Background and Future of the Hechard and Carlioz Long Bone Growth Graph

The prediction at the end of growth of child, of the importance of an Inequality of Length of the Lower Limbs, is an unavoidable element to decide on a possible treatment and to program it. Among the existing methods, the one published by Hechard and Carlioz in the Revue de Chirurgie Orthopédique in 1978 is still, according to a report dating from 2018, the most used in France. It will be soon possibly disappeared because of the development of "modern computerized treatment" techniques. This durability is mainly due to its simplicity brought by a diagram available for consultation and incorporated into the patient’s dossier. The construction on an orthogonal marker of the growth curves of the femurs and tibias adjusted in straight lines from the tables of Green and Anderson (3,4), allows not only a direct and fast calculation of the final inequality when it is regular but also a graphic representation of the evolution. On this same diagram, the overly of a layer allows to determine the possible dates of epiphysiodesis. Whatever the method used, it is based on the studies of Green and Anderson (3,4) who have shown the interest of referring to the bone age determined by the radiological atlas of Greulich and Pyle (5) which represents the least precise variable, the length of the bone segments being able to be calculated to the nearest millimeter by CTscan, MRI or EOS. The qualitative assessment of the bone age induces an imprecision of plus or minus 6 months, which is all the more impactful as the child is young. The use of dedicated software has made it possible to introduce the concept of Remaining Growth Index (RGI), applicable to each long bone, based on X-rays of the wrist of children who were regularly monitored during their growth. This technique was quickly relayed by MRI, which has the advantage of avoiding the exposition to rays and importantly of visualizing the cartilage. Moreover, it is possible to obtain a computerized calculation of the (RGI), which will be more reliable in the near future.