Lower extremity growth and deformity

Whitaker, Amanda T.; Vuillermin, Carley

doi:10.1007/s12178-016-9373-4

Cited by 12 publications

(8 citation statements)

References 55 publications

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“…Higher correlations among age and body size in the longitudinal dimension (body height and segmental lengths) were found in PS than in SC. This finding is in line with the fact that velocity of growth is higher from birth to five years of age, followed by a decline thereafter [ 2 ]. However, the lack of any association between BMI and age suggests that changes in body dimensions, musculature, and adiposity do not occur proportionally.…”

Section: Discussionsupporting

confidence: 79%

“…Growth and functional development as a function of chronological age have often been examined from birth to adolescence [ 1 – 4 ]. Between those instances, the age from three to eight years is defined as early childhood, and constitutes a period with relatively slower changes in body dimensions compared to the two growth phases before and after it that typically show accelerated growth rate [ 2 , 5 ]. However, some growth-related parameters, such as bone dimensions, do not systematically change with chronological age [ 6 – 8 ], and the patterns of change can be different for muscle size [ 9 – 11 ], subcutaneous adipose tissue [ 9 , 12 , 13 ], and muscle strength [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of inhomogeneous lower extremity growth and development in early childhood: a cross-sectional study

Apibantaweesakul

Omura

et al. 2021

BMC Pediatr

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Background Early childhood is a transferring stage between the two accelerated growth periods (infant and adolescent). Body dimensions are related to physical growth and development. The purpose of this study was to investigate physical growth in terms of anthropometry, muscle growth of the lower extremity, and functional development over early childhood. Methods A cross-sectional study was carried out on 29 preschool children (PS: 3–5 years), 21 school children (SC: 6–8 years), and 22 adults (AD: 20–35 years). Lower extremity characteristics (segmental dimensions, muscle and adipose tissue thicknesses of the thigh and lower leg), and voluntary joint torque (knee and ankle) were measured. Correlations between parameters and group comparisons were performed. Results All the parameters except for body mass index (BMI) and subcutaneous adipose tissue thickness were correlated with age for PS and SC combined (r = 0.479–0.920, p < 0.01). Relative thigh and shank lengths to body height were greatest in AD and smallest in PS (p < 0.05) but the relative foot dimensions were significantly larger in PS and SC than in AD (p < 0.05). Relative subcutaneous adipose tissue thickness was largest in PS and lowest in AD. Muscle thickness and the muscle volume measure (estimated from muscle thickness and limb length) were significantly larger in older age groups (p < 0.05). All groups showed comparable muscle thickness when normalized to limb length. Joint torque normalized to estimated muscle volume was greatest for AD, followed by SC and PS (p < 0.05). Conclusions Relative lower extremity lengths increase with age, except for the foot dimensions. Muscle size increases with age in proportion to the limb length, while relative adiposity decreases. Torque-producing capacity is highly variable in children and rapidly develops toward adulthood. This cross-sectional study suggests that children are not a small scale version of adults, neither morphologically nor functionally.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Characteristics of inhomogeneous lower extremity growth and development in early childhood: a cross-sectional study

Apibantaweesakul

Omura

et al. 2021

BMC Pediatr

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“…Furthermore, SEM 95% of tibial and femoral length was determined. Those values are essential for a proper estimation of residual growth and correction potential using the Multiplier Method according to Paley [15,16,43]. The Multiplier Method need an exact determination of the bone length (either tibia or femur) to give a precise information about the correction potential.…”

Section: Discussionmentioning

confidence: 99%

Intra- and Interobserver Reliability Analysis of Pediatric Lower Limb Parameters on Digital Long Leg Radiographs

