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This study aimed to compare the clinical and radiographic results of three different pelvic fixation techniques, i.e., Galveston Rod, Iliac Screw, and Sacroiliac Screw, in managing neuromuscular scoliosis in nonambulatory children with spastic cerebral palsy (CP).This retrospective study included nonambulatory children aged18 years with neuromuscular scoliosis secondary to CP, undergoing a spinal fusion and pelvic fixation by either Galveston rod, iliac screw, or sacroiliac screw techniques. The primary outcome variable was to determine the stability of the major curve angle and pelvic obliquity over timeline intervals for each pelvic fixation tech nique. The two radiographic parameters were measured at five timeline intervals and were compared to define stability among the groups.One hundred and one patients (54 females [53%]) with spastic nonambulatory CP met the inclusion criteria; the mean age at sur gery was 13.5±3.1 years. Mean follow-up intervals were first-year (12.9±1.5) and second-year (25.8±2.5). Forty-one patients had minimum five-year (81.5±23 months) postoperative follow-up. Groups were based on pelvic fixation techniques: 25 patients with the Galveston rod, 24 with the iliac screw, and 52 with the sacroiliac screw. Of the 41 patients with a minimum five-year follow-up, 10 had the Galveston rod, 11 had an iliac screw, and 20 had sacroiliac screw fixation. Gross Motor Function Classification System level, medical comorbidities, intra thecal baclofen pump, and vitamin D level were compared with each pelvic fixation technique (P.05). Major curve angle parameters were measured at the five timelines as 70.5°±21.1°, 15.7°±13°, 15.7°±12°, 17.5°±12.7°, and 15.1°±9.6°, and pelvic obliquity as 14.8°±10.4°, 4.9°±4.2°, 5.7°±4.6°, 5°±4.4°, and 7.2°±4.4°, respectively. After the surgery, corrected major curve angle and pelvic obliquity showed no sta tistically significant difference between pelvic fixation techniques (P.05) and remained stable over timeline intervals (P.05). Fifteen patients had complications requiring additional surgery. The iliac screw group (nine patients) had the highest rate of complications.All three pelvic fixation techniques can provide equivalent correction for major curve angle and pelvic obliquity in managing neuromuscular scoliosis in nonambulatory CP children. Pelvic obliquity after surgery may remain stable regardless of pelvic fixation type. A higher rate of postoperative complication can be encountered with the iliac screw.Level III, Retrospective Study.

Coronavirus disease 2019 (COVID-19) has claimed the lives of millions of people worldwide since it first emerged. The impact of the COVID-19 pandemic on public health and the global economy has highlighted the medical need for the development of broadly acting interventions against emerging viral threats. Galidesivir is a broad-spectrum antiviral compound with demonstrated in vitro and in vivo efficacy against several RNA viruses of public health concern, including those causing yellow fever, Ebola, Marburg, and Rift Valley fever. In vitro studies have shown that the antiviral activity of galidesivir also extends to coronaviruses. Herein, we describe the efficacy of galidesivir in the Syrian golden hamster model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Treatment with galidesivir reduced lung pathology in infected animals compared with untreated controls when treatment was initiated 24 h prior to infection. These results add to the evidence of the applicability of galidesivir as a potential medical intervention for a range of acute viral illnesses, including coronaviruses.

Collaboration and service evaluation are essential enablers for improving models of health and social care. Significant benefits can be achieved when they are combined to form a collaborative service evaluation, particularly when such collaboration involves different clinical professions. This article uses the NHS 111 Wales service to explore a simple example of collaborative service evaluation and to discuss the benefits and challenges identified. While the tabletop exercises described were expected to focus solely on compliance data and the reasons for non-compliance, broader learning was identified for all parties involved. It became clear that there was a lack of shared understanding of each service, and that there were opportunities for education and opportunities to develop new national pathways. It is hoped that readers may be able to compare, learn and possibly replicate the collaborative approach used in their practice settings to achieve similar outcomes.

Radiographic lucency around a smooth pelvic rod (Galveston/unit rod technique) or sacroiliac/iliac screw following spinal fusion in children with nonambulatory spastic cerebral palsy (CP) has been described as a "windshield wiper" phenomenon. We evaluated demographics, radiographs, and complications in 101 cases from a single center to determine prevalence, risk factors, and complications associated with persistent radiographic lucency from 1 to 5 years following spinal fusion.Inclusion criteria were diagnosis of nonambulatory spastic quadriplegic CP [Gross Motor Function Classification System (GMFCS) IV-V], under 18 years of age, scoliosis treated by posterior fusion from upper thoracic to sacrum with pelvic fixation (Galveston rod, iliac screw, or sacroiliac screw), adequate radiographs (preoperative, immediate postoperative, first-year, and second-year), and minimum 5-year follow-up. We evaluated demographics, radiographic parameters, comorbidities, scoliosis curve type, type of pelvic screw/rod, use of off-set connector, screw width, associated with posterior column osteotomy and/or additional anterior spinal release concurrent with posterior spine fusion, and infection over the follow-up period. Specific attention was given to the area and shape of the radiographic lucency. The logistic regression analysis was performed for continuous and categorical variables to define risk factors ( P =0.05).In 101 patients, data were collected at mean intervals of 1-year, 2-year, and5-year follow-up and were 12.9±1.5, 25.8±2.5, and 81.5±23.0 months, respectively. Prevalence of pelvic rod/screw radiographic lucency was unchanged at 33%, 35%, and 24% at 1-year, 2-year, and5-year follow-up, respectively, and radiographic parameters did not change ( P0.05). Furthermore, no risk factors or complications were associated with radiographic lucency around pelvic rods/screws ( P0.05).In patients with spastic nonambulatory CP who had scoliosis treated with posterior spinal fusion from upper thorax to pelvis, the prevalence of pelvic rod/screw lucency is high. Persistent lucency2 mm around pelvic implants is not clinically significant, does not warrant advanced imaging, or indicate a complication if stable over time and wider distally than proximally.Level III.

A 16-year-old boy with a history of Down syndrome presented with right knee pain and swelling. He was diagnosed with isolated septic arthritis of the knee due to Fusobacterium necrophorum in the absence of current or recent oropharyngeal infection. He was successfully treated with arthroscopic irrigation and debridement and 12 weeks of oral antibiotics.Fusobacterium necrophorum is a part of the normal oral flora and a rare cause of septic arthritis, typically associated with recent oropharyngeal infection. However, patients with immune dysregulation such as those with Down syndrome may develop isolated septic arthritis due to transient hematogenous seeding.

Early-onset scoliosis in children with skeletal dysplasia is progressive, contributing to cardiopulmonary restrictive disease. Serial elongation-derotation-flexion (EDF) casting, used in other etiologies of scoliosis to delay curve progression, may be beneficial in maximizing spine growth. Our hypothesis is serial EDF casting can be safely used as a temporary alternative to surgery, delaying progression and preserving growth, to treat scoliosis in skeletal dysplasia.All patients with skeletal dysplasia treated at a single institution with serial EDF casting for scoliosis were reviewed retrospectively. Radiographic parameters: Cobb angle of major and minor curves, curve location, thoracic height, thoracolumbar height, space available for lung, and rib vertebra angle difference were measured before casting (C1), in first casting (C2), in last casting (C3), and out of last casting (C4). Peak inspiratory pressure (PIP) values were monitored and recorded during the casting application.Eleven patients met the inclusion criteria (mean 9.7 castings). The mean duration of EDF serial casting was 35 months. The mean major Cobb angles were 54 degrees° (C1), 30 degrees (C2), 37 degrees (C3), and 49 degrees (C4) with no statistically significant differences. The mean minor Cobb angles were 35 degrees (C1), 25 degrees (C2), 33 degrees (C3), and 51 degrees (C4) with no statistically significant differences. The mean thoracic heights were 130 mm (C1), 155 mm (C2), 173 mm (C3), and 160 mm (C4). The 19-mm mean difference between C2 and C3 represents spinal growth. The PIP-1, PIP-2, and PIP-3 mean values were 15, 27, and 18 cmH2O, respectively. Changes in PIP-1 and PIP-2 and PIP-2 and PIP-3 were statistically significant.Serial EDF casting can delay surgical scoliosis correction in children younger than 7 years with a diagnosis of skeletal dysplasia. Our study showed that serial casting controls progression of the major curve and allows longitudinal growth of the spine with possible expansion of lung volume for nearly 3 years. During cast application, PIP increased with molding and traction, and improved until windowing and trimming of the cast.Level IV-retrospective study.

