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At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Thyroid hormone levels in patients with slipped capital femoral epiphysis.

Twelve patients with slipped capital femoral epiphysis and 12 age- and sex-matched controls were prospectively studied. Their height, weight, skeletal maturation, and thyroid status were assessed. The duration of symptoms and severity of the slip was recorded in the test group. There was no correlation between duration of symptoms and severity of the slip or delay in making the diagnosis and severity. Although 50 percent of patients with slipped capital femoral epiphysis were over the 90th percentile for weight, there was no overall significant difference in weight, height, or skeletal maturation between the two groups. There was no evidence of either overt or subclinical hypothyroidism in patients with slipped capital femoral epiphysis.

Adolescent↗
PubMedDate not supplied

Mechanical factors in slipped capital femoral epiphysis.

We performed three-dimensional force analyses on the hips of 50 normal patients and 50 patients with slipped capital femoral epiphysis to determine if mechanical factors alone could account for slips. We found that slipped epiphysis patients have reduced resistance to shear because of increased body weight and a decreased neck shaft-plate shaft angle. Slipped epiphysis patients have relative retroversion, and this generates increased sagittal plane shear stress at the proximal femoral growth plate. We suggest that, during running, these mechanical factors cause shear failure of the growth plate in obese adolescents.

Adolescent↗
PubMedDate not supplied

Epiphyseal growth after pinning of slipped capital femoral epiphysis.

Seventy-seven hips in 61 patients (mean age, 13 years) with slipped capital femoral epiphysis treated with in situ pinning were retrospectively evaluated to determine the frequency and magnitude of epiphyseal growth after pinning. Threaded Steinmann pins, Knowles pins, and cannulated screws were used. Evidence of the epiphysis "growing off" the pins was seen in 29 and 18% of the hips treated with Steinmann and Knowles pins, respectively. No hips with cannulated screws continued to grow after surgery. The use of one cannulated screw in the treatment of mild and moderate slipped capital femoral epiphysis is recommended.

Adolescent↗
PubMed2004

Slipped capital femoral epiphysis in dogs.

In a retrospective review of 43 femoral fractures, three dogs had separation of the femoral capital epiphysis from the metaphysis in the absence of trauma. Two of these dogs also had evidence of pathology in the contralateral femoral neck including, in one dog, displacement of the capital epiphysis in relation to the metaphysis without actual separation. The case histories, radiographic features and histopathological findings of these cases were reviewed and compared with previous cases of slipped capital femoral epiphysis (SCFE) reported in dogs and also with SCFE in children. Pre-slip, acute, chronic and acute-on-chronic slips were Identified. Based on the cases reviewed, the authors advise internal fixation of stable slipped epiphyses in dogs. This may also be appropriate for unstable separations, although resorption of the femoral neck may preclude stable fixation and necessitate femoral head and neck excision.

Animals↗
PubMed1991

Avulsion fractures of the proximal tibial epiphysis.

Fractures of the tibia through the proximal epiphysis are rare. This injury usually results from severe direct or indirect force about the knee, and has not been described as resulting from a patellar tendon avulsion injury. Four patients presented with five avulsion fractures of the proximal tibial epiphysis. All were older adolescent males who had been engaged in jumping sports when the injury occurred; one had bilateral injury. All the patients were treated by closed reduction and plaster cast immobilization for 4-8 weeks, with satisfactory results. On the basis of our cases and five cases previously reported, the authors would agree with Ryu and Debenham's suggestion that the Watson-Jones classification, which divides avulsion fractures of the tibial tubercle into three types, should be expanded to include this fourth type - avulsion fracture of the proximal tibial epiphysis.

Adolescent↗
PubMed1993

Hematopoietic bone marrow within the proximal humeral epiphysis in normal adults: investigation with MR imaging.

The occurrence of hematopoietic bone marrow within the axial skeleton and meta-diaphyseal regions of long bones is well known. However, it has been generally accepted that hematopoietic marrow is not present within the epiphysis of long bones in normal adults. This study involved evaluation of marrow patterns in 96 patients presenting for shoulder magnetic resonance (MR) imaging examinations. Residual hematopoietic marrow was present within the proximal humeral metaphysis in 99% of patients and extended into the epiphysis in 62%. Epiphyseal hematopoietic marrow was more prominent in female subjects (P = .015) and showed correlation with prominence of hematopoietic marrow within the proximal humeral metaphysis (P = .01). The most characteristic pattern was a curvilinear distribution of hematopoietic marrow involving the subcortical region of the medial humeral head, though in some patients more centrally located patchy or globular regions of hematopoietic marrow were observed. These findings indicate that when signal intensity variations are observed within the epiphysis on MR images, the possibility of residual or reconverted hematopoietic marrow should be considered.

Adolescent↗
PubMedDate not supplied

Stress changes of the distal radial epiphysis in young gymnasts. A report of twenty-one cases and a review of the literature.

Between 1980 and 1983, 21 young, high-performance gymnasts with stress changes related to the distal radial epiphysis, were treated and followed for a mean of 24 months (range, 6 to 42 months). Eleven of the gymnasts presented with roentgenographic changes of the distal radial epiphysis, and in these recovery took at least 3 months. This group was compared to a group of ten gymnasts who had similar symptoms but no roentgenographic changes, and who recovered within an average of 4 weeks. The roentgenographic changes, which are described in detail, are considered to represent stress changes, possibly stress fractures, of the distal radial epiphysis. No residual growth-related problems have been observed. Possible etiologic factors are discussed, and the literature as it pertains to stress-related adaptation and injury in the growing athlete is reviewed.

Adolescent↗
PubMed1983

Epiphysial growth after free fibular transfer with and without microvascular anastomosis. Experimental study in the dog.

The proximal fibular epiphysis was transferred in young puppies using microvascular techniques. The study demonstrated, as have previous investigators, that free epiphysial transfer without vascular anastomosis results in death of the chondrocytes of the growth plate. Histologically, the chondrocytes do not take up labelled proline, indicating diminished metabolic activity; do not take up radioactive thymidine, indicating that they are not dividing; and there is eventual disruption of the normal histological picture. In contrast, where the microvascular anastomoses re-established the blood supply to the growth plate, the epiphyses demonstrated normal histological appearance, uptake of radioactive proline and thymidine and continued to grow but at a slightly diminished rate. It is concluded that continued growth can occur after free vascularised epiphysial transfer in the dog.

Animals↗
PubMed1987

Fractional necrosis of the femoral head epiphysis after transient increase in joint pressure. An experimental study in juvenile rabbits.

Ischaemia resulting from increased joint pressure may play a role in the pathogenesis of necrosis of the femoral head epiphysis. We studied the effect of temporary vascular occlusion on this epiphysis in young rabbits. Occlusion for six hours resulted in necrosis of trabecular bone and of intertrabecular marrow and vascular tissue, later followed by revascularisation and repair, as has been demonstrated previously. In contrast, raised intra-articular pressure lasting for only two hours resulted in a more complex picture: trabecular osteocytes were dead, whereas the bone-forming marrow was shown by fluorochrome labelling to remain viable, and to form appositional repair bone throughout the epiphysis. We concluded that transient vascular occlusion may cause the death of trabeculae despite intact perfusion of the bone. This type of change may be important in the pathogenesis of Perthes' disease.

Animals↗
PubMed2002

Anterior physeal separation. A sign indicating a high risk for avascular necrosis after slipped capital femoral epiphysis.

A study of 78 children (110 hips) was undertaken in an attempt to assess the risk of avascular necrosis (AVN) after slipped capital femoral epiphysis based on the radiological appearances of the hip at the time of presentation. Physeal separation, which was defined as the amount of separation of the anterior lip of the epiphysis from the metaphysis on the frog lateral view, was assessed. Of the eight hips which developed AVN, seven had anterior physeal separation. We conclude that anterior physeal separation is associated with a high incidence of subsequent AVN after slipped capital femoral epiphysis and that screw fixation may not be appropriate in these patients.

Adolescent↗
PubMed2004

Slipped capital femoral epiphysis in skeletally immature patients.

