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PubMed1981

Fracture-separation of the lower humeral epiphysis in young children.

Five fracture-separations of the lower humeral epiphysis, type II according to the Salter-Harris classification, are presented. The fracture line generally passes through the cartilaginous epiphysis, which does not show up in roentgenograms, and sometimes included a laterally based metaphyseal wedge. This injury is often misdiagnosed as it is mistaken for other injuries of the elbow, especially fracture of the lateral humeral condyle. The concomitant displacement of the radius and ulna in relations to the capitellar ossification center is the key to the diagnosis of fracture-separation of the lower humeral epiphysis. Good results are obtained with treatment by closed methods if this lesion is correctly diagnosed.

Child↗
PubMed1985

Transient ischaemia of the proximal femoral epiphysis in the child. Interpretation of bone scintimetry for diagnosis in hip pain.

99mTc-MDP-scintimetry was performed in 25 consecutive cases of radiographically silent transient synovitis of the hip in children. Fourteen cases had normal scintimetry; seven cases had an increased uptake in the epiphysis; four cases had markedly defective uptake in the epiphysis, indicating interrupted vascular supply. At repeat scintimetry 6 weeks later, the uptake was normal or increased in three of these four cases; the one case with a persistent defect was the only case in this series who later developed radiographic evidence of Legg-Calvé-Perthes' disease. In some cases presenting with clinical symptoms of synovitis of the hip, there is a transient, spontaneously recovering ischaemia of the proximal femoral epiphysis, not followed by radiographic evidence of necrosis. This should be considered in attempts to make a pre-radiographic diagnosis of Legg-Calvé-Perthes' disease by radionuclide methods.

Child↗
PubMed1996

Stable Slipped Capital Femoral Epiphysis: Evaluation and Management.

Slipped capital femoral epiphysis (SCFE) has been classified traditionally on the basis of the duration of symptoms, but it has recently been recognized that this classification system may be misleading. It has instead been recommended that slips be classified on the basis of the presence or absence of gross instability between the epiphysis and the metaphysis. An adolescent with chronic SCFE has had symptoms for more than 3 weeks and does not have physeal instability. The first priority of treatment of stable chronic SCFE is to avoid the complications of avascular necrosis and chondrolysis while securing the epiphysis from further slippage. The treatment of choice for stable chronic SCFE is stabilization in situ, which can be most easily achieved with single-screw fixation. Primary realignment procedures, such as osteotomies, are not recommended.

Journal Article↗
PubMedDate not supplied

Fracture separation of the distal humeral epiphysis in children younger than three years old.

This study evaluated the change of carrying angle and the causes of cubitus varus after the fracture separation of the distal humeral epiphysis in young children. Twelve cases of fracture separation of distal humeral epiphysis were treated from January 1995 to July 1997. The age of all patients was younger than 3 years old. A metaphyseal fragment was seen in all cases (Salter-Harris type II), but the size of the metaphyseal fragment was either a very small flake or a large Thurston-Holland fragment. Posteromedial displacement was seen in all cases. There were three treatment groups: closed reduction with percutaneous pinning, closed reduction with cast, and cast without reduction. Follow-up period averaged 23.5 months (range, 12-40). Cubitus varus deformity was seen in seven cases, and six of them had a partial defect of the medial condyle that was avascular necrosis. The methods of treatment, age of injury, and the type of epiphyseal injury had no influence on the development of cubitus varus, but avascular necrosis of the medial condyle was related to the cubitus varus deformity (p<0.05). The results of this study suggest that fracture separation of distal humeral epiphysis in young children is likely to produce cubitus varus deformity with the development of avascular necrosis of the medial humeral condyle.

Casts, Surgical↗
PubMed1975

Effect of estradiol on the activity of serotonin N-acetyltransferase in the rat epiphysis.

Administration of estradiol to ovariectomized females did not affect either the rhythm and basic levels of activity of the enzyme regulating the formation of melatonin in the rat epiphysis-serotonin N-acetyltransferase or the activation of this enzyme by isoproterenol in vivo. Daily administration of estradiol to young rats from birth did not alter the rhythm or activity of serotonin N-acetyltransferase in the epiphysis as estimated on the 8th day of age. The ability of estradiol to suppress noradrenaline activation of adenyl cyclase in epiphysial homogenates and its inability to suppress the same activation of serotonin N-acetyltransferase suggests either that the activation of the latter enzyme by catecholamines could occur by other mechanisms than the adenyl cyclase system or that activation of adenyl cyclase by noradrenaline is not suppressed by estradiol to the same degree in vivo as in vitro.

Acetyltransferases↗
PubMedDate not supplied

Significance of the lateral epiphysis of the acetabulum to hip joint stability.

