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At least 217 records · Page 12Linked to original sources
PubMed2005

Correlation of age and ossification of the medial clavicular epiphysis using computed tomography.

OBJECT: The aim of this study was the examination of relationship between the age and the ossification of medial epiphysis of the clavicle referred to CT examination. MATERIALS AND METHODS: Concerning the epiphyseal ossification of the clavicle CT's of 100 patients (50 male and 50 female) between 16 and 25 years (10 patients for each year) were analyzed by three viewers. RESULTS: In the legal relevant age segment (16-25a) we saw a turnover from stage 3 to stage 4 at the age of 21 years. The calculated empiric distribution function showed 95% of stage 4 over 21 years while 75% of the patients with stage 3 were under 21 years. A reconstruction kernel suitable for osseous structures should be used, images should be viewed or presented in a bone window. CONCLUSION: According to these results it can be concluded that a person with stage 4 is probably 21 years or older, while a stage 3 leads to an estimated age under 21 years. On the other hand, a confidence level of 99.67% is not reached. Therefore, CT of the medial epiphysis of the clavicle will only be suitable for age estimation around the age of 21 years, if this relevant statistic obstacle is defeated. Bearing this in mind, further studies are needed to evaluate slice thickness as the most critical parameter.

Adolescent↗
PubMed2006

Abnormal triangular epiphysis causing angular deformity of the thumb.

PURPOSE: To present a triangular-shaped abnormal secondary ossification center of the distal phalanx causing angular deformity of the thumb and the surgical outcome of corrective closing-wedge osteotomy for this deformity. METHODS: We treated 6 patients with abnormal triangular epiphysis in the distal phalanx of the thumb, including 3 bilateral cases. The average age was 43 months and there were 2 boys and 4 girls. Of the 9 thumbs intraepiphyseal closing-wedge osteotomy was performed in 5 and proximal phalangeal closing-wedge osteotomy was performed in 4. We measured the deformities in degrees of angulation and the range of motion of the interphalangeal (IP) joint. The average duration of the follow-up period was 27 months after the surgery. RESULTS: Preoperative angular deformity of ulnar deviation averaged 30 degrees , which was reduced to an average of 12 degrees after osteotomy at the last follow-up assessment. All osteotomies healed and there was no evidence of physeal or articular damage. Interphalangeal joint range of motion did not decrease after surgery in all cases. Patients and parents were satisfied with the results of the surgery, although mild deformity persisted in the interphalangeal joint when in the flexed position after proximal phalangeal osteotomy. CONCLUSIONS: Abnormal triangular epiphysis causing angled thumb is different from delta bone and can be treated with either intraepiphyseal or proximal phalangeal closing-wedge osteotomy. The intraepiphyseