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PubMed1988

Epiphyseal injuries in the small joints of the hand.

The principles followed in treatment of epiphyseal injuries of the hand are essentially the same as those used in treating epiphyseal injuries elsewhere in the child. Special patience is required in treating the patients, and methods of immobilization must be modified appropriately for the active child. A knowledge of the mechanism of injury and potential effects on the growth potential of the digit are important in determining treatment and counseling parents on possible growth disturbance and later deformity. The epiphyses of the proximal phalanges of the fingers and the thumb metacarpal are the most frequently injured. Salter Type I and II fractures frequently demonstrate remarkable remodeling potential, whereas intra-articular Salter III and IV fractures often require surgical repair and may be more frequently associated with later problems of growth and post-traumatic arthritis. The physician should establish a trusting relationship with the child and his or her parents in order to provide comforting reassurance, facilitate treatment and compliance, and promote an understanding of the possible outcomes associated with injuries of the vulnerable growth plate. When these principles are followed appropriately, the long-term follow-up of these children provides for a very satisfying and rewarding experience for the physician and family.

Casts, Surgical↗
PubMed1987

Pseudo-achondroplastic variant of multiple epiphyseal dysplasia with cataract and vitiligo.

Multiple epiphyseal dysplasias may present as congenital or late-onset (tarda) forms or as the variant pseudo-achondroplastic type. While the association between cataract and skin anomalies is well known in the congenital type, it has not been reported for the late-onset type of multiple epiphyseal dysplasia. A 5 1/2-year-old child with the pseudo-achondroplastic variant of multiple epiphyseal dysplasia has been observed to have the unusual association of cataracts and vitiligo, a condition which lacked previous documentation.

Cataract↗
PubMed1987

Biochemical events during stapling of the proximal tibial epiphyseal plate in pigs.

Epiphyseal stapling is considered a safe, effective method of correcting angular deformities of the knee in growing children. A study of the underlying biochemical events would contribute to a better understanding of the control of longitudinal growth rate in epiphyseal growth plates and of the molecular pathology of exaggerated physiologic bowleg or knock-knee deformities. Blount stainless staples were applied to the medial side of the proximal tibia epiphyseal growth plate of domestic pigs. The resulting biochemical changes were investigated by incubation of the isolated growth plate cartilage under organ culture conditions. On the fourth to the eighth day after stapling, a significant decrease of [14C]glucose uptake and lactate formation and a significantly lower specific radioactivity of the isolated glycosaminoglycans were observed in relation to the controls. During the second to 12th week, the incorporation of [3H]thymidine and the specific radioactivity of the glycosaminoglycans following incubation with [14C]glucose showed statistically significant decreases. The glycosaminoglycan content of the cartilage was not altered, but the chondroitin sulfate/keratan sulfate ratio was lower in the stapled than in the nonstapled areas. In this period, glucose uptake and lactate production were found to be normalized.

Animals↗
PubMed1985

Clonal proliferation and cell density of chondrocytes isolated from human fetal epiphyseal, human adult articular and nasal septal cartilage. Influence of hormones and growth factors.

The present study characterizes the cell density and cellular growth characteristics of functionally and morphogenetically different human cartilages. In fetal epiphyseal, in postnatal nasal septal and in articular cartilage the influence of aging on cell density and in vitro growth characteristics were investigated. Cell density was highest in fetal epiphyseal cartilage and lowest in articular cartilage. In vitro growth of isolated chondrocytes as measured by clonal growth in a semisolid assay was almost identically high in fetal epiphyseal and septal cartilage and significantly lower in articular cartilage. Cell density increased with age in the nasal septal cartilage whereas no age dependency was found in the other cartilages. The stimulatory effects of human biosynthetic insulin, human growth hormone and partially purified IGF I on clonal growth of chrondrocytes were assessed. Only IGF I stimulated clonal growth of chondrocytes and its stimulatory effect was significantly higher in postnatal than in fetal chondrocytes.

Adolescent↗
PubMed1985

Arthritis in children with multiple epiphyseal dysplasia.

Multiple epiphyseal dysplasia is an autosomal dominantly inherited disorder characterized by dwarfism, stubby digits, and abnormalities in maturing epiphyses. This syndrome has been associated with the onset of osteoarthritis during early adolescence; frank arthritis before puberty has not been reported. We describe 4 children with multiple epiphyseal dysplasia who developed chronic arthritis during the first decade of life.