Normal development of the acetabulum is crucial to the growth and stability of the hip. Twenty-five New Zealand White rabbits (postweaning) weighing 1.5-2.2 kg were used. Both hips were exposed through an anterolateral approach. On the right hip, a fixed area of superolateral physeal cartilage was damaged with drills. Sham open reduction was performed for the left hip. Radiographic changes of the right hips were evident at 6 weeks. At 12 weeks, the right hip dislocated in a posterior and superior direction. The left hip remained normal. Histopathologic analysis correlated strongly with the radiographic findings. There were thinning of cartilage cells of the acetabulum, with disorganization. The acetabular roof was poorly formed. The lateral acetabular epiphysis is vital to the development of the acetabular roof. Damage to this epiphysis may result in acetabular maldevelopment and subsequent hip instability. We tested the hypothesis that abnormality in this epiphysis can give rise to abnormal acetabular development.

Acetabulum↗
PubMedDate not supplied

Coronal split fracture of the proximal tibia epiphysis through a partially closed physis: a new fracture pattern.

SUMMARY: A comminuted coronal split fracture of the proximal tibial epiphysis is an uncommon injury in children. The authors evaluated and treated two patients who sustained an epiphyseal fracture through a partially closed proximal tibial epiphysis. Plain radiography and computed tomography with three-dimensional reconstruction showed a comminuted coronal split fracture of the proximal tibial epiphysis. Each patient underwent definitive operative fixation of the fracture and was followed at least 1 year after clinical union. A mechanism consisting of three-point bending on the tibial plateau is proposed.

Accidental Falls↗
PubMedDate not supplied

Vascular supply to slipped capital femoral epiphysis.

The etiology of avascular necrosis associated with slipped capital femoral epiphysis has not been well understood. The aims of this study were to clarify the blood supply to the slipped epiphysis and to examine whether this vascular supply is damaged before the reduction. Twelve patients (12 hips) underwent selective angiography of the medial circumflex femoral artery. There were seven stable slips and five unstable slips. All patients with slips underwent angiography before reduction, and one patient with an unstable slip underwent angiography both before and after reduction. The superior retinacular artery (SRA) was filled in all stable slips. This result was in accordance with the previous report that stable slips result in low rates of avascular necrosis. Of five unstable slips, the SRA was stained in two and was not filled in three. In one slip examined both before and after the manipulative reduction, the SRA was not seen before it but was well stained after it. These results have suggested that in some unstable slips the vascular injury occurs at the time of injury, before reduction, and that the reduction dose not necessarily contribute to the risk of avascular necrosis after slipped capital femoral epiphysis.

Adolescent↗
PubMedDate not supplied

Progressive slippage after pinning for slipped capital femoral epiphysis.

The authors retrospectively reviewed seven cases of progressive slipped capital femoral epiphysis after screw fixation. All seven patients initially presented with chronic symptoms, and five had an acute exacerbation of symptoms with the appearance of an acute-on-chronic slip. Of the other two, one had obvious motion at the proximal femoral physis and the other had increased symptoms but did not have an obvious acute slip radiographically. All underwent percutaneous screw fixation. In four patients a single screw was placed, and in three patients two screws were placed. No patient became symptom-free after surgery. Slip progression was noted on average 5 months after treatment. Radiographs in all patients revealed an increase in slip severity and loss of screw purchase in the femoral neck while fixation in the proximal femoral epiphysis remained secure. One patient had hypothyroidism and another Cushing disease, both diagnosed after the slipped epiphysis. Slips occurring in children with underlying endocrinopathies, and unstable slips in children with a history of antecedent knee or hip pain (commonly called an acute-on-chronic slip) may be susceptible to screw fixation failure. In such patients, close radiographic follow-up, particularly in the presence of continued symptoms, is required to document slip progression and fixation failure as soon as possible.

Bone Screws↗
PubMed2002

Premature closure of the physeal plate after treatment of a slipped capital femoral epiphysis.

BACKGROUND: Treatment of a slipped capital femoral epiphysis (SCFE) should stabilize the epiphysis and prevent complications. Attempting to obtain physeal closure is still controversial. The purpose of this study was to evaluate the clinical results and complications after treatment of SCFE. METHODS: From 1989 to 2000, 12 patients (14 hips) underwent pinning for treatment of SCFE. For acute and acute-on-chronic slippage, longitudinal traction was attempted for reduction. Patients with chronic slippage received fixation in situ. All patients were available for follow-up for an average of 63 months. RESULTS: Nine of the 14 hips had excellent or good functional results, and 5 had fair results. One hip developed avascular necrosis of the femoral head with a fair result. There was no chondrolysis or osteoarthritis of the joint at the most recent follow-up. Physeal closure in 9 hips occurred at an average of 16 months. The change in articulotrochanteric distance averaged 5.4 mm. CONCLUSION: Although most functional results were not adversely influenced after premature closure of the physeal plate of consideration should be given to the device, such as a dynamic screw, that stabilizes the epiphysis and prevents premature physeal closure in patients who have significant growth potential. To understand the influence of growth disturbance of the proximal femur and the effect of dynamic screw fixation, long-term follow-up is mandatory.

Adolescent↗
PubMed2003

7th Yahya Cohen Lecture. Significance of the lateral epiphysis of the acetabulum to hip joint stability.

Normal development of the acetabulum is crucial to the growth and stability of the hip. Twenty-five New Zealand white rabbits (postweaning) weighing 1.5 to 2.2 kg were used. Both hips were exposed through an anterolateral approach. On the right hip, a fixed area of superolateral physeal cartilage was damaged with drills. Sham open reduction was performed for the left hip. Radiographic changes of the right hips were evident at 6 weeks. At 12 weeks, the right hip dislocated in a posterior and superior direction. The left hip remained normal. Histopathologic analysis correlated strongly with the radiographic findings. There were thinning of cartilage cells of the acetabulum, with disorganisation. The acetabular roof was poorly formed. The lateral acetabular epiphysis is vital to the development of the acetabular roof. Damage to this epiphysis may result in acetabular maldevelopment and subsequent hip instability. We tested the hypothesis that abnormality in this epiphysis can give rise to abnormal acetabular development.

Acetabulum↗
PubMed2003

[Closed reduction and pinning for acute slipped capital femoral epiphysis].

Acute slipped capital femoral epiphysis is a rare adolescent hip disorder, which may be a problem for orthopedic surgeon. No series to date has demonstrated the superiority of any treatment method. The purpose of the study was to evaluate the outcome of treatment and to assess the risk factors of avascular necrosis associated with this condition. Fourteen cases of acute slipped capital femoral epiphysis were treated with closed reduction and pinning. There were 9 boys and 5 girls. The average age at presentation was 11.8 years (range 9.1-15.3). Eight children were treated 4-10 days and six within 48 hours of the onset of their acute symptoms. The severity of the slip was classified according to the system of Southwick. Presence of chondrolysis and avascular necrosis was estimated. The clinical results were graded with the use of the criteria of Aadelen et al. Four slips were classified as mild, seven as moderate and three as severe. Average follow up was 5.2 years (range from 2.4 to 14.3). In two hips with severe slip AVN developed. One of these cases was treated within 48 hours and one after 7 days. Chondrolysis developed in one hip and was associated with presence of intra-articular fixation. Twelve of the fourteen hips had good and vary good results and remaining 2 with AVN had poor. Closed reduction and pinning in acute slipped capital femoral epiphysis is an effective and giving satisfactory outcome method of treatment. Early reduction is not associated with a high rate of AVN and should be performed as soon as possible. More severe slips were noted to have an increased risk of AVN.

Adolescent↗
PubMed2003

Epidemiology of slipped capital femoral epiphysis in a population with a high proportion of New Zealand Maori and Pacific children.

AIM: To describe the epidemiology of slipped capital femoral epiphysis in NZ Maori and Pacific children residing in Auckland compared with NZ European children. METHODS: The charts and radiographs of 211 children admitted with 307 slipped capital femoral epiphyses to Starship Children's Hospital between 1988 and 2000 were reviewed. RESULTS: The average age at first presentation was 132.6 +/-16.7 months in girls (range 95 to 170 months) and 149.5 +/- 19.3 months in boys (range 99 to 190 months), p <0.05. The age at presentation was not statistically different between the three ethnic groups. One hundred and seventy one children (81%) presented with a unilateral slipped capital femoral epiphysis. Forty children presented with bilateral simultaneous slipped capital femoral epiphyses; however, after two years of follow up, a further 56 children had been readmitted for pinning of the opposite hip, giving an overall rate of bilateral hip pinning of 45.5%. The relative racial frequency of slipped capital femoral epiphysis in the New Zealand Maori and the Pacific population was 4.2 times and 5.6 times the New Zealand European population, respectively. CONCLUSIONS: Children as young as eight years are now presenting with slipped capital femoral epiphyses. General practitioners should be aware of the possibility of this diagnosis, particularly in children of NZ Maori or Pacific ethnicity.

Adolescent↗
PubMed1992

Biomechanical comparison of three internal fixations for treatment of slipped capital femoral epiphysis in immature dogs.

