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At least 163 records · Page 9Linked to original sources
PubMed2005

[Juvenile unstable severe slip of the proximal femoral epiphysis: case report and review of treatment options].

The authors present the case of a severe unstable slip of the proximal femoral epiphysis in a 14-year-old boy. A serious metabolic disorder diagnosed in the boy led to postponement of necessary surgical intervention. The primary development of necrosis of the proximal femoral epiphysis during the 6 months following the slip is reported here. A good outcome was eventually achieved by three-plane valgus, flexion and derotational osteotomy of the femur at second-stage surgery. The authors emphasize the prognostic importance of stability assessment in the displaced epiphysis.

Adolescent↗
PubMed1992

Slipped capital femoral epiphysis. A prospective study of fixation with a single screw.

Forty-four children (fifty-eight hips) who had a slipped capital femoral epiphysis were managed by in situ pinning with a single cannulated screw. This method of treatment was first used in our institution in 1983. Thirty-one boys and thirteen girls were followed for an average of three years (range, two to six years). There were eight acute slips and fifty chronic slips. Thirty-four patients were black and ten patients were white. The clinical criteria of Heyman and Herndon and the radiographic parameters cited by Boyer et al. were used to grade the results. Fifty-four hips were rated as either excellent or good. Avascular necrosis developed in one patient who had an acute slipped capital femoral epiphysis, but chondrolysis did not occur in any patient. The complications included a subtrochanteric fracture in one patient and an increase in the degree of slippage of the capital femoral epiphysis in two patients.

Adolescent↗
PubMed2005

Measurement variability of the lateral head-shaft angle in slipped capital femoral epiphysis.

The lateral head-shaft angle as described by Southwick is used to assess the severity of slipped capital femoral epiphysis and to measure progression. Intraobserver variability in measuring the lateral head-shaft angle may influence decision making. The purpose of this study was to determine intraobserver variability in the measurement of the lateral head-shaft angle of slipped capital femoral epiphysis. The lateral head-shaft angle of 108 hips was measured twice by three observers. The two-way analysis of variance method of Bland and Altman as outlined by Loder was used to determine the intraobserver variability. For the lateral head-shaft angle in slipped capital femoral epiphysis, the intraobserver variability was +/-5.9 degrees . To ensure true change, a single observer should document at least a 12 degrees change in the lateral head-shaft angle between two radiographs.

Adolescent↗
PubMed1995

The elusive slipped capital femoral epiphysis.

Slipped capital femoral epiphysis is the most common disorder of the hip in young adolescents. Although it is not completely understood, predictive indicators give clues as to who is at risk. Slipped capital femoral epiphysis need not be painfully disabling. Many children are quite active during an active slip. Any child between the ages of 10 and 15 years presenting with thigh, knee, and/or hip pain and no special history of trauma should have a good hip examination to rule out slipped capital femoral epiphysis.

Journal Article↗
PubMed2006

Comparison of fracture versus radiolucent table in the treatment of slipped capital femoral epiphysis.

PURPOSE: Compare slipped capital femoral epiphysis stabilized on fracture versus radiolucent table. METHODS: Twenty unilateral stable mild slipped capital femoral epiphyses were stabilized in-situ with a single screw. Age, sex, side, body-mass index, type of table, anesthesia time, surgery time, fluoroscopy time, number of fluoroscopy images, preoperative/postoperative lateral head-shaft angle, and number of screw threads engaging the epiphysis were noted. RESULTS: There were no differences in the measured parameters. CONCLUSIONS: Stabilization of mild slipped capital femoral epiphysis can be accomplished reliably and safely with the use of either a radiolucent or fracture table.

Adolescent↗
PubMed1991

[Medial and lateral shift of the femoral head epiphysis].

The authors demonstrate a developmental anomaly of the position of the epiphysis of the hip joint, i.e. its medial shift. They assumed that it will be a pre-arthrotic condition, as other known dysplasias of the hip joint. However, the position was reversed as if the shift of the epiphysis of the head of the femur in a medial direction protected the hip joint from the development of arthrotic changes. In case of a medial shift of the epiphysis of the head of the femur--caput varum prearthrosis is not involved.

