Weinstein Lovell and Winters Pediatric Orthopaedics 7e

1532

CHAPTER 30  |  The Child with a Limb Deficiency

Girls: Lengths of the Long Bones Including epiphyses a

TABLE 30.2

Femur

Distribution

s d

s m

+2 s d 16.16 20.01 23.49 26.60 29.19 31.75 34.25 36.59 38.94 41.32 43.75 45.75 47.17 47.68 47.86 47.97 47.98 48.02 +2 s d 12.86 15.99 18.00 21.15 23.37 25.45 27.50 29.46 31.55 33.67 35.77 37.46 38.58 38.89 38.94 38.93 38.97 38.97

+1 s d 15.48 19.12 22.39 25.26 27.76 30.14 32.43 34.66 36.83 39.02 41.28 43.25 44.74 45.41 45.67 45.77 45.79 45.82 +1 s d 12.22 15.25 17.70 20.00 22.07 23.99 25.86 27.68 29.55 31.47 33.38 35.03 36.20 36.66 36.76 36.78 36.81 36.81

−1 s d 14.14 17.34 20.19 22.58 24.88 26.90 28.77 30.78 32.59 34.42 36.34 38.23 39.88 40.87 41.27 41.39 41.41 41.44 −1 s d 10.92 13.77 15.92 17.72 19.47 21.07 22.58 24.10 25.57 27.09 28.62 30.19 31.46 32.20 32.42 32.48 32.49 32.49

−2 s d 13.46 16.45 19.09 21.24 23.45 25.29 26.95 28.85 30.48 32.12 33.87 35.73 37.45 38.60 39.08 39.19 39.22 39.24 −2 s d 10.28 13.03 15.02 16.57 18.17 19.61 20.94 22.32 23.57 24.89 26.23 27.76 29.08 29.97 30.24 30.33 30.33 30.33

Number

Age (yr)

Mean 14.81 18.23 21.29 23.92 26.32 28.52 30.60 32.72 34.71 36.72 38.81 40.74 42.31 43.14 43.47 43.58 43.60 43.63 11.57 14.51 16.81 18.86 20.77 22.53 24.22 25.89 27.56 29.28 31.00 32.61 33.83 34.43 34.59 34.63 34.65 34.65 Mean

30 52 63 66 66 66 67 67 67 67 67 67 67 67 67 67 67 67 61 67 67 67 67 67 67 67 67 67 67 67 67 67 67 67 67 67

1 2 3 4 5 6 7 8 9

0.673 0.888 1.100 1.339 1.437 1.616 1.827 1.930 2.117 2.300 2.468 2.507 2.428 2.269 2.197 2.193 2.192 2.195 0.646 0.739 0.893 1.144 1.300 1.458 1.640 1.786 1.993 2.193 2.384 2.424 2.374 2.228 2.173 2.151 2.158 2.161 s d

0.082 0.109 0.134 0.164 0.176 0.197 0.223 0.236 0.259 0.281 0.302 0.306 0.310 0.277 0.277 0.268 0.268 0.269 0.082 0.090 0.109 0.140 0.159 0.178 0.200 0.218 0.243 0.259 0.291 0.296 0.290 0.272 0.265 0.263 0.264 0.264 s m

10 11 12 13 14 15 16 17 18

Tibia

Distribution

Number

Age (yr)

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18

a Orthoradiographic measurements from longitudinal series of 67 children. From Anderson M, Messner MB, Green WT. Distribution of lengths of the normal femur and tibia in children from one to eighteen years of age. J Bone Joint Surg Am 1964;46:1197, with permission.

Routine evaluation can detect the problem before it is painful, and surgical correction is fairly straightforward at this point. Prosthetic adjustments may help delay surgical revision, but will seldom be sufficient with significant overgrowth.

Treatment of overgrowth has included implantation of various plastic and metallic devices over the end of the bone (the so-called stump-capping procedures). However, these techniques are not commonly used because the results are no