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May 25, 1963


JAMA. 1963;184(8):652-653. doi:10.1001/jama.1963.03700210086016

Continuing efforts to devise a satisfactory procedure for equalizing leg length in children who have been afflicted with poliomyelitis, trauma, or a congenital anomaly emphasize the inadequacy of most of the procedures available. Attempts have been made to stimulate bone growth, to arrest bone growth, to lengthen the affected leg, and to shorten the unaffected leg. Each has carried its own risk; none has guaranteed a perfect yield.

In 1950 Janes and Jennings1 of the Mayo Clinic applied a century-old observation to the problem. In experimental studies on dogs, they were able to stimulate growth of an atrophic leg by creating a systemic arteriovenous fistula in the leg. Since that time they have used the iatrogenic fistula to treat approximately 100 children.2 Although it is still too soon for final evaluation, the preliminary results demonstrate the physiologic soundness of the procedure. Nevertheless, it, too, carries more than just