Adult↗
PubMedDate not supplied

Congenital dislocation of the hip: acetabular deficiency in adolescence (absence of the lateral acetabular epiphysis) after limbectomy in infancy.

Acetabular development in adolescence was assessed in 61 patients with congenital dislocation of the hip (CDH). Limbectomy was performed in 31; in these, the lateral acetabular (iliac) epiphysis failed to appear by age 13 years. This failure was associated with loss of cover of the femoral head in patients followed up until the third decade. The lateral acetabular epiphysis appeared in all remaining patients in whom reduction was achieved without limbectomy. Acetabular development in adolescence is affected adversely by limbectomy; this is due at least in part to absence of the lateral acetabular epiphysis.

Acetabulum↗
PubMed1989

[Injuries to the upper tibial epiphysis. Apropos of 20 cases].

The authors report 20 cases of injuries involving the proximal tibial epiphysis (16 avulsion fractures of the tibial tubercle, 4 epiphyseal fractures), occurring in adolescents engaged in athletics, in 3/4 of the cases. Sixteen displaced fractures needed open reduction and internal fixation with screw(s). Leg shortening (12 mm) occurred in a 14 year-old male with a displaced fracture of both the tibial tubercle and proximal epiphysis, in which premature ossification had taken place; fixation with Kirschner wires would have been the treatment of choice before closure of the tibial epiphysis. At follow-up, function was acceptable in all cases; all the patients had returned to full daily activity and no further surgical procedures were needed. Long-term knee laxity became obvious in one patient, however, with repeated fracture of the tibial tubercle. Associated ligamentous and meniscal tears should therefore be sought on early clinical examination and confirmed by arthroscopy or arthrotomy after surgical fixation.

Adolescent↗
PubMed1989

The neck shaft-plate shaft angle in slipped capital femoral epiphysis.

We looked for structural differences between normal patients and those with slipped capital femoral epiphysis to explain shear failure of the growth plate in terms of mechanics. Hip radiographs of 50 normal adolescents were examined, and it was found that lines drawn along the axis of the femoral neck and perpendicular to the growth plate intersected at an average angle of 23 degrees (neck shaft-plate shaft angle). Radiographs of 50 patients with slipped capital femoral epiphysis were examined, and the femoral neck shaft-plate shaft angle was found to be between 10 degrees and 20 degrees in patients with unilateral slips and less than 10 degrees in patients with bilateral slips. These abnormalities in the femoral neck shaft-plate shaft angle suggest there are mechanical differences between normal hips and those that develop a slip of the capital femoral epiphysis that may predispose to shear failure of the growth plate.

Adolescent↗
PubMed1987

[Acute slipped femur head epiphysis. Causes--surgical treatment--results].

The juvenile slipped capital femoral epiphysis depends on a dysendocrinia during puberal acceleration. The weakening of mechanical stability of the epiphyseal cartilage leads in most of the cases to a slow, only in some cases to an acute dorsocaudal slipping of the capital femoral epiphysis. Representation of our own patients of Orthopedic University Hospital D-Homburg/Saar with altogether 27 acute slipped capital femoral epiphyses during the years 1965-1981. The early operative stabilisation seems to be most important for a good prognosis (danger of development of femoral head necrosis). The opening of the hip joint during the operation by a ventral capsulotomy facilitates the reduction and decompresses the haematoma. In consideration of the mostly slow beginning, in many cases an ideal correction could not be achieved in most of the patients. In contrast to the osteosynthesis by screws the growth in length is less influenced by using a lamellar nail or Kirschner-wires. In cases of an acute slipped capital femoral epiphysis a first conservative treatment with subsequent correction osteotomy does not seem to be justifiable, because the danger of femoral head necrosis raises drastically. In case of opportune operation and correct technique good to fair functional results can be achieved.

Acute Disease↗
PubMed1988

Team physician #4. Avulsion fracture of the distal tibial epiphysis in skeletally immature athletes (juvenile Tillaux fracture).