Arthritis↗
PubMed1984

Free microvascular epiphyseal-plate transplantation. An experimental study in dogs.

To evaluate the feasibility of transplanting vascularized epiphyseal plates while maintaining normal growth in the recipient site, twenty-two puppies from known, large breeds were divided into one control and three experimental groups of four animals each and one long-term group of six animals. The control group underwent insertion of a radiopaque marker in the fibular metaphysis bilaterally, and, in addition, a fibular osteotomy was performed on one side. In the experimental groups, a fibular switch was carried out, selecting one fibula as a vascularized graft and the other as a non-vascularized graft. Both the controls and the experimental groups were evaluated using serial roentgenograms, histological examination, fluorescent bone-labeling, and microangiography. One week, six weeks, three months, and seven months postoperatively, animals from each group were killed. Continuous growth was observed in the vascularized epiphyseal transplants and in the controls, with no statistical difference noted, whereas the non-vascularized transplants exhibited considerably less or no growth. Vascularized transplants demonstrated an average 21.2-millimeter increase in length while non-vascularized transplants showed a 6.6-millimeter increase. Histological examination, fluorochrome bone-labeling, and microangiography confirmed the continued viability of the vascularized epiphyseal transplants in contrast to the non-vascularized transplants.

Angiography↗
PubMedDate not supplied

[Epiphyseal chondroblastoma. Clinical and anatomo-radiographic aspects].

The clinical radiological and anatomohistological features of fourteen cases of epiphyseal chondroblastoma are described. The seat, origin, and evolution of the tumor are discussed. The diagnosis of the epiphyseal localization is easy, but there are same problems in the differential diagnosis of the epiphyseal-metaphyseal of metaphyseal forms.

Adolescent↗
PubMed1979

Distal radial epiphyseal displacement after impaired distal ulnar growth.

Impairment of growth of the distal end of the ulna was produced in rabbits by excision of the distal epiphyseal plate. This caused a sequence of changes in the distal radial epiphysis consisting of combined increased chondrogenesis and decreased osteogenesis of the radial two-thirds of the distal epiphysis, and decreased chondrogenesis and increased osteogenesis on the ulnar side. At six to nine days postoperatively, cracks appeared concomitant with tilting of the plate and epiphysis, in the epiphyseal plate or at its metaphyseal junction. An incomplete radial epiphyseal separation occurred, a step-like deformity developed in the metaphysis, and an ulnar deviation developed.

Animals↗
PubMed1993

[Torsional strength of the epiphyseal plate and fracture patterns with aging (three-dimensional analysis with SEM)].

The tortional strength and fracture patterns of the proximal tibial epiphyseal plate in 4-, 8-, and 12-week-old rabbits were investigated (n = 11, 13 and 8, respectively). The strength was measured with a torsional machine, and then maximum torque, angular deformation and energy absorption were calculated from the load-deformation curve. The rotation axis was aligned to the long axis of the specimen, and a holding method for the specimen was devised to minimize positional error. The fracture surfaces were then examined both histologically and with three-dimensional scanning electron microscopy (SEM). The torsion test showed that maximum torque and energy absorption with the exception of angular deformation increased significantly with age. Histological examination by light microscope of sagittal sections passing through the midline of fragments revealed that epiphysiolysis commonly occurred between the calcification layer and the metaphysis in the anterior portion, as well as between the transitional part of the palisading layer and the hypertrophying layer in the posterior portion. These results indicate that epiphysiolysis is most likely to occur between adjacent layers with the greatest structural differences. Three-dimensional SEM micrographs revealed that fracture patterns became more varied as the torsional strength of the epiphyseal plate was increased with age. Additionally, SEM revealed that the density of the collagen network in the cartilaginous matrix surrounding cells in the proliferating layer also increased with age. One of the reasons for the increase in torsional strength is related to a morphological change such as the development of three-dimensional wave-like structure of epiphyseal plate. Another reason appears to be a qualitative change such as the variety of the fracture patterns and an increase in the collagen network density of the cartilaginous matrix with age.

Aging↗
PubMed1993

[A Dutch family with hereditary joint symptoms; multiple epiphyseal dysplasia].

