Percutaneous vs modified phemister epiphysiodesis of the lower extremity.

Epiphysiodesis of the lower extremity for limb-length discrepancy has been performed on 24 patients by both the modified Phemister and a percutaneous method. The primary complication of epiphysiodesis by both methods was continued growth of the physeal plate (12% and 15%, respectively). Failure of epiphysiodesis was attributed to young skeletal age at surgery in three of five cases. Closer attention to physeal ablation and close follow up should prevent this complication. No angular deformities resulted in any patient. During 16 proximal fibular procedures, there were no neurologic complications. The percutaneous method is preferred due to ease of surgical procedure, minimal incisions, limited disability to the normal extremity, and equal results.

Closed femoral shortening.

Eighteen patients underwent closed intramedullary femoral shortening at a children's teaching hospital. Their average age was 16 years 2 months (range 14-18 years). Clinical and radiographic union was obtained in < or = 3 months in all patients. Shortening averaged 4.4 cm (range 3-5 cm). Complications included one case of acute respiratory distress and three cases of fixation loss. We describe the procedure for closed intramedullary rodding without use of a fracture table and recommend (a) that reaming proceed slowly through an enlarged proximal portal, and (b) that in all cases nails be interlocked both proximally and distally.

The use of polyethylene mesh (Marlex) as an adjunct in reconstructive surgery of the extremities.

When Marlex mesh is inserted into the body it serves as a scaffold into which migrates fibroblastic tissue. Throughout the process of maturation of fibrous connective tissue, the mesh remains inert. Experience covering 15 years demonstrates that Marlex mesh is useful for repair of ligament, muscle, and bone defects.