Adolescent athletic injuries are special in that they differ from those of the skeletally mature athlete in several respects. The physis is weaker than the ligaments, so that the typical mechanism of injury, which might be expected to result in a syndesmosis sprain of the ankle in adults with subsequent tearing of the ligaments, frequently causes an epiphyseal avulsion in children. The potential for leg length discrepancy and growth aberrations exists only if a significant amount of growth remains in the unfused epiphysis. The juvenile Tillaux fracture of the anterolateral distal tibial epiphysis is rare because it requires a specific mechanism of injury of dorsiflexion and external rotation at a time when the tibial epiphysis is fused medially but open laterally. We have also noted in these injuries a tear of the interosseous ligament, which has not previously been stressed in the literature. Intraoperative findings have helped to clarify the pathoanatomy and mechanism of injury. Anatomic reduction is necessary to prevent posttraumatic sequelae.

Adolescent↗
PubMed1988

[Endocrine function of the epiphysis in disorders of cerebral circulation (morphological study)].

In a quantitative morphological study of the epiphyses from 56 patients whose death was related to various types of cerebral circulation disorders the authors have specified the characteristics of the endocrine function of this organ in each of the pathological types studied, with the status of the merocrine and "emergency" holocrine secretion of the epiphysis being assessed separately. The authors consider the possible significance of the identified epiphysis dysfunction in the development and course of cerebrovascular diseases and outline possible types of involvement of the epiphysis in their pathogenesis.

Aged↗
PubMed1986

The metaphyseal blanch sign of slipped capital femoral epiphysis.

In the early stage of slipping of the capital femoral epiphysis, the epiphysis slips posteriorly in relation to the neck of the femur. When this occurs, the posterior portion of the femoral head is seen on the anteroposterior radiograph as a crescent-shaped area of increased density overlying the metaphysis adjacent to the epiphyseal plate. This metaphyseal blanch sign suggests that slipping of the capital femoral epiphysis has occurred and that a lateral radiograph should be made to confirm or exclude the diagnosis.

Adolescent↗
PubMed1986

Slipped capital femoral epiphysis.

Slippage of the capital femoral epiphysis typically presents as hip pain in a child. Radiographic examination demonstrates translocation of the upper femoral epiphysis away from its normal anatomic position on the neck of the femur. Slipped capital femoral epiphysis can result in permanent deformity if it is not promptly corrected. Closed pinning is the treatment for acute slips, but treatment options are complex when the condition is chronic.

Adolescent↗
PubMed1977

[Blood vessels of the epiphysis in comparative-anatomical aspect].

The structure of the epiphysis and its inner blood vessels were studied in the representatives of nine orders of placental mammals and in man by means of injection of stained masses into the arteries and veins and subsequent preparation of histological sections. Not only form and topography of the organ differ in the representatives of different orders, but histological picture of the epiphysis is specific for each of them. In insectivores and chiroptera the loops of the inner three-dimensional capillary network are stretched along the longitudinal axis of the organ. In the epiphysis of carnivores, ungulata and monkey, the intraorganic vessels are situated in stromal trabeculae and the loops of the capillary network have polygonal shape. The intraepiphyseal vessels in man are arranged in peculiar baskets which envelope parenchymal lobules. The intraorganic veins beginning from the loops of the capillary network do not follow the arteries penetrating into the organ, but independently go to different surface parts of the organ where they flow into extraorganic veins.

Animals↗
PubMed1981

[Experimental studies on the reparative processes of infarcted capital femoral epiphysis in puppies--with special reference to the correlation of radionuclide (99mTc-MDP) uptake with radiological and pathohistological changes (author's transl)].

To investigate the correlation of radiological and pathohistological changes with radionuclide (99mTc-methylene diphosphonate) uptake, avascular necrosis of the femoral capital epiphysis of puppies was produced after the modified method of Henard and Calandruccio, by casting the hip joint in the position of hyperextention, full internal rotation and abduction for eighteen to twenty hours. Seventy-six puppies were divided into three groups according to frequency and time intervals of casting; in group A the animals were cast once, in group B cast twice with one week interval between the 1st and 2nd casting and in group C cast twice as group B but with four-week interval. Radiological, pathohistological changes and RI uptake in the capital femoral epiphysis were sequentially studied at certain intervals (1, 3, 5, 9, 15 and 20 weeks after the 1st casting). The results were as follows: 1) The radiological and pathohistological changes in the upper parts of the femora were simulated to those of human LCPD. At three to five weeks after the 1st casting (in group B and C, after the 2nd casting) radionuclide (99mTc-MDP) accumulation in the capital femoral epiphysis decreased compared with the healthy side. At this point X-ray showed coxa plana or vara and sclerotic changes in ossific nucleus, and "head within a head" feature was recognized in several cases. Pathohistologically, osseous healing and connective tissue invasion into the marrow spaces were recognized surrounding the central necrotized focus with multifarious features. 2) Radiologically in the cases of groups B and C, more severe deformities of the femoral head such as coxa vara and/or coxa plana were noted than in group A. 3) As to the RI accumulation, for 3 to 5 weeks after the last casting RI uptake was shown to decrease and then gradually increase compared with the healthy side, and this tendency was more conspicuous in group C than in groups A and B. It can be concluded that 99mTc-MDP is accumulated greatly at the site of active osteogenesis.