COVID-19 presents an ongoing global health crisis. Protein-based COVID-19 vaccines that are well-tolerated, safe, highly-protective and convenient to manufacture remain of major interest. We therefore sought to compare the immunogenicity and protective efficacy of a number of recombinant SARS-CoV-2 spike protein candidates expressed in insect cells. By comparison to a full length (FL) spike protein detergent-extracted nanoparticle antigen, the soluble secreted spike protein extracellular domain (ECD) generated higher protein yields per liter of culture and when formulated with either Alum-CpG55.2 or Advax-CpG55.2 combination adjuvants elicited robust antigen-specific humoral and cellular immunity in mice. In hamsters, the spike ECD when formulated with either adjuvant induced high serum neutralizing antibody titers even after a single dose. When challenged with the homologous SARS-CoV-2 virus, hamsters immunized with the adjuvanted spike ECD exhibited reduced viral load in day 1-3 oropharyngeal swabs and day 3 nasal turbinate tissue and had no recoverable infectious virus in day 3 lung tissue. The reduction in lung viral load correlated with less weight loss and lower lung pathology scores. The formulations of spike ECD with Alum-CpG55.2 or Advax-CpG55.2 were protective even after just a single dose, although the 2-dose regimen performed better overall and required only half the total amount of antigen. Pre-challenge serum neutralizing antibody levels showed a strong correlation with lung protection, with a weaker correlation seen with nasal or oropharyngeal protection. This suggests that serum neutralizing antibody levels may correlate more closely with systemic, rather than mucosal, protection. The spike protein ECD with Advax-CpG55.2 formulation (Covax-19® vaccine) was selected for human clinical development.

Rift Valley fever virus (RVFV) is a mosquito-borne pathogen with significant human and veterinary health consequences that periodically emerges in epizootics. RVF causes fetal loss and death in ruminants and in humans can lead to liver and renal disease, delayed-onset encephalitis, retinitis, and in some cases severe hemorrhagic fever. A live attenuated vaccine candidate (DDVax), was developed by the deletion of the virulence factors NSs and NSm from a clinical isolate, ZH501, and has proven safe and immunogenic in rodents, pregnant sheep and non-human primates. Deletion of NSm also severely restricted mosquito midgut infection and inhibited vector-borne transmission. To demonstrate environmental safety, this study investigated the replication, dissemination and transmission efficiency of DDVax in mosquitoes following oral exposure compared to RVFV strains MP-12 and ZH501. Infection and dissemination profiles were also measured in mosquitoes 7 days after feeding on goats inoculated with DDvax or MP-12. Hypothesis: DDVax should infect mosquitoes at significantly lower rates than other RVF strains and, due to lack of NSm, be transmission incompetent. Exposure of Ae. aegypti and Cx. tarsalis to 6-8 log plaque forming units (PFU)/mL DDVax by artificial bloodmeal resulted in significantly reduced DDVax infection rates in mosquito bodies compared to controls. Plaque assays indicated negligible transmission of infectious DDVax in Cx. tarsalis saliva (1/140 sampled) and none in Ae aegypti saliva (0/120). Serum from goats inoculated with DDVax or MP-12 did not harbor detectable infectious virus by plaque assay at 1, 2, or 3 days-post-inoculation; infectious virus was, however, recovered from mosquito bodies that fed on goats vaccinated with MP-12 (13.8% and 4.6%, respectively), but strikingly, DDvax positive mosquito bodies were greatly reduced (4%, and 0%, respectively). Furthermore, DDVax did not disseminate to legs/wings in any of the goat-fed mosquitoes. Collectively, these results are consistent with a beneficial environmental safety profile .

Accurate length measurements of extremity bones are essential in treating limb deformities and length discrepancies in children.This study aimed to determine errors in common techniques used to measure lower limb lengths in children.Precision and instrument errors in length measurements were studied utilizing electro-optical system (EOS), orthoroentgenogram, and teleoroentgenogram The goal was to measure a 70-cm metallic rod phantom (average length of the lower extremity of a 10-year-old boy in the 50th percentile) in 3 phases. In Phase 1, the length measurements were performed in an EOS unit with internal calibrations, a magball/magstrip in various scan positions, and measurement with TraumaCAD software. In Phase 2, the measurements were repeated utilizing a single radiation "shot" teleoroentgenogram. In Phase 3, an orthoroentgenogram was utilized with a radiopaque ruler reference. The reliability and validity of measurements were calibrated by 4 physicians (a radiologist, senior orthopaedic attending, and 2 orthopaedic fellows).EOS measurements utilizing internal references had excellent accuracy (for a 700-mm real length, magnification error (ME)] of 0.09%. Teleoroentgenogram with a magball reference and measurements performed with automatic calibration by TraumaCAD program results in ME of 1.83% with insignificant intraobserver/interobserver difference. Teleoroentgenogram with a magball or magstrip reference measured manually showed that the magball has higher intraobserver/interobserver variance than magstrip, with a 6.60 and 0.33-mm SD, respectively. The length by manual measurement utilizing the magstrip has ME of 2.21%. Orthoroentgenogram is accurate with ME of 0.26%, but does not allow anatomical analysis and is also radiation-costly.EOS and orthoroentgenogram are very accurate for length measurements. Teleoroentgenogram is less accurate in measuring length; however, addition of an external reference (magball, magstrip) placed lateral to the target improves accuracy. Automatic calibration with computer-based analysis of the external reference improves the accuracy more than manual calibration. If manual calibration is utilized, the length measurement is less accurate with the magball than the magstrip.Level II-comparative in vitro study.

