Radial head reduction after a missed Monteggia fracture: brief report.

THE JOURNAL OF BONE AND JOINT SURGERY alternative methods, such as epiphyseodesis by inserting a bone peg (Weiner et al. 1984). The hook-pin has eliminated the risk of lost epiphyseal grip : it cannot slide back and it is retracted in its channel with the growth of the femoral neck. Inserted in a pre-drilled hole there is only minimal trauma to the growth plate ; and as only one pin (inserted under fluoroscopy) is used, there is very little risk of joint penetration. Our investigation has shown considerable growth of the femoral neck after pinning. As slipping occurs through the hypertrophic layer of the growth-plate, there is usually no damage to the germinative layer before treatment, and consequently a potential for further growth. In our oldest patient nd growth of the femoral neck or of the greater trochanter was recorded. This boy had a bilateral chronic slip with onset of symptoms at least one year before pinning and the absence of growth in his case could be due to normal cessation of growth. In children with endocrine disorders or severe trauma a slipped capital femoral epiphysis is sometimes seen under the age of ten, when there is still considerable potential for growth of the femoral neck. The hook-pin allows growth to continue so that the hips develop normally.