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PubMed1987

Vascular events associated with the appearance of the secondary center of ossification in the murine distal femoral epiphysis.

Although the formation of a secondary center of ossification is often compared with that of the primary center, there are striking differences between these processes. In the formation of the primary center, vascular invasion is always associated with the maturation of chondrocytes, whereas vascularization of the epiphysis can proceed in two different ways. In some species, the epiphysis is vascularized by cartilage canals before the appearance of the secondary center. However, in the mouse, the distal femoral epiphysis is vascularized by peripheral vascular invasion without pre-existing cartilage canals. Histological study of serial sections and studies of vascularization by injection with India ink demonstrated the relationship between hypertrophic chondrocyte formation, vascular invasion, and the formation of the secondary center of ossification in the murine distal femoral epiphysis.

Aging↗
PubMed1989

Biochemical parameters of osteogenesis in epiphysis of mice irradiated and repopulated with syngeneic bone marrow.

Whole-body irradiation of BALB/cann mice with 600 R of gamma rays produces a profound atrophy of the spleen and diminishes alkaline phosphatase activity in the homogenates of epiphysis. The acid phosphatase activity remains unchanged until day 10, then slightly declines. Incorporation of 45Ca into epiphysis is practically not impaired following irradiation. Repopulation of irradiated animals with 1-1.5 million nucleated syngeneic bone marrow cells restores spleen weight within 6 days, but until day 11 the activity of alkaline phosphatase of epiphysis remains lower. Full recovery of enzyme activities was not observed until day 14, but on day 28 these activities returned to the normal level. Histological inspection did not reveal a full recovery of bone marrow in the epiphysis of irradiated animals until day 14, possibly because of trapping of the vast majority of stem cells by the spleen and liver. On day 28, however, epiphyses were completely filled with the bone marrow.

Acid Phosphatase↗
PubMedDate not supplied

[Biogenic amines in the epiphysis and hypothalamus under normal conditions and following ovariectomy].

Melatonin content in the epiphysis, serotonin, noradrenaline, dopamine-in the hypothalamus, gonadotropins--in the hypophysis of rats was studied under normal conditions and following ovariectomy; regularly of the estral cycle phases was studied as well. Two series of experiments were conducted on 120 rats with regular estral cycles. The animals were divided into groups according to the estral cycle phase. Melatonin concentration in the epiphysis, serotonin, noradrenaline, dopamine--in the hypothalamus was subject to variations coinciding with the estral cycle phases. Serotonin, noradrenaline, and dopamine content decreased in the hypophysis of ovariectomized rats in comparison with control; melatonin content rose in the epiphysis. There was no complete extinction of the estral cycle in the course of investigation (20 days). The action of castration on the sexual cycle depended on the phase at which the rats were subjected to ovariectomy. A reverse relationship existed between the melatonin content in the epiphysis and serotonin content in the hypothalamus, this serving as one of the important factors in the regulation of the sexual function.

Animals↗
PubMed1995

Acute hematogenous osteomyelitis of the epiphysis.

Acute primary infection of the epiphysis is uncommon. This article presents 2 cases. An acute osteomyelitis of the distal femoral epiphysis, which was not diagnosed until 2 weeks after the onset of symptoms, developed in a 4-year-old boy. The epiphyseal infection spread into the knee joint, necessitating surgical debridement. An acute osteomyelitis of the proximal tibial epiphysis developed in a 23-month-old girl. Although the diagnosis was not confirmed until 1 week after the onset of symptoms, she responded well to a course of intravenous antibiotics followed by oral antibiotics. The epiphysis is a potential site for acute hematogenous osteomyelitis. Prompt diagnosis and early treatment may prevent spread of the infection into the adjacent joint.

Acute Disease↗
PubMed1996

Natural history of untreated chronic slipped capital femoral epiphysis.

From 1915 to 1952, 31 hips in 28 patients with slipped capital femoral epiphysis were observed without interventional treatment at the University of Iowa Department of Orthopaedic Surgery. A slip was considered chronic if the symptoms had been present for 3 weeks or more. The severity of the slip was determined by radiographs. Assessment included Iowa Hip Rating and grading of radiographic degenerative changes. The mean duration of patient followup from the onset of symptoms was 41 years. The mean patient age was 54 years old at review, and 13 years old at onset of symptoms. Degenerative arthritis developed in hips with displaced slipped capital femoral epiphysis. Untreated slipped capital femoral epiphysis can progress to a severe degree. The natural history of chronic slipped capital femoral epiphysis is favorable provided that displacement is minimal and remains so.

Adolescent↗
PubMed1996

Valgus slipped capital femoral epiphysis. Fact or fiction?

The cases of 2 patients with valgus slipped capital femoral epiphysis are presented. Additional imaging studies provide support for true posterolateral epiphyseal displacement. Increased femoral anteversion and coxa valga contribute to the pathogenesis of valgus slipped capital femoral epiphysis. In situ pin fixation is recommended for stable valgus slipped capital femoral epiphysis. The importance of valgus slipped capital femoral epiphysis lies in its recognition and appropriate screw placement when internal fixation is used. The percutaneous technique should be used with caution. A limited open technique is recommended when the anterior skin portal is near the femoral neurovascular bundle.

Child↗
PubMed1995

Treatment of slipped capital femoral epiphysis with severe displacement (report of 14 hips in 12 non Caucasian patients).

This paper presents a report of a study of 14 hips in 12 non Caucasian patients treated for severe slipped capital femoral epiphysis. There were four Sudanese, two Syrians, and six Libyan patients. Three hips in two patients had severe acute slip and eleven hips in ten patients had severe chronic slip. Patients with severe acute slip were treated by closed reduction and internal fixation. Patients with severe chronic slip were treated by open replacement of the femoral epiphysis using the procedure advocated by Dunn and Angel[1]. One patient treated for acute severe slip developed over reduction of the epiphysis after closed manipulation. The results were good in all the three hips with acute slip. Two hips with severe chronic slip developed avascular necrosis and chondrolysis. Considering the results in this small series, closed reduction and internal fixation is a satisfactory method of treatment for severe acute slip while results of open replacement of the epiphysis for severe chronic slip has high incidence of complication in non caucasian patients as compared to those reported for caucasians.

Acute Disease↗
PubMed1998

Slipped capital femoral epiphysis.

Slipped capital femoral epiphysis occurs during the adolescent growth spurt and is most frequent in obese children. Up to 40 percent of cases are bilateral. Recent classification methods emphasize epiphyseal stability rather than symptom duration. Most cases of slipped capital femoral epiphyses are stable and have a good prognosis if diagnosed early. Unstable slipped capital femoral epiphysis has a much poorer prognosis because of the high risk of avascular necrosis. Early radiographic clues are the metaphyseal blanch sign and Klein's line. Once diagnosed, treatment should begin immediately. The most widely accepted treatment for a stable slipped capital femoral epiphysis is in situ fixation with a single central screw. The treatment for an unstable slipped capital femoral epiphysis is much more controversial. Corrective osteotomy is usually reserved for treatment of severe deformities after the patient has stopped growing.

Diagnosis, Differential↗
PubMed1983

Bilateral asymmetry in cone epiphysis of the middle phalanx, fifth finger.

The form of epiphyseal-diaphyseal dysostosis in the phalanges of the hand having the appearance of a cone-and-crater (cone-shaped epiphysis) is a common variant in otherwise normal individuals. Dysplasia on the radial margins of the epiphysis and diaphysis, typically resulting in clinodactyly, is another variant and is also common in Down's syndrome. Both variants frequently involve brachymesophalangia. The strong female bias in cone epiphyses and the lack of such bias in dysplasia not involving cones has led to the interpretation of distinct etiologies for the two patterns. A single case displaying brachymesophalangia with cone epiphysis in the middle phalanx of the left fifth finger and brachymesophalangia with clinodactyly in the corresponding bone of the right hand is reported. This is evidence that in certain cases the two patterns of mid-5 dysostosis are manifestations of the same condition.

Abnormalities, Multiple↗
PubMed1979

Slipped capital femoral epiphysis following radiotherapy and chemotherapy.

There may be an increased frequency of slipped femoral epiphysis in pediatric patients who have received radiation to the pelvic area and combination chemotherapy. Previous reports include bilateral slipping of the epiphysis, eight years after radiation, in a patient with a pelvic neuroblastoma and the occurrence in a patient who had received radiation for Hodgkin disease, with a primary site in the pelvic region. No direct correlation was established in either case. This is a report of two patients who received pelvic radiation and combination chemotherapy who subsequently developed slipped femoral epiphysis. Our purpose is to heighten the suspicion in patients who have received radiation and chemotherapy for pelvic tumors. It is recommended that the femoral heads and acetabula be shielded when their inclusion in the treatment fields is not crucial to the treatment of the underlying disease.

Antineoplastic Agents↗
PubMed2002

[Dyamic screw fixation for slipped capital femoral epiphysis. Treatment results].

Slipped capital femoral epiphysis always requires surgical treatment. The operative technique depends on the degree of dislocation and the type of the slip. The goal of treatment is to achieve physeal stability until the epiphyseal plate closes without harming the further femoral growth. In situ fixation is generally recommended for slipped capital femoral epiphyses of a mild degree. For this purpose the technique of dynamic screw fixation (DSF) is applicable using a long cannulated screw with a short thread.DSF is easy to handle, provides sufficient long-term fixation of the epiphysis, does not promote premature closure of the epiphysis, and engenders few complications. Therefore, this technique is also applicable for the prophylactic treatment of the contralateral unaffected hip, which we always perform. Moreover, DSF can be used following gentle reduction of acute epiphysiolysis, if the amount of eventual residual dislocation does not exceed 30 degrees. We report our results with dynamic screw fixation of 29 slipped capital femoral epiphyses of a mild degree, and the prophylactic dynamic screw fixation of 34 unaffected hips. The fixation technique achieved a reliable stabilization with no visible growth disturbance of the femoral neck in all cases.

Adolescent↗
PubMed2002

[Indication for and results of intertrochanteric osteotomy in slipped capital femoral epiphysis].

The progression of degenerative changes of the hip after slipped capital femoral epiphysis (SCFE) largely correlates with the patient's age at the time the deformity occurs and with the degree of the epiphyseal gliding. From the pathogenetic point of view, the altered biomechanical conditions of the hip joint with deformation of the proximal femur may result in an impingement of the femoral neck metaphysis against the anterior acetabular rim. Observations of the "natural course" or after "in situ fixation" of the epiphysis show the development of secondary hip arthritis at an average of 20 years after SCFE, specifically in slips with more than 30 degrees of epiphyseal gliding. The intertrochanteric osteotomy as introduced by G. Imhäuser aims at restoring joint congruity to reduce the prearthrotic deformity and thus to decrease the incidence of later hip arthritis. The reorientation of the predominantly posteriorly slipped femoral epiphysis is achieved by an intertrochanteric flexion osteotomy, which reduces the potential for femoroacetabular impingement. On the basis of a long-term evaluation, the indication for and results of an intertrochanteric osteotomy for chronic unilateral SCFE were presented. Of the 51 patients operated on between 1962 and 1972 and examined clinically and radiographically at an average follow-up time of 24 years (20-29 years) after osteotomy, 55% showed a hip free of degenerative changes, 28% had developed moderate degenerative changes, and 17% had advanced arthritis. Aside from a few technical errors, the correction at the intertrochanteric level for moderate slips proved to be a safe procedure regarding risk for femoral head necrosis. The long-term development after SCFE is most important for patients with SCFE. More than half of the patients have hip joints free of degenerative changes more than 20 years after intertrochanteric osteotomy according to G. Imhäuser, which compares favorably to the "natural course" or to "in situ fixation" and which supports the indication for this corrective procedure in SCFE.

Adolescent↗
PubMed2005

[Slipped capital femoral epiphysis and overweight].

The slipped capital femoral epiphysis (SCFE) is defined as a nontraumatic epiphyseal separation and slipping of the proximal femoral epiphysis, which usually occurs during the adolescent growth spurt. Slipping of the upper femoral epiphysis may be classified as acute, chronic, and acute on chronic. The etiology of the disease is still not fully understood but seems to be multifactorial. The typical SCFE during puberty has to be differentiated from the atypical form, which may be associated with an endocrinological disorder or with its therapy. The typical SCFE may be found in male patients, with increased height and weight. It is likely that the growth rate is slightly accelerated before slippage. Obesity is often associated with a decreased femoral anteversion accounting for abnormal mechanical shear forces at the growth plate. SCFE is treated surgically. Surgical methods are administered according to the degree of disease. Because of possible alterations of blood supply to the femoral head, acute SCFE is an emergency. Following SCFE, complications such as chondrolysis and avascular necrosis are feared.

Epiphyses, Slipped↗
PubMed2006

The relationship between alpha angle and resistive index of the femoral epiphysis in the normal and abnormal infant hip.

BACKGROUND: The arterial vascularity of the hip has been investigated in normal infants using duplex Doppler sonography. This study addressed the differences in hip vascularity in infants with respect to gender and acetabular morphology. OBJECTIVE: To determine whether there is a relationship between the resistive index of the vessels of the femoral chondroepiphysis and the alpha angle in normal infant hips and in those with developmental dysplasia of the hip. MATERIALS AND METHODS: We studied 76 hips (38 patients) with gray-scale and power Doppler US. The patients were referred because of a possible abnormal clinical hip examination or had risk factors for developmental dysplasia of the hip. The infants ranged in age from 1 day to 6 weeks. There were 13 boys and 25 girls. Gray-scale images were initially performed in the coronal and transverse planes to evaluate acetabular morphology, alpha angle and position of the femoral chondroepiphysis relative to the acetabulum. The hips were then examined with power Doppler US, in both sagittal and transverse planes, to identify arterial vessels within the femoral epiphysis. Resistive indices were then recorded from the spectral analysis in each vessel identified. Each examination was performed by one of five pediatric radiologists. Mixed model regression was used to assess the relationship between resistive index and alpha angle, age and gender. RESULTS: Of the 76 hips, 34 had an alpha angle of 60 degrees or greater and were classified as normal, 26 had an alpha angle between 50 degrees and 59 degrees and were classified as immature, and 13 had an alpha angle of less than 50 degrees and were either subluxed or dislocated at the time of examination. At least two vessels were documented in each femoral epiphysis except in three hips, in which no vessels could be documented because of technical factors. There was a statistically significant linear relationship between the alpha angle and resistive index, such that the resistive index tended to rise with increasing alpha angle (P=0.0022). In addition, female infants had a significantly higher average resistive index than the average resistive index in male infants with the same alpha angle (P=0.0005). CONCLUSION: There is a direct linear relationship between alpha angle and resistive index in the infant hip. Female infants have a higher average resistive index than male infants. We believe that these results might serve as a model for predicting an infant hip at risk of ischemia. In addition, the fact that lower resistive indices of the femoral epiphysis are associated with acetabular dysplasia might help explain the documented low incidence of avascular necrosis in untreated hip dysplasia.

Acetabulum↗
PubMed2002

Avascular necrosis of the epiphysis of the first metatarsal bone.

We report a case of avascular necrosis of the epiphysis of the right first metatarsal in a 6-year-old boy. Radiographs showed sclerosis, collapse and a crescent sign in the epiphysis. The diagnosis was confirmed by magnetic resonance imaging and scintigraphy. Arch support was the therapy of choice. Six months after the onset of symptoms, a definite reossification was present. To our knowledge, this is the first radiological report of avascular necrosis of the epiphysis of the first metatarsal bone in the world literature, which prompted a review of the osteochondroses and their etiology.

Child↗
PubMed2001

Arterial blood supply of the proximal humeral epiphysis.

The arterial blood supply of the proximal humeral epiphysis is known to derive mainly from the anterior humeral circumflex a. (ACA), but this description may minimize the role of the posterior circumflex humeral a. (PCA). The studies of Laing [9] and Gerber [3] emphasized the role of the ACA and of its branches, the ascending anterolateral artery and arcuate artery Thus, this description could not explain either the necrosis or the absence of necrosis in all the cases of fracture or dislocation of the glenohumeral joint. The evaluation of the risk of a vascular post-traumatic necrosis of the humeral head requires a knowledge of its arterial vascularization, and the aim of this study was to determine the respective areas of vascularization of both the humeral circumflex aa. 32 shoulders of adult cadavers were studied: the ACA and the PCA were injected with latex containing two differently colored fluids. The proximal humeral epiphysis was removed with the arteries. The extraosseous vessels and the coloration of the capsule were noted; then the epiphysis was sectioned in 5 mm horizontal scans, and the bone staining was studied in order to define the distribution of the arterial supplies. The origin of the ACA and PCA was common in only 10 cases. The mean diameters were: ACA 0.8 mm (0.3 to 2) and PCA 2.1 mm (1.5 to 4). The subchondral bone was colored in 29 specimens by the PCA, and by both the ACA in the cranial part and PCA in the caudal part in 3. The apex of the head was colored by the ACA in 7 cases, the PCA in 7 and both ACA and ACP in 1 case; the head was colored by the PCA in 17 and the ACA in 12 cases; the lesser tubercle by the ACA in 23, the PCA in 2 and both arteries in 7 cases; the greater tubercle by the PCA in 19, the ACA in 5 cases and both in 1 case; the intertubercular groove by the ACA in 29, the PCA in 1 and both arteries in 2 specimens. The arcuate a. was distributed along the metaphyseal side of the epiphyseal plate, and small branches crossed the plate to reach the epiphyseal side and give numerous anastomoses to the branches of the ACA or the PCA. The diameter of the ACA was constantly smaller than that of the PCA. Exclusive vascularization of the humeral head by the ACA was not confirmed. The roles of both the ACA and PCA remain important, and must be taken into account in evaluating the risk of necrosis after a fracture, by carefully considering the topography of the separation and the displacement of the different parts.

Adult↗
PubMed2006

Evaluation of femoral head vascularization in slipped capital femoral epiphysis before and after cannulated screw fixation with use of contrast-enhanced MRI: initial results.

In this study we used contrast-enhanced magnetic resonance imaging (MRI) to evaluate the vascularization of the femoral head in children with slipped capital femoral epiphysis (SCFE) before and after cannulated screw fixation. Eleven consecutive children with SCFE, seven boys and four girls, aged 10-15 years were included in the study. There were no preslips; four children had acute, three acute-on-chronic, and four chronic SCFE. The MRI examinations were performed in a 1.5 Tesla MR scanner with use of a coronal STIR sequence, a coronal contrast-enhanced T1-weighted spin-echo sequence, and a sagittal three-dimensional gradient-echo sequence. Morphology, signal intensities, and contrast-enhancement of the femoral head were assessed by two radiologists in consensus. Morphologic distortion of the physis, bone marrow edema within the metaphysis and epiphysis, and joint effusion were the preoperative MRI findings of SCFE in each child. In nine children, the vascularization of the femoral head before and after surgery was normal. In one child, a preoperative avascular zone in the superolateral aspect of the epiphysis revascularized completely after surgery. One child with severe SCFE developed avascular necrosis of the femoral head after open reduction of the slip. We conclude that MRI allows for accurate evaluation of the femoral head vascularization before and after surgery in children with SCFE.

Adolescent↗