The aim of this study was to evaluate the association of contractures, fractures, and deformities in four patients with Bruck syndrome treated in our facility. Data were collected from medical records, radiographs, dual-energy X-ray absorptiometry (DEXA) scans, genetic tests, and gait analysis. All had contractures at birth and genotypic findings including mutations in PLOD2 or FPKB10. Three cases were treated with bisphosphonates with improvement in bone density verified by DEXA. In Bruck syndrome, orthopedic deformities include the following sequential aspects: contractures, characterized by upper and lower extremity contractures such as clubfeet; fractures, characterized by multiple diaphyseal fractures in the long bones of the extremities; and deformities, characterized by malalignment of extremities and the spine. Physical therapy and bracing proved helpful for the contractures to try to stop progression. Bone fragility needs to be considered when deciding to attempt cast correction. Surgeries in the soft tissues can be performed to retain joint movement. In fractures with angulation, intramedullary nail fixation was useful, and in cases without deformity, casting alone was successful. We suggest monitoring the bone density with DEXA, nutrition support with vitamin D and calcium, and treatment with bisphosphonates. Spine deformities were successfully treated by spinal fusion and instrumentation.

Politicians tend to use the word opportunity as a catch-all term. This paper is contending that opportunities can be classified as tangible or intangible. Lawmakers do not appear to consider the idea that opportunities are hierarchical or link to a firms’ ability to leverage opportunities. The context for the paper is Brexit and its strategic implications. Furthermore, a hard Brexit will throw up more intangible opportunities than tangible opportunities, which suggests that firms will require different strategies for hard Brexit and soft Brexit environments. This paper suggests that there are two possible dominant strategies available to executives, namely leverage logic and opportunity logic, and the application of the strategies is dependent on the type of Brexit situation. The time horizon to develop and refine the dominant strategies is dependent on the type of Brexit environment, with a hard Brexit requiring the longest time horizon.

To determine if pan-coronavirus neutralizing antibodies are induced by SARS-CoV-2 infection, human monoclonal antibodies (mAb) targeting the highly conserved S2 domain of the Spike glycoprotein were cloned from B cells isolated from convalescent patients with rationally designed SARS-CoV-2 stabilized S2 and SARS-CoV/SARS-CoV-2 S1S2 chimera recombinant protein probes. mAbs emerged capable of binding SARS-CoV-2, including the variants of concern (Beta, Gamma, Delta, and Omicron), SARS-CoV and MERS-CoV. The most potent neutralizing mAb with greatest breadth, 1249A8, recognizes all beta-coronaviruses tested including high affinity for SARS-CoV-2, SARS-CoV, and MERS-CoV. The 1249A8 lineage appears to have developed from a pre-existing OC43-specific memory B cell that was expanded as result of SARS-CoV-2 infection, and further expanded following COVID-19 vaccination. Treating K18 hACE2 transgenic mice with 1249A8 intraperitoneally prior to co-infection with SARS-CoV-2 Wa-1 and Beta VoC strains prevented weight loss and death, with viral titers below detectable levels by 4 days post-infection. 1249A8 delivered as a single 4mg/kg intranasal (i.n.) dose to hamsters 12 hours following infection with SARS-CoV-2/Delta significantly protected them from weight loss, with therapeutic activity enhanced when combined with an S1-specific neutralizing mAb. As little as 2 mg/kg of 1249A8 i.n. 20 hours following infection with SARS-CoV/Urbani protected hamsters from weight loss. 1249A8 recognizes a highly conserved region near HR2 of the S2 domain of Spike. These results indicate that potent pan-coronavirus neutralizing mAbs with therapeutic potential can be induced in humans and can inform pan-coronavirus vaccine development. Supported in-part by Aridis Pharmaceuticals and NIH (R01AI161175).