The biomechanical strength and stiffness of 3 fixation techniques used to repair acute slipped capital femoral epiphysis were evaluated in bone specimens from immature dogs. A servohydraulic testing machine was used to create slipped capital femoral epiphysis in 9 pairs of femurs by shearing the capital femoral epiphysis along the physis in a craniocaudal direction. The slip was reduced and repaired with 1, 2, or 3 double-pointed, 1.6-mm (0.062-inch) smooth pin(s) and retested. The strength and stiffness of each intact femur (which served as the control) and repaired femur were compared. Results of the study indicated that differences among the failure strengths of 1- and 2-pin fixations and their respective controls were not significant; however, the 3-pin fixation was 29% stronger than its control and was 60 and 45% stronger than the 1- and 2-pin fixations, respectively. One- and 2-pin fixations were 34 and 24% less stiff than their respective controls, whereas the stiffness of the 3-pin fixation was similar to its control. The 2- and 3-pin fixations were 48 and 76% stiffer, respectively, than the 1-pin fixation, but were not significantly different, compared with each other.

Animals↗
PubMed2003

[Slipped capital femoral epiphysis associated with hyperparathyroidism. A case report].

Slippage of the upper femoral epiphysis can occur in association with multiple endocrine imbalances. A case of slipped femoral epiphysis with primary hyperparathyroidism is reported. The patient was an adolescent, 16 Years of age, who presented bilateral slipped epiphysis. Investigation showed that he had hypercalcemia (3.1 mmol/l) related to primary hyperparathyroidism. A parathyroid adenoma was removed. Outcome was favorable and the slipped femoral epiphyses did not require a specific treatment.

Adenoma↗
PubMed2005

[Slipped capital femoral epiphysis treated with a specially designed screw].

BACKGROUND: In 1992 we developed a specially designed Olmed screw for treatment of slipped capital femoral epiphysis. The segment of which the screw is threaded is shorter than a regular Olmed screw. In that way the threaded portion of the screw can be placed entirely within the epiphysis. This makes the shank of the screw smooth through the physis; the purpose of this is to allow continued growth in the neck of femur. The threads are reverse cutting to make the screw easier to remove. MATERIAL AND METHODS: From 1992 to 2004, we treated 18 hips with slipped capital femoral epiphysis; all patients were treated percutaneously with in situ fixation. We have retrospectively reviewed the medical records and radiographs. Nine patients were reviewed clinically and radiographically after an average follow up of seven year and nine months. RESULTS: There were no difficulties with the surgical procedure, including removal of the screw. No further slippage, avascular necrosis or chondrolysis occurred. Radiographs showed that the screw allows continued growth of the neck of femur. Most of the patients had decreased internal rotation, but few had symptoms at follow up.

Adolescent↗
PubMed2005

[Anatermic separated epiphysis or avulsion fracture: image observation].

OBJECTIVE: To explore an approach to distinguish avulsion fracture of articular portion from anatomic separated epiphysis. METHODS: 21 cases with suspicioned avulsion fracture of articular portion of tubular bone were reviewed. The cortical continuity of separate small bone and contiguous bone portion was investigated. The swell of soft tissue around these small bones was observed simultaneously. Then the configuration of the fracture was researched by injury mechanics. RESULTS: Continued bone cortex between separate small bone and corresponding bone was seen in 15 cases, so they were considered as a separate epiphysis. Sharp linear fracture between the separate small bone and corresponding bone were seen in 6 cases. The swell of soft tissue around the separate small bone was observed in all cases, so they were considered as a avulsion fracture. CONCLUSION: The meticulous investigation of separated small bone at the articular portion by image observation is of important value for distinguishing avulsion fracture from anatomic separate epiphysis.

Adolescent↗
PubMed2005

Ultrastructural organization of epiphysis in rats under the action of electromagnetic fields and during mammary carcinogenesi.

Experiments conducted by the authors, as well as clinical studies, show that in addition to hormonal mis-balance, development of mammary gland cancer is significantly influenced by the action of low frequency electromagnetic fields on epiphysis. By reducing the production of melatonin it increases the risk of development of mammary gland tumors. The review of scientific literature indicates that pinealocytes are the main morphological substrate responsible for functional activity of pineal cells. When estimating large specific weight of lipids, many researchers point to the dependence of their presence in epiphysis on the level of melatonin. It is thought that hormones of pineal cells are deposited in the form of lipid drops. The most characteristic feature in the structure of pinealocytes is the presence of large number of various size complexes in their bodies and appendices. According to many authors this could be the form of depositing the secretory products of pinealocytes, such as melatonin, biological amines, etc. Ultrastructure characteristic of pinealocytes described in the review provides deeper understanding of the fine structure morpho-physiology of epiphysis, enable to point out the peculiarities of its functionality under the influence of electromagnetic fields and discover the organizational structure of pineal body at a time of the mammary gland tumor development.

Animals↗