Physiologic bowing in children: an analysis of the pendulum mechanism.

Prompted by common observations, we investigated why physiologic bowing occurs in infants and what purpose is served by its characteristic varus to valgus to neutral movement of the mechanical axis of the knee which we term "pendulum-like swing" in the frontal plane. Anthropomorphic data were readily available on age-related increase in weight, femoral and tibial lengths, and changes in lower extremity to allow construction of an "average" leg representing "normal" limb alignment of a growing infant male aged 1-8 years. This enabled us to calculate the bending moments on five anatomic levels of the limb about the knee; more important, during some growth periods the bending moments are minimal and may be used to diagnose pathologies of the lower limb. This form of analysis may prove useful in pathologies in which mechanisms serve to "mask" problems diagnosed on the basis of knee angle alone. When the child begins to stand, the pendulum mechanism is needed to equalize physeal growth about the knee.

Epiphysiodesis in slipped capital femoral epiphysis: a comparison of various surgical modalities.

This retrospective study surveys patients treated between 1960 and 1978 for slipped capital femoral epiphyses. The parameters reported are fusion time, blood replacement, hospitalization time, aseptic necrosis, cartilage necrosis, and complications. Twenty-eight hips (24 patients) were treated by pinning, and three hips (three patients) were treated by Smith-Petersen nails. The Heyman or Howorth bone pegging procedures were performed in 48 hips in 41 patients. The average fusion time was 9.4 months for hips treated with Knowles pins, 3.7 months for Hagie or Tachdjian pins, and 4.8 months for bone pegging procedures. Blood loss, hospitalization time, surgical scars, and duration of anesthesia were greater for the bone pegging procedures.

Osteogenesis imperfecta with unusual skeletal lesions: report of three families.

Thirteen individuals with osteogenesis imperfecta (OI) from three families were evaluated. All examined persons with OI had multilocular radiolucent, radiopaque, or radiolucent-radiopaque lesions of the maxilla and mandible. In most patients, the lesions involved the tooth bearing areas, but in two, the rami also were involved. Teeth were normal. Radiologic findings in the extragnathic skeleton included marked coarseness of trabeculae and diffuse osteopenia. It is proposed that these patients represent yet another dominantly inherited OI syndrome.

A possible explanation of the pathogenesis of osteochondritis dissecans.

We present a case in which osteochondritis dissecans of the lateral femoral condyle was associated with a torn discoid lateral meniscus. To our knowledge, this is the first reported case of this association in the radiographic and orthopedic literature. Previous trauma is suggested to play an important role in the development of both lesions.

Long-term results in the treatment of femoral-shaft fractures in young children by immediate spica immobilization.

Manual traction reduction without anesthesia and immediate immobilization in a spica cast were used to treat eighty-five children ranging in age from birth to ten years old who had closed femoral-shaft fractures and no associated injuries. Up to two centimeters of overriding, 30 degrees of anterior angulation, and 15 degrees of medial angulation were accepted. Any angulation in excess of these amounts, or lateral or posterior angulation, was corrected by wedging the cast at the fracture site. Further telescoping of the fracture fragments in the case was attributed to the child pressing the foot against the bottom of the cast and was prevented by removing the sole of the cast. Of the seventy-five children examined two to eighteen years after fracture, none had any residual skeletal deformity or joint stiffness. The length discrepancies of the fractured limbs ranged from 1.7 centimeters of shortening to 0.9 centimeter of overgrowth.