. When planning epiphyseodesis, locate the child's skeletal age on the Anderson-Green growth chart, read off the distal femoral or proximal tibial growth remaining (with its percentile range), and adjust for whether the child trends tall or short and whether their skeletal age has been consistently advanced or delayed.
Remember the two numbers that define your surgical targets: the distal femoral physis contributes 71% of femoral growth, and the proximal tibial physis contributes 57% of tibial growth. Arresting these two sites is precisely why epiphyseodesis works.
One nuance worth knowing: the growth on the shorter side in the 2-3 years before surgery matters more than the total historical discrepancy. A chronically inhibited limb will gain less correction than the chart predicts. Factor that in before you commit to a timing.
Anderson, Green, and Messner followed 100 children with annual orthoroentgenographic measurements through skeletal maturity. The study quantifies how much growth remains in the distal femur and proximal tibia at each skeletal age level. It asks: which predictor — skeletal age or chronological age — most precisely estimates remaining lower-extremity growth for surgical planning?
Every child with limb length discrepancy who walks into your clinic is asking: 'How much bigger will this gap get, and when should you operate?' Before this paper, the answer was based on chronological age — a predictor so imprecise during adolescence that two 12-year-old boys could have growth estimates differing by several centimeters.
This paper is why you order a bone age radiograph at every evaluation. When planning epiphyseodesis, locate the child's skeletal age on the Anderson-Green growth chart, read off the distal femoral or proximal tibial growth remaining (with its percentile range), and adjust for whether the child trends tall or short and whether their skeletal age has been consistently advanced or delayed.
Remember the two numbers that define your surgical targets: the distal femoral physis contributes 71% of femoral growth, and the proximal tibial physis contributes 57% of tibial growth. Arresting these two sites is precisely why epiphyseodesis works.
One nuance worth knowing: the growth on the shorter side in the 2-3 years before surgery matters more than the total historical discrepancy. A chronically inhibited limb will gain less correction than the chart predicts. Factor that in before you commit to a timing.