Animals↗
PubMed1984

Transtrochanteric rotational osteotomy in the treatment of idiopathic and steroid-induced femoral head necrosis, Perthes' disease, slipped capital femoral epiphysis, and osteoarthritis of the hip. Indications and results.

Transtrochanteric rotational osteotomies were successful in 342 hips (274 patients) for the treatment of idiopathic and steroid-induced osteonecrosis of the femoral head, Perthes' disease, slipped capital femoral epiphysis, osteoarthritis, and other disorders. One hundred fifty-eight hips (113 patients) with idiopathic and steroid-induced necrosis were followed up for two to 11 years. In 121 of 158 hips, excellent results were obtained clinically and roentgenographically. In 42 Grade I or II hips, excellent results were obtained in every respect (success rate, 86%). Eighty-eight of 93 hips in which the intact surface was greater than one-third of the total on lateral roentgenograms obtained prior to surgery showed no collapse of the newly created weight-bearing area (success rate, 95%). Ninety-eight of the 102 hips in which the ratio of the intact area of the femoral head to the acetabular weight-bearing area on postoperative anteroposterior roentgenograms was greater than 36% showed no further collapse. These results suggest that adequate rotation is essential. Intentional varus positioning should be designed for patients with advanced collapse and extensive lesions. In the case of Perthes' disease all seven hips showed excellent results, and repair processes were completed within one year. In the treatment of slipped epiphysis anterior rotational osteotomies were performed in ten hips (10 patients); nine of the ten hips showed excellent results, with perfect correction of the deformity. Twenty-two patients with osteoarthritis were treated by rotational osteotomy. Ten of these patients were followed up for two to nine years; nine of ten showed excellent results. In only one hip with a severely dysplastic acetabulum was there a recurrence of pain and narrowing of joint space. These results suggest that this procedure may be used not only for femoral head necrosis but for patients with Perthes' disease, slipped capital epiphysis, and osteoarthritis of the hip as well.

Adolescent↗
PubMed1978

Combined valgus derotation osteotomy and cervical osteoplasty for severely slipped capital femoral epiphysis: mechanical analysis and report preliminary results using compression screw fixation and early weight bearing.

Although considerable remodeling can occur in slipped capital femoral epiphysis, it is generally conceded that the severely-slipped epiphysis requires corrective osteotomy to restore adequate range of motion, and to prevent early degenerative changes. A study of artifically-created severe slips in cadaver specimens demonstrated that removal of the cervical prominence, as well as valgus-derotational osteotomy is necessary to restore good range of motion and provide a satisfactory weight-bearing surface. Clinical trial in 6 patients also demonstrated that the cervical prominence is a barrier to flexion, internal rotation, and abduction even after a valgus derotational osteotomy. The Watson-Jones approach afforded adequate exposure of the anterior femoral neck and head as well as the femoral shaft to allow excision of the cervical prominence, insertion of internal fixation, and adjustment of valgus and rotation under direct vision. The Richards compression screw proved to be ideal for fixation in the proper degree of valgus, and for allowing rotary alignment of the distal fragments. Early results were very good, and all patients had near-normal hip flexion, internal rotation, and abduction; and most were able to bear weight in the early postoperative period. The operation appears to offer a workable solution to the problem posed by the severly slipped capital femoral epiphysis, but more definitive conclusions must await the results of a larger series.

Adolescent↗