Treatment of infantile tibia vara or Blount disease (ITV/BD) in patients3 years old and Langenskiold stages I-III consists of orthosis and, in relapsing cases, proximal tibial osteotomy and/or proximal tibial guided growth laterally with a tension band plate. Our aim was to evaluate the results of treatments in a consecutive group. After Institutional Review Board approval, data from 2002 to 2018 were collected. Thirty-nine knees (average age 22.4 months) with ITV/BD were treated with orthoses, and 10 knees failed. Six knees showed hyperintense T2-weighted signal in the medial proximal tibial epiphyseal cartilage on magnetic resonance imaging. Three of six knees with tibial osteotomy failed and underwent guided growth. Tibial plateau slopes were abnormal medially from the ITV/BD and laterally from the guided growth (triangular physis and depressed plateau deformities) because of factors such as orthotic treatment, tibial osteotomy, magnetic resonance imaging "physis severity score," and guided growth. (Journal of Surgical Orthopaedic Advances 29(3):141-148, 2020).

Background In Nepal, knowledge of proper handling, management and causes of cattle diseases is still limited. The main objective of this study was to explore the impact of deworming on milk production and its effect on milk qualities. Methods A total of 200 faecal samples (100 buffaloes and 100 cows) were collected and analysed for parasitic burden. Half of the infected cattle (buffaloes, Bos bubalis; cow native, B indicus; European, B taurus) were then dewormed with Levamisole Hydrochloride-Oxyclozanide bolus, and the remaining 50 per cent were left untreated. The milk yield from both infected and dewormed cattle was recorded for 30 days and the qualities of milk were analysed. Results The prevalence of parasitic infection was found to be 22.0 per cent. Fasciola hepatica was the predominant parasite (81.8 per cent), followed by Toxocara vitulorum (34.1 per cent), Strongyloidespapillosus (6.8 per cent) and Bunostomum phlebotomum (4.5 per cent). The average milk yield (litre/day/cow) significantly increased, which was 1.22 litres per day for treated cows and 1.06 litres for treated buffaloes. The intervention effect of deworming among cows was 0.79 (14.06 per cent increment) and for buffaloes was 0.42 (8.32 per cent increment). After deworming the infected cattle, the protein percentage was significantly improved in cows (P=0.035), whereas the lactose percentage and solid percentage had increased significantly in buffaloes (P=0.002 and P=0.028). Conclusion Antiparasitic treatment in cattle had positive effects on milk qualities such as solid non-fat, lactose, solid percentage and total protein percentage.

Social media is a pervasive platform, and consumers increasingly want to connect with it. The growth of mobile devices has increased connectivity to social media, but accessing social media platforms has uncovered interesting results with gender differences between males and females. Trust models have evolved to take account of website interactivity, website environment design, and brand effect on brand trust. Themes on ability, benevolence, integrity, and predictability are also influencers on brand trust. Increasing access to social media is changing attitudes and behaviour to challenge established social and behavioural norms. Brands in the online and offline environments are exposed to risks, but the sheer level of interactivity and connectedness of social media increases the consequence of negative responses. However, the use of brand communities could be a way forward to negate the risk of brand contamination.

A developmental dysplasia of the hip (DDH) case treated by closed reduction and casting and subsequently confirmed to have avascular necrosis (AVN) was retrospectively noted to have an abnormal pattern of echogenicity in the femoral head on sonograms obtained within 1.5 months of surgery. Patchy increased echogenicity in parts of the unossified cartilage replaced the normal pattern of central coalescence of vessels described with development of the ossification center. An additional case with similar findings confirms this should be considered a sign of evolving AVN following closed reduction.

Case A female with 24 years of follow-up who received multiple intramuscular injections of penicillin in the buttock at age 2 years. By age 6 years, she had left hip subluxation and underwent operative soft-tissue release and femoral plating. At age 12 years, she developed progressive anterior hip dislocation and had release of the gluteal contracture, open reduction, and femoral osteotomy. Currently, she is aged 26 years, fully employed, and active at home. Conclusions This is the first reported case associated with anterior hip dislocation after progressive post-injection gluteus muscle fibrosis with a follow-up of 24 years.

