[Partial arrest of growth after intra partum physeal injury.].
Treatment of the sequelae of the osseous connection between the metaphysis after damage of a part of the growth plate (bone bridge, partial arrest of growth) is still difficult. In addition to many symptomatic operations (repeated osteotomies, prolongation of the bones, epiphyseal distraction, epiphyseodesis etc.) also causal provisions can be made. Because transplantations of the physis are not yet very successful in clinical work, the only procedure which has an impact on the cause of restricted growth is resection of the bone bridge and interposition of inert material prevents a relapse of ossification at the site of the impaired physis. The position is particularly alarming when partial growth arrest develops in neonates and while only symptomatic treatment is used it is essential to perform many operations to achieve the correct length and axis of the affected bone. The authors present the case of a little girl where inter partum separation of the distal epiphysis of the femur occurred and already at the age of 10 months a central bridge caused shortening of the bone by 2 cm. At the age of 11 months the authors resected the bridge and interposed autogenous fat, as described by Langenskiold. After this intervention substantial, though incomplete restitution of the physis occurred. Therefore the authors resected at the age of 2 years and 4 months the remainder of the bridge and interposed autogenous adipose tissue. After this operation complete improvement of the shape of the epiphysis occurred and restoration of normal growth of the femur. Now at the age of five years the femur grows normally, the original shortening of the bone by 2 cm persists and the axis of the extremity is correct. The patient walks normally with a heel higher by 1 cm. Key words: physis, injury, partial arrest of growth, different length of extremities.
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Klinika detské chirurgie IPVZ, Fakultní Thomayerova nemocnice, Praha.
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