Multiple epiphyseal dysplasia is a rare disease with autosomal dominant heredity which affects the epiphyseal ends of long bones; it leads to severe destruction of the joints. A large Dutch family with multiple epiphyseal dysplasia is described with manifestations of clinical disease predominantly in the lower extremities.

Adolescent↗
PubMed1997

Onset of epiphyseal mineralization and growth plate closure in radiographically normal and dysplastic Labrador retrievers.

OBJECTIVE: To determine whether onset of mineralization of the femoral and proximal tibial epiphyses and age at closure of the femoral and acetabular triradiate growth plates was different for Labrador Retrievers that were radiographically normal or that had canine hip dysplasia (CHD). DESIGN: Cohort study. ANIMALS: 36 Labrador Retriever puppies. PROCEDURE: Puppies were radiographed every other day from the time they were 8 to 10 days old until ossification of the femoral heads was apparent. Radiographs were then obtained weekly until puppies were 1 month old and then monthly until puppies were 8 to 12 months old. Age at which mineralization was first observed in the proximal and distal femoral and proximal tibial epiphyses and at which the femoral capital, triradiate acetabular, and distal femoral growth plates were no longer radiographically visible were recorded. Fifteen dogs were euthanatized and necropsied to determine whether dogs had CHD. RESULTS: There were 26 radiographically normal left and right hip joints and 10 dysplastic left and right hip joints. Onset of mineralization of the proximal femoral epiphyses and of the right proximal tibial epiphysis was significantly later in dysplastic than in radiographically normal puppies. The left femoral capital growth plates closed significantly later in dysplastic than in radiographically normal joints, but other differences in growth plate closure were not detected. CLINICAL IMPLICATIONS: Endochondral ossification may be abnormal in dogs with CHD. The disease appears to affect multiple joints, even though it is most evident clinically in the hip joint.

Aging↗
PubMedDate not supplied

Immunohistochemical localization of bone morphogenetic proteins and the receptors in epiphyseal growth plate.

The expression of bone morphogenetic proteins (BMPs) and BMP receptors (BMPRs) in the epiphyseal growth plate has not been clarified. In this study, we studied immunohistochemically the spatial and temporal localization of BMP-2/4, osteogenic protein-1 (OP-1, or BMP-7), and BMP receptors (BMPR-IA, BMPR-IB, and BMPR-II) in the epiphyseal plate of growing rats. The proximal parts of tibia in growing rats were observed. At 12 weeks after birth, BMP-2/4 and OP-1 were expressed markedly in proliferating and maturing chondrocytes. BMPR-IA, IB and II were clearly co-expressed in proliferating and maturing chondrocytes, and the expression was decreased in hypertrophic chondrocytes. At 24 weeks, the expression of BMP-2/4 and OP-1 was decreased, but BMPRs were still well-expressed in proliferating chondrocytes. The temporal and spatial expression of BMP and BMPR suggests that BMP and BMP receptors play roles in the multistep cascade of enchondral ossification in the epiphyseal growth plate.

Aging↗
PubMed1980

[The scintigraphic diagnosis and follow-up of injuries to the epiphyseal plates (author's transl)].

Injuries to the epiphysel plates without involvement of the epiphyses or metaphyses, such as crush fractures or pure epiphysiolysis may be difficult to diagnose radiologically. Thirteen bone scans after damage to the growth plate have been performed on eight children. These indicate that these scans are able to diagnose lesions of the epiphyseal plates at an early stage and with certainty. The scintigrams also provide information concerning the healing process of the plate; they indicate when healing has been completed and when the extremity can be used for weight-bearing again. Radiation exposure of the children during scintigraphy with 99mTc-polyphosphate is within acceptable limits.

Adolescent↗
PubMed1955

Epiphyseal stimulation in the lower extremities.

Epiphyseal stimulation to correct disparity in the length of lower extremities was done in 12 children. The total number of procedures was 15. In 11 of the 15 instances the operation was beneficial. Ivory pegs were used in some cases, brass screws in others and multiple drill holes in still others. There seemed to be no difference between them in the amount of stimulation brought about. Stimulation persisted for from six to ten months after operation. Complications that may occur are varus or valgus deformities, delay in growth, complete fusion, or infection. To prevent varus or valgus deformity, both medial and lateral sides may be stimulated simultaneously. Great care must be taken to place the screws no closer than one-fourth inch to the epiphyseal plate to avoid trauma which may delay rather than stimulate growth. Late infection may be obviated by the use of absorbable materials. The increase brought about by stimulation procedures is probably attributable to hyperemia following subperiosteal stripping.

Child↗
PubMed1978

[Corrective orthopedic surgery following injury to the epiphyses adjacent to the knee joint (author's transl)].

Epiphyseal lesions adjacent to the knee joint may result in disturbances of growth with subsequent changes of leg length and knee axis. Both conditions involving the weight-bearing lower extremities call for correction. Knowledge of the epiphysis' pathophysiology, the case history, and the actual situation compared to the contralateral extremity is the basis of management along with the command of physiologically reasonable as well as technically feasible operations. Final normalisation may be achieved by static correction using modern internal fixation techniques and bone grafts once growth is terminated. Serious axis deviations and leg length discrepancies exceeding 10 degrees and 3 centimeters respectively should, however, be corrected, even if growth is still in progress. It may be possible to eliminate the cause of deformation by removing an epiphysiodesis. Methods to accelerate growth have not been useful clinically. Temporary deceleration of growth by means of epiphyseal staples is justified in certain cases provided close follow-up is possible. Static correction as outlined will also produce the most dependable results if growth is still in progress.

Epiphyses↗
PubMed1977

[Radiologic diagnosis of injuries of the epiphyses in childhood (author's transl)].

The future of epi- and metaphyseal fractures depends on exact radiologic diagnosis. This will always have to show whether the growthzone has been damaged. This can be clearly indicated by classification of slipped epiphyses and fractures (Aitken I-III). The pathophysiology of epiphyseal injuries, possible classifications and general and special radiology of these injuries are discussed.

Bone Development↗
PubMed1996

Syndrome of multiple epiphyseal dysplasia (ribbing type) with rhizomelic shortness, cleft palate, and micrognathia in two unrelated patients.

We report on two unrelated patients with an apparently new syndrome. In each family they are the only affected members, their parents are not consanguineous, and paternal and maternal ages are not advanced. At birth each patient was noted to have a marked Robin phenotype (cleft of the secondary palate and micrognathia) plus rhizomelic shortness. Delay in the appearance of long bone epiphyses was noted and followed by small fragmented and later very flat epiphyses of all long bones. The fibulae are short and radial heads dislocated. Scoliosis and marked genu valgum developed in both. Both patients have normal intelligence, vision, and hearing. Both have mildly upward slanting palpebral fissures, broad nasal tip, and apparent hypertelorism.

Adult↗
PubMed2001

Lissencephaly type III, stippled epiphyses and loose, thick skin: a new recessively inherited syndrome.

We report on two new cases of syndromic lissencephaly in two consanguineous sibs, with skeletal abnormality, born to young, healthy, second cousin parents with healthy children. In Case 1, fetal ultrasound screening at 32 weeks of gestation showed microcephaly, skin infiltration and equinovarus feet. MRI disclosed cerebral agyria, hypoplastic cerebral mantle and posterior agenesis of the corpus callosum. The propositus, a boy, died soon after birth at term. In Case 2, fetal ultrasound study performed at 16 weeks of gestation disclosed skin infiltration. MRI at 22 weeks of gestation showed microcephaly with agenesis of corpus callosum and cerebellar hypoplasia. Pregnancy was terminated at 22 weeks of gestation. The fetus had normal 46, XY karyotype and similar anomalies found in the index case, with cranio-facial edema and arthrogryposis. X-ray films showed epiphyseal stippling of cervical vertebrae, feet and sacrum. Metacarpal bones were shortened with hypoplastic distal phalanges. Neuropathological findings were concordant with the pattern described in type III lissencephaly: an agyric brain with hypoplastic brain stem and cerebellum, severe neuronal loss of the cortical plate, matrix zone, basal ganglia, brainstem nuclei and spinal cord with axonal swelling and microcalcification. This entity seems to be a new syndromic lissencephaly type III, because of epiphyseal calcifications and metacarpophalangeal bone dysplasia.

Abnormalities, Multiple↗