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SHORTENING LEGS
506 The
tions of life and climate should not ultimately produce even the substantial differences met with in the local treponematoses which keep coming to light among backward and remotely situated peoples. Their investi. gation may tell us a good deal about the mutual adaptation between man and his ,parasites under varying conditions. And our peripatetic correspondent who describes his first meeting with bejel on another page wonders whether all this group of diseases will respond, as syphilis has and yaws seems likely to do, to penicillin_7
SHORTENING LEGS IN 1933 Phemiste-rdescribed a method of compensating for unequal leg length by fusing the epiphysio-diaphyseal junction at selected points in the sound longer leg while growth continued. The usual cause was infantile paralysis which had stunted one limb ; and the fusion operation was done -at the main growing points of the other leg-the epiphyses around the knee. Shortening has become fairly popular since then, and for other lesions such as fracture or disease. The two main methods have been epiphysiodesis, and deliberate resection of the requisite amount of bone from the sound femur or tibia after the end of the growth period. Both methods are probably preferable to lengthening the shorter side, because they are performed on healthy bone, and non-union, as far as shaft operations are concerned, is therefore much less likely. However, the epiphyseal procedure sometimes -caused varus or valgus deformity from failure of fusion on one side of the junction, and the calculations of when to do the operation for a particular discrepancy were intricate; by contrast, the shaftshortening was exact, but it meant waiting until the patient was 18-20 years old. White and Stubbins2 have described a simple technique of recording length discrepancy, and calculating age for operation and for the fusion itself, based on experience in 250 cases. They prefer radiographic records to clinical measurement. Teleradiograms are unnecessary. The patient lies on a table with the feet pressed hard and flat on a platform, and the difference in the distance of the femoral heads from a horizontal line on a plain anteroposterior pelvic film gives the discrepancy in length. There is of course a standard error. If it be assumed-what is not strictly true-that the shortening occurs in the acute stage of the illness and both limbs grow -thereafter at the same rate, the problem is to retard the growth of the sound limb so that both become about equal when growth ceases at 16. The time available for -this is known ; fusion of the lower femoral epiphysis retards growth by t inch a year, and the upper tibial and fibular epiphyses supply a further inch. In this way a fairly accurate estimate can be made of how much to do and how long before the age of 16 to do it -e.g., with 2 inches shortening at the age of 12, growtharrest above and below the knee will produce approximate equality at 16. At operation a square chisel is used to remove a block 1 inch deep centred at the epiphyseal plate, on the lateral and medial sides of the large bones, and the lateral side of the fibula. The blocks are removed, the adjacent parts of the junction being curetted, and-are then reinserted after rotation through 90°. They now act as a double bone-graft across the junction, the two halves of each graft separated by the piece of epiphyseal cartilage removed with them. The operation is essentially similar to Milgram’s rotation arthrodesis of the knee,3 where a large cylindrical block is removed from the bone ends at the level of the joint line and reinserted after
right-angle rotation, acting again the joint.
as
a
double
graft
across
1. Phemister, D. J. Bone Jt Surg. 1933, 15, 1. 2. White, J. W., Stubbins, S. G. J. Amer. med. Ass.
3. Milgram, J. E. Surg. Gynec. Obstet. 1931,
1944, 126, 1146.
53, 335.
ingenious, and it must be fascinating getting relatively shorter through They should not be allowed to get too short,
operation
is
to watch these long legs
the years. but under-correction is the usual
error.
FRANKLIN D. ROOSEVELT THE successes and failures of Mr. Roosevelt as President of the United States cannot be assessed by contemporaries, especially from a distance of several thousand miles. No historian, however, can alter the fact that he carried the hopes of millions in this country as well as his own. His death at 63 comes therefore as a blow ; but it leaves us profoundly thankful that he died no sooner, and that he overcame his physical disabilities sufficiently to lead his nation. In 1921, when he was 39, he contracted poliomyelitis, and despite great benefit from treatment at Warm Springs in Georgia he never regained the full use of his legs. His
attitude towards this handicap will long be
an
inspiration
to disabled people in all walks of life, and his illness has also led directly to increase in knowledge of the disease by which he was attacked. He founded the National
Foundation, for Infantile Paralysis and for the last twelve years he had celebrated his birthday by launching an appeal for its funds. The proceeds of the first birthday drive in 1934 were given to the foundation at Warm Springs. Other institutions benefited each year and laterimoneywas also set aside for research, emergency aid in epidemics, and the aftercare of victims. As an American of his day and generation he appreciated the value of scientific work. Last year, in to the director of the Office of Scientific Research and Development, he wrote : " New frontiers of the mind are before us. If they are pioneered with the same vision, boldness, and drive with which we have waged this war, we can create a fuller and more fruitful employment and a fuller and more fruitful life." These were always his aims.