Braun

Brenneis

Holder

et al. 2022

Preprint

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Background:Malalignments of the lower extremity are common reasons for orthopedic consultation because it may lead to osteoarthritis in adulthood. An accurate and reliable radiological assessment of lower limb alignment in children and adolescents is essential for clinical decision-making on treatment of limb deformities and for regular control after a surgical intervention.Objective: First, does the analysis of full-length standing anteroposterior radiographs show a good intra- and interobserver reliability? Second, which parameter is most susceptible to observer-dependent errors? Third, what is the Standard Error of Measurement (SEM95%) of the absolute femoral and tibial length?Methods:Two observers evaluated digital radiographs of 144 legs from 36 children and adolescents with pathological valgus alignment before a temporary hemiepiphysiodesis and before implant removal. Parameters included Mechanical Femorotibial Angle (MFA), Mechanical Axis Deviation (MAD), mechanical Lateral Distal Femoral Angle (mLDFA), mechanical Medial Proximal Tibial Angle (mMPTA), mechanical Lateral Proximal Femoral Angle (mLPFA), mechanical Lateral Distal Tibial Angle (mLDTA), Joint Line Convergence Angle (JLCA), femur length, tibial length. Intra- and interobserver reliability (ICC2,1), SEM95% and proportional errors were calculated.Results:The intra- and interobserver reliability for almost all measurements was found to be good to excellent (Intra-ICC2,1: 0.849–0.999; Inter-ICC2,1: 0.864–0.996). The SEM95% of both observers was found to be ±1.39° (MFA), ±3.31mm (MAD), ±1.06° (mLDFA) and ±1.29° (mMPTA). The proportional error of MAD and MFA are comparable (47.29% vs. 46.33%). The relevant knee joint surface angles show a lower proportional error for mLDFA (42.40%) than for mMPTA (51.60%). JLCA has a proportional error of 138%. Furthermore, the SEM95% for the absolute values of the femoral and tibial length were 4.53mm for the femur and 3.12mm for the tibia.Conclusions:In conclusion, a precise malalignment measurement and the knowledge about SEM95% of the respective parameters is crucial for correct surgical or nonsurgical treatment. The susceptibility to error must be taken into account when interpreting malalignment analysis and must be considered when planning a surgical intervention. The results of the present study elucidate that MAD and MFA are equally susceptible to observer-dependent errors. This study shows good to excellent intra- and interobserver ICCs for all leg alignment parameters and joint surface angles, except for JLCA.Trial registration: This study was registered with DRKS (German Clinical Trials Register) under the number DRKS00015053.Level of Evidence: Level I, Diagnostic Study

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“…The mean rates at the human tibia are reported as 0.58°/month by Burghardt and Herzenberg, 7 0.5°/month by Ballal et al 25 and 0.79°/month by Danino et al 26 The average age during treatment was 9.59, 7 11.6 25 and 11.35 years, 26 respectively. Based on modulation rates of 1.02 °/mm (200 N implant), 0.46°/mm (120 N implant) and assuming a growth of 6 mm growth/year (0.5 mm/ month) at the human proximal tibia, 26 , 28 the resulting monthly modulation rates of the proposed concept are 0.23°/month for the 120 N implant and 0.51°/month for the 200 N implant. For the average treatment duration of 14.2 months 7 this would result in 3.3° angular change with the 120 N implant and 7.2° with the 200 N implant.…”

Section: Discussionmentioning

confidence: 99%

Growth modulation of angular deformities with a novel constant force implant concept-preclinical results

Buschbaum

Freitag

Slongo

et al. 2021

Journal of Children's Orthopaedics

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Purpose Varus-valgus deformities in children and adolescents are often corrected by temporary hemi-epiphysiodesis, in which the physis is bridged by an implant to inhibit growth. With standard implant solutions, the acting forces cannot be regulated, rendering the correction difficult to control. Furthermore, the implant load steadily increases with ongoing growth potentially leading to implant-related failures. A novel implant concept was developed applying a controlled constant force to the physis, which carries the potential to avoid these complications. The study aim was to proof the concept in vivo by analyzing the effect of three distinct force levels on the creation of varus deformities. Methods The proposed implant is made of a conventional cerclage wire and features a twisted coil that unwinds with growth resulting in an implant-specific constant force level. The proximal medial tibial physes of 18 lambs were treated with the implant and assigned to three groups distinct by the force level of the implant (200 N, 120 N, 60 N). Results The treatment appeared safe without implant-related failures. Deformity creation was statistically different between the groups and yielded on average 10.6° (200 N), 4.8° (120 N) and 0.4° (60 N) over the treatment period. Modulation rates were 0.51°/mm (200 N), 0.23°/mm (120 N) and 0.05°/mm (60 N) and were constant throughout the treatment. Conclusion By means of the constant force concept, controlled growth modulation appeared feasible in this preclinical experiment. However, clinical trials are necessary to confirm whether the results are translatable to the human pathological situation.

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Lower extremity growth and deformity

Cited by 12 publications

References 55 publications

Characteristics of inhomogeneous lower extremity growth and development in early childhood: a cross-sectional study

Characteristics of inhomogeneous lower extremity growth and development in early childhood: a cross-sectional study

Intra- and Interobserver Reliability Analysis of Pediatric Lower Limb Parameters on Digital Long Leg Radiographs

Growth modulation of angular deformities with a novel constant force implant concept-preclinical results

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