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Purpose The multiplier method is a technique to predict limb length discrepancy (LLD) at maturity in pediatric patients. Various tools have been developed for performing the multiplier calculations to predict LLD and timing of epiphysiodesis. These include multiplier/growth applications (apps) and a spreadsheet which have helped to facilitate LLC calculations in an efficient and easy manner. We have updated the spreadsheet to improve features for making LLD calculations and facilitate pasting data into electronic medical records (EMRs). Methods Tools currently in use were critically examined for features that limited their function, created possible sources of error or could be more user-friendly. Simplemind pro crack.

Chicken invaders 1 play online. These features were modified and recreated in an improved Excel spreadsheet that uses patient age, sex, limb lengths, and previous lengthening surgeries as inputs to predict LLD at maturity and offer options for timing of epiphysiodesis for both congenital and developmental LLD. Our multiplier spreadsheet function was then compared to manual calculations and other multiplier tools for accuracy and ease of use.

Background The multiplier method was first developed by Paley et al. In 2000 to predict limb length discrepancy (LLD) at skeletal maturity and the timing of epiphysiodesis []. They looked at a number of different populations to confirm that for a given chronological age and sex, the ratio of a patient’s bone length at maturity to current bone length remains the same across different races, anthropologic eras, and height percentiles. The ratios were made into a table of multipliers for a given sex and age (Table ). Validating studies have further supported the use of the multiplier method and favorably compared it to other methods as an accurate and reliable tool for clinical application [–].

The practicality of this method was greatly enhanced by the creation of the Multiplier application (app) and the Paley Growth (PG) app. They both use the multiplier method in an iOS and Android interface to facilitate the calculations for clinical use. They contain a number of features used in different clinical scenarios to include calculations for upper and lower extremity LLD, timing of epiphysiodesis, height and growth charts and information regarding other growth disorders.

The formulae within the apps are derived from those of the original formulae from Paley et al. Additionally, Sanders et al. Published a Microsoft Excel spreadsheet that, apart from the obvious differences in interface, functions similarly to the Multiplier app and the PG app []. It calculates predicted lower extremity LLD and timing of epiphysiodesis using the multiplier method formulae and tables for both congenital and developmental LLD.

Our goal was to improve upon this spreadsheet by making a more user-friendly interface that could be cleanly pasted into electronic medical record (EMR) progress notes and to add several useful features. Discussion This update to the spreadsheet by Sanders et al. Enables the user to enter previous lengthening surgeries when calculating LLD at skeletal maturity and timing of epiphysiodesis (Figs., ) []. It also provides the option to enter foot height, which can be a significant contributor to congenital causes of LLD. The calculations are simplified into separate worksheets for congenital and developmental LLD which helps to differentiate these clinical scenarios and provides a clean-looking datasheet for conveniently pasting into an EMR. The date of the calculations is clearly placed at the top of the datasheet to avoid confusion when copying and updating notes in the EMR. This also allows for multiple worksheets from different dates to be copied into a single progress note so the clinician can see trends, know lengthening history, and better predict LLD.

Like the first edition of this worksheet, the process of predicting LLD and appropriate timing of epiphysiodesis is simplified into a single step from the two-step process required by both of the apps. Additionally, a separate tab is included to predict adult height at skeletal maturity to assist clinicians when parents ask about their child’s growth potential. This table is similar to the adult height calculators found in both of the apps using the multiplier method for predicting adult height []. Developmental LLD worksheet The formulae used in our spreadsheet were derived from the multiplier method developed by Paley et al. The use of the multiplier method for congenital discrepancy assumes a Shapiro type 1 growth pattern where the ratio of growth in the short limb to that of the long limb does not change over time []. The congenital LLD table is used for congenital short femur, fibular hemimelia, hemihypertrophy, hemiatrophy, and posteriomedial bowing of the tibia [].