a letter
THE two
MPs who won their seats at the Scottish week are both medical men. Sir JOHN last by-elections ORR, FRS, who will represent the Scottish Universities as an Independent, is a doctor of medicine and science of the University of Glasgow, and won the DSO and MC in the last war. Director of the Rowett Research Institute and the Imperial Bureau of Animal Nutrition, and temporarily professor of agriculture at Aberdeen, Orr has made the study of human dietetics his life-work, new
was a British delegate to the Hot Springs conference. His thesis that the poorer half of our population was inadequately fed and that poverty and disease were linked by malnutrition was politically more novel in pre-war days when he produced his Food, Health and - Zcome ;but his knowledge will still be invaluable at Westminster. Dr. ROBERT McINTYRE, who becomes MP for Motherwell, graduated at Edinburgh in 1938. He is the first Scottish Nationalist elected to Parliament.
and
Surgeon Captain MACDONALD CRITCHLEY, RNVR, will deliver the Croonia,n lectures at, the Royal College of Physicians of London on Tuesday and Thursday, May 8 and 10, at 4.30 PM. He is to speak on problems of naval warfare under climatic extremes. ‘
RUSSIAN MEDICAL MissiON.—A medical mission, consisting of two orthopaedic surgeons and three engineers, has arrived in this country to study limb prosthesis and particularly the production of artificial limbs. The orthopaedic surgeons are Prof. M. N. Polonski and Prof. G. F. Kalmykov, who are connected with the veterans and social security administrations in Moscow and Leningrad. They- have been to Canada and America, and are anxious to exchange ideas and experiences. They are making a tour of various British hospitals and taking particular interest in our methods for reabling wounded men.
,
tions of life and climate should not ultimately produce even the substantial differences met with in the local treponematoses which keep coming to light among backward and remotely situated peoples. Their investi. gation may tell us a good deal about the mutual adaptation between man and his ,parasites under varying conditions. And our peripatetic correspondent who describes his first meeting with bejel on another page wonders whether all this group of diseases will respond, as syphilis has and yaws seems likely to do, to penicillin_7
SHORTENING LEGS IN 1933 Phemiste-rdescribed a method of compensating for unequal leg length by fusing the epiphysio-diaphyseal junction at selected points in the sound longer leg while growth continued. The usual cause was infantile paralysis which had stunted one limb ; and the fusion operation was done -at the main growing points of the other leg-the epiphyses around the knee. Shortening has become fairly popular since then, and for other lesions such as fracture or disease. The two main methods have been epiphysiodesis, and deliberate resection of the requisite amount of bone from the sound femur or tibia after the end of the growth period. Both methods are probably preferable to lengthening the shorter side, because they are performed on healthy bone, and non-union, as far as shaft operations are concerned, is therefore much less likely. However, the epiphyseal procedure sometimes -caused varus or valgus deformity from failure of fusion on one side of the junction, and the calculations of when to do the operation for a particular discrepancy were intricate; by contrast, the shaftshortening was exact, but it meant waiting until the patient was 18-20 years old. White and Stubbins2 have described a simple technique of recording length discrepancy, and calculating age for operation and for the fusion itself, based on experience in 250 cases. They prefer radiographic records to clinical measurement. Teleradiograms are unnecessary. The patient lies on a table with the feet pressed hard and flat on a platform, and the difference in the distance of the femoral heads from a horizontal line on a plain anteroposterior pelvic film gives the discrepancy in length. There is of course a standard error. If it be assumed-what is not strictly true-that the shortening occurs in the acute stage of the illness and both limbs grow -thereafter at the same rate, the problem is to retard the growth of the sound limb so that both become about equal when growth ceases at 16. The time available for -this is known ; fusion of the lower femoral epiphysis retards growth by t inch a year, and the upper tibial and fibular epiphyses supply a further inch. In this way a fairly accurate estimate can be made of how much to do and how long before the age of 16 to do it -e.g., with 2 inches shortening at the age of 12, growtharrest above and below the knee will produce approximate equality at 16. At operation a square chisel is used to remove a block 1 inch deep centred at the epiphyseal plate, on the lateral and medial sides of the large bones, and the lateral side of the fibula. The blocks are removed, the adjacent parts of the junction being curetted, and-are then reinserted after rotation through 90°. They now act as a double bone-graft across the junction, the two halves of each graft separated by the piece of epiphyseal cartilage removed with them. The operation is essentially similar to Milgram’s rotation arthrodesis of the knee,3 where a large cylindrical block is removed from the bone ends at the level of the joint line and reinserted after
right-angle rotation, acting again the joint.
as
a
double
graft
across
1. Phemister, D. J. Bone Jt Surg. 1933, 15, 1. 2. White, J. W., Stubbins, S. G. J. Amer. med. Ass.
3. Milgram, J. E. Surg. Gynec. Obstet. 1931,
1944, 126, 1146.
53, 335.
ingenious, and it must be fascinating getting relatively shorter through They should not be allowed to get too short,
operation
is
to watch these long legs
the years. but under-correction is the usual
error.
FRANKLIN D. ROOSEVELT THE successes and failures of Mr. Roosevelt as President of the United States cannot be assessed by contemporaries, especially from a distance of several thousand miles. No historian, however, can alter the fact that he carried the hopes of millions in this country as well as his own. His death at 63 comes therefore as a blow ; but it leaves us profoundly thankful that he died no sooner, and that he overcame his physical disabilities sufficiently to lead his nation. In 1921, when he was 39, he contracted poliomyelitis, and despite great benefit from treatment at Warm Springs in Georgia he never regained the full use of his legs. His
attitude towards this handicap will long be
an
inspiration
to disabled people in all walks of life, and his illness has also led directly to increase in knowledge of the disease by which he was attacked. He founded the National
Foundation, for Infantile Paralysis and for the last twelve years he had celebrated his birthday by launching an appeal for its funds. The proceeds of the first birthday drive in 1934 were given to the foundation at Warm Springs. Other institutions benefited each year and laterimoneywas also set aside for research, emergency aid in epidemics, and the aftercare of victims. As an American of his day and generation he appreciated the value of scientific work. Last year, in to the director of the Office of Scientific Research and Development, he wrote : " New frontiers of the mind are before us. If they are pioneered with the same vision, boldness, and drive with which we have waged this war, we can create a fuller and more fruitful employment and a fuller and more fruitful life." These were always his aims.
a letter
THE two
MPs who won their seats at the Scottish week are both medical men. Sir JOHN last by-elections ORR, FRS, who will represent the Scottish Universities as an Independent, is a doctor of medicine and science of the University of Glasgow, and won the DSO and MC in the last war. Director of the Rowett Research Institute and the Imperial Bureau of Animal Nutrition, and temporarily professor of agriculture at Aberdeen, Orr has made the study of human dietetics his life-work, new
was a British delegate to the Hot Springs conference. His thesis that the poorer half of our population was inadequately fed and that poverty and disease were linked by malnutrition was politically more novel in pre-war days when he produced his Food, Health and - Zcome ;but his knowledge will still be invaluable at Westminster. Dr. ROBERT McINTYRE, who becomes MP for Motherwell, graduated at Edinburgh in 1938. He is the first Scottish Nationalist elected to Parliament.
and
Surgeon Captain MACDONALD CRITCHLEY, RNVR, will deliver the Croonia,n lectures at, the Royal College of Physicians of London on Tuesday and Thursday, May 8 and 10, at 4.30 PM. He is to speak on problems of naval warfare under climatic extremes. ‘
RUSSIAN MEDICAL MissiON.—A medical mission, consisting of two orthopaedic surgeons and three engineers, has arrived in this country to study limb prosthesis and particularly the production of artificial limbs. The orthopaedic surgeons are Prof. M. N. Polonski and Prof. G. F. Kalmykov, who are connected with the veterans and social security administrations in Moscow and Leningrad. They- have been to Canada and America, and are anxious to exchange ideas and experiences. They are making a tour of various British hospitals and taking particular interest in our methods for reabling wounded men.
,