Cortical visual impairment caused by twin pregnancy.

PURPOSE: To report a possible relationship between twin pregnancy and cortical visual impairment. METHODS: Three children who had been the products of twin pregnancies were identified as having cortical visual impairment. One child (Patient 2), a dizygotic twin, developed cortical visual impairment after a preterm birth. Two children (Patients 1 and 3), the products of monochorionic pregnancies, developed cortical visual impairment. All children were examined ophthalmologically and neurologically. RESULTS: An evaluation of the gestations of these children indicates that twin pregnancy per se was probably etiologic in the development of cortical visual impairment. In Patient 2, twin pregnancy probably caused preterm birth and resulting cortical visual impairment. In Patients 1 and 3, twin-to-twin transfusion syndrome was the cause of cortical visual impairment. In Patient 1, fetal demise precipitated an acute twin-to-twin transfusion syndrome. CONCLUSIONS: Children who show cortical visual impairment at or shortly after birth should be evaluated for the possibility of twin pregnancy. Twin pregnancy increases the risk of neurologic damage, including damage to the visual cortex, to optic radiations, or both.

Femoral and tibial lengthening.

Results and complications are reviewed in 18 femoral and seven tibial lengthenings performed using Wagner's technique. Lengthening achieved averaged 5.7 cm for the femoral and 5.6 cm for the tibial patients. Shortening was congenital in origin in 12 patients, and a soft tissue excision is recommended for these individuals. Two nonunions developed and two stress fractures occurred after plate removal. Pin tract infections occurred in 15 patients and deep infection in three. No serious long-term sequelae of infection have been seen at follow-up averaging 3 years 3 months. Additional complications included: patella dislocation, posterior tibial subluxation, and partial peroneal nerve palsy. No hypertension was observed. Five of 25 patients had no complications; additional operative procedures were performed in eight patients. Wagner's technique of limb lengthening is exacting and complications, although often remediable, may be expected frequently. However, the method remains a significant advance in the management of limb length inequality in the young patient.

Epiphysiodesis for limb length inequality: results and indications.

In view of the minimum morbidity, low incidence of complciations, and averall success rate, epiphysiodesis is an excellent method for correction of moderate limb length discrepancies. Skeletally immature patients with discrepancies between 2.5-8 cm with adult height predicted to be in the normal range (5 feet or greater) are good candidates for epiphysiodesis. Preoperative evaluation over several years prior to operation, utilizing the principles of Green-Anderson or the straight line graph, provide an accurate means of predicting future growth and determination of time of operation. Technique of epiphysiodesis is reliable and technical complications resulting from its use are few. Patient with a paralytic basis for shortening do best functionally with an end result undercorrection of 1.5 cm; equalization or overcorrection is to be avoided in these patients. Nonparalytic patients do best if limb lengths are equalized, with 1.5 cm of overcorrection or under-correction equally well tolerated.