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Social media is a pervasive platform, and consumers increasingly want to connect with it. The growth of mobile devices has increased connectivity to social media, but accessing social media platforms has uncovered interesting results with gender differences between males and females. Trust models have evolved to take account of website interactivity, website environment design, and brand effect on brand trust. Themes on ability, benevolence, integrity, and predictability are also influencers on brand trust. Increasing access to social media is changing attitudes and behaviour to challenge established social and behavioural norms. Brands in the online and offline environments are exposed to risks, but the sheer level of interactivity and connectedness of social media increases the consequence of negative responses. However, the use of brand communities could be a way forward to negate the risk of brand contamination.

NHS Direct Wales provides a single point of access where members of the public can telephone and seek medical support and/or advice. The service is provided for all the Health Boards in Wales by a single virtual call centre run from a main location in Swansea with 2 satellite locations. Patients in Wales can also access a local General Practitioner service during the evenings and at weekends, by phoning their Out of Hours service. The introduction of a ‘111’ service is intended to combine these two operations on a pan-Wales basis using the existing NHS Direct Wales call centre and staff, with the existing Health Board Out of Hours ‘hubs’. The merger of the two services is intended to improve the overall performance of both services. This paper focuses on the planned introduction of ‘111’ in Cwm Taf and Hywel Dda University Health Boards. The purpose of the case study was to support the merger of the two telephony systems from both an organisational and service delivery perspective, by developing a Discrete Event Simulation to model the impact on service levels and staffing. In particular, to examine the percentage increase / decrease in the staffing requirements needed under partial or full integration of the two services. The results from the scenario analysis highlight that extra staffing resources would be required in certain groups (nurses and call handlers) whilst savings could be achieved in others, provided that there wasn’t an increase in call volume after implementation of the new service.

In a perceptive academic article published early in her career, the linguist and poet Anne Cluysenaar challenged poets to engage strongly with science so as to stimulate their imaginations by freeing them from inadequate interpretations of the world. This challenge requires poets to find means of engaging with the core of scientific practice in ways that are sufficiently intense as to appropriate into their subjective interactions with the world the apparently objective knowledge that science provides. The present article explores and analyses how Cluysenaar’s own engagement with science influenced her creative writing and assesses whether the challenges she identified were met in her own poetry. Cluysenaar’s poetry shows particularly knowledgeable interaction with evolutionary theory, genetics, the origins of consciousness and geology, all of which are linked through her awareness of ‘deep time’. Her poetry exemplifies how, through serious study and interaction with scientists, a poet can appropriate science with intensity and discernment such that it becomes an integral part of her awareness of the world. Her eloquent writing provides for the reader intelligible and subtle connections between the apparently objective world of science and the subjective experiences of life. At the same time, the poems sensitively keep a perspective on the findings of science through inclusion of expression of feelings, ethical concerns and a willingness to value other means of knowing. Her poetry shows how science greatly enriched her imagination and her life, that science mattered personally to her and hence that it can matter personally to us.

In brief The authors provide guidelines for returning children with Perthes disease to sporting activities. They suggest maintenance of hip motion and containment of the femoral head in the acetabulum until the extent of the femoral epiphyseal necrosis can be determined. Swimming and adaptive physical therapy help regain the motion and strengthen the hip abductor muscles. Abduction brace therapy is continued in patients with a risk of femoral head deformity until reossification of the necrotic femoral head begins. Surgical containment, as an alternative to brace therapy, is recommended when an orthosis is not socially tolerated. Once reossification of the femoral head occurs, the patient may begin full activity, but osteochondritis dissecans with an osteocartilaginous loose body should be considered if catching or locking of the hip joint occurs.

Limb-length inequality is a clinical problem in children with hypertrophy associated with vascular malformations. The purpose of this study was to determine a pattern of growth, predict discrepancy at maturity, and evaluate the timing and results of epiphysiodesis. Hypertrophy with vascular malformation, follow-up from childhood until maturity, annual physical examination, and annual orthoroentgenograms and anteroposterior left hand–wrist radiographs were the inclusion criteria. The developmental pattern of the growth discrepancy was established. Limb-length discrepancy and remaining growth were calculated. All 3 patients underwent distal femur or proximal tibia and fibula percutaneous epiphysiodesis. All cases showed the constant upward slope of the developmental pattern of discrepancy until the time of epiphysiodesis. The length of the uninvolved limb at maturity corresponded to the length predicted by the methods that used skeletal age, allowing calculation of the proper timing for epiphysiodesis. The multiplier and the rule of thumb methods failed, with skeletal age not corresponding to chronological age. In these 3 cases, limb-length discrepancy was successfully treated with percutaneous epiphysiodesis, and there were no complications. [ Orthopedics. 2018; 41(4):e574–e579.]