Tibial cast wedging: a simple and effective technique.

THE JOURNAL OF BONE AND JOINT SURGERY Frohlich-type body and anatomical variations such as excess retroversion. In contrast, bilateral cases are most common during treatment for hypothalamo-pituitary axis failure, during which hormone replacement can result in a rapid gain in height and weight. Another cause is hyperparathyroidism, either primary or secondary to chronic renal failure. ‘In-situ’ pinning has been used for a mild or moderate slip but in this young age group complications such as growth arrest are numerous. Leg-length discrepancy is often less than should theoretically occur; in some cases the contralateral physis also undergoes premature fusion, as a result of the underlying constitutional disorder or from asymptomatic slip. Chondrolysis is another possible complication of nailing, and avascular necrosis may follow any type of manipulative reduction. Severe slips have a poorer long-term prognosis for arthritic degeneration but the theoretical advantages of improving the biomechanics are outweighed by the complications of osteotomy in this young age group. Spica-cast treatment has not been associated with chondrolysis in this age group, and has been shown to stabilise the slip and leave excellent potential for remodelling (Clarke and Harrison 1986).