Fixation by a single screw is considered the current treatment of choice for a slipped capital femoral epiphysis. This approach promotes premature physeal closure. The use of a modified, standard, single, cannulated screw designed to maintain epiphyseal fixation without causing premature closure of the physis was reviewed in ten patients. The nine boys and one girl aged between 10.6 and 12.6 years with unilateral slipped capital femoral epiphysis (SCFE), were markedly skeletally immature (Tanner stage I, bone age 10 to 12.6 years). Clinical and radiological review at a mean follow-up of 44.3 months (36 to 76) showed no difference in the time to physeal closure between the involved and uninvolved side. Measurement of epiphyseal and physeal development showed continued growth and remodelling in all patients. Use of this device provided epiphyseal stability and maintained the capacity for physeal recovery and growth following treatment for both unstable and stable slipped capital femoral epiphysis.

Age Determination by Skeleton↗
PubMed2001

Physeal dysplasia with slipped capital femoral epiphysis in 13 cats.

Separation of the femoral capital epiphysis is associated with severe trauma in most species. This report describes 13 cats with slipped capital femoral epiphysis characterized by a distinctive lesion in the physeal cartilage. The lesion consists of irregular clusters of chondrocytes separated by abundant matrix on both the epiphyseal and metaphyseal side of the cleavage site. The affected population in this study is 85% male, 90% overweight, 23% Siamese, and 4.5-24 months old. The histopathology and demographics are similar to slipped capital femoral epiphysis in humans, which most often affects overweight adolescent boys.

Age Factors↗
PubMed2006

Monozygotic twins with Turner syndrome develop slipped capital femoral epiphysis on growth hormone therapy.

Monozygotic twins with Turner syndrome have rarely been reported. An increased incidence of slipped capital femoral epiphysis has been associated with growth hormone therapy, as well as with Turner syndrome, but has never been described in twins with Turner syndrome. We report the first case of monozygotic twins with Turner syndrome with a 46,Xi(Xq) karyotype, both of whom developed slipped capital femoral epiphysis during growth hormone therapy. This report adds to existing reports of monozygotic twins with Turner syndrome and contributes to recognition of the potential clinical course in such patients. In addition, the association between slipped capital femoral epiphysis, growth hormone therapy, and Turner syndrome is emphasized.

Adolescent↗
PubMed2005

[Primary hyperparathyroidism associated to slipped capital femoral epiphysis in a teenager].

Primary hyperparathyroidism (PHP) is an uncommon disease in children and adolescents. The association between PHP and slipped capital femoral epiphysis is rare, and so far only four cases have been reported in the literature. Herein, we report a case of PHP due to a parathyroid adenoma, with several painful skeletal deformities and associated with slipped capital femoral epiphysis in an 18-year-old male patient. Laboratory evaluation showed: calcium of 13.6 mg/dL, parathyroid hormone of 1,524 pg/mL and alkaline phosphatase of 3,449 U/L. Deformities were caused by late diagnosis during the growth spurt, and this association is the result of combinations between metabolic and mechanical factors. The patient underwent parathyroidectomy and, in agreement with the literature, since the removal of the adenoma is followed by prompt resolution of the slipped capital femoral epiphysis we decided for a conservative approach. We observed improvement of the pain and normalization of calcium and parathyroid hormone levels.

Adolescent↗
PubMed1984

Hormone receptors in the epiphysial cartilage.

In order to assess which hormones may exert direct effects on skeletal growth at the epiphysial growth plate, the specific binding of hormones to the epiphysial cartilage of growing dogs and rabbits was studied. Membrane fractions obtained by centrifugation of homogenates prepared from dog and rabbit growth plate cartilage at 600, 15 000 and 105 000 g showed significant specific binding of serum insulin-like activity and insulin. Binding of growth hormone and prolactin by the three membrane fractions was negligible. Saturable binding sites for triiodothyronine could be demonstrated in nuclei from the dog growth plate. Nuclear binding showed an apparent Kd of 11 +/- 3.6 nmol/l and a maximum binding capacity of 4.1 +/- 1.6 pmol/mg DNA, a level comparable to dog liver. Using a viable chondrocyte suspension prepared from dog epiphysial cartilage, specific steroid binding in the cells could be demonstrated for [3H]dexamethasone but not 17 alpha-methyltrienolone, oestradiol-17 beta or 1 alpha, 25-dihydroxycholecalciferol. Scatchard analysis of dexamethasone binding showed high affinity binding sites having a Kd of 1.2 +/- 0.35 nmol/l and a capacity of 1700 sites/cell, and a low affinity binding with a Kd of 109 +/- 57 nmol/l and a capacity of 24 000 sites/cell. Steroid competition for the specific binding showed the following sequence of affinity: dexamethasone greater than corticosterone greater than 11-deoxycortisol greater than testosterone greater than oestradiol-17 beta.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan.

The records of 224 children who had a slipped capital femoral epiphysis and who had no underlying metabolic or endocrine disorder were studied retrospectively to investigate the epidemiology of bilateral slipped capital femoral epiphysis. Eighty-two (37 per cent) of the 224 children (fifty-one boys and thirty-one girls) had a bilateral slip. Sixty-four of these children were black and eighteen were white. The age at the time of the diagnosis of the first slip was 13 +/- 1.7 years (mean and standard deviation), the duration of the symptoms was 5 +/- 5.0 months, and the angle of the slip was 26 +/- 16 degrees. Obese children were younger at the time of the diagnosis of the first slip (12 +/- 1.6 compared with 13 +/- 1.6 years for the children who were not obese, p = 0.001). The diagnosis of a slipped capital femoral epiphysis was made simultaneously in both hips in forty-one children and sequentially in forty-one children. Compared with the children in whom both hips were diagnosed simultaneously, the children in whom the hips were diagnosed sequentially had had a shorter duration of the symptoms before the diagnosis of the first slip (3 +/- 2.4 compared with 7 +/- 5.9 months, p = 0.0003), were younger at the time of the diagnosis of the first slip (12 +/- 1.9 compared with 13 +/- 1.2 years, p = 0.001), and tended to be more obese (p = 0.025). In 88 per cent of the patients who had sequential slips, the second slip was diagnosed within eighteen months after the diagnosis of the first slip.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

Prophylactic pinning of the contralateral hip after unilateral slipped capital femoral epiphysis.

BACKGROUND: The management of the contralateral hip after unilateral slipped capital femoral epiphysis is controversial. The purpose of this study was to determine, with use of expected-value decision analysis, the optimal management strategy-prophylactic in situ pinning versus observation-for the contralateral hip. METHODS: Outcome probabilities were determined from a systematic review of the literature. Utility values were obtained from a questionnaire on patient preferences completed with use of a visual analog scale by twenty-five adolescent male patients without slipped capital femoral epiphysis. A decision tree was constructed, fold-back analysis was performed to determine the optimal treatment, and one and two-way sensitivity analyses were performed to determine the effect on decision-making of varying outcome probabilities and utilities. RESULTS: Observation was the optimal management strategy for the contralateral hip given the outcome probabilities and utilities that we studied (the expected value was 9.5 for observation and 9.2 for prophylactic in situ pinning, with a marginal value of 0.3). Increased rates of a late second slip favored prophylactic in situ pinning (the threshold probability was 27%). Risk-taking patients with a high utility for uncomplicated prophylactic in situ pinning favored prophylaxis (the threshold utility was 9.8). CONCLUSIONS: The iatrogenic risks of treating a healthy patient or an uninvolved body part rarely outweigh the potential benefits unless the probability of the adverse event is likely and the consequences of the adverse event are very severe. In this decision analysis, the optimal decision was observation. In cases where the probability of contralateral slipped capital femoral epiphysis exceeds 27% or in cases where reliable follow-up is not feasible, pinning of the contralateral hip is favored. For a given individual patient, the optimal strategy depends not only on probabilities of the various outcomes but also on personal preference. Thus, we advocate a model of doctor-patient shared decision-making in which both the outcome probabilities and the patient preferences are considered in order to optimize the decision-making process. LEVEL OF EVIDENCE: Economic and decision analysis, Level III-1 (limited alternatives and costs; poor estimates). See Instructions to Authors for a complete description of levels of evidence.

Bone Nails↗
PubMed1975

Acute slipped capital femoral epiphysis. Treatment in 8 cases.

The results are reported of the treatment of eight cases of acute (traumatic) slipped capital femoral epiphysis, reduced by forceful traction on the tubercle of the tibia, followed by drilling through with Kirschner wires. No necrosis of the epiphysis developed among the eight cases. In the light of these results, this therapy is recommended in cases of acute slipping of the capital femoral epiphysis. On the other hand, as far as the late complications are concerned, such as degenerative arthritis, the late results are probably no better than those obtained with other forms of treatment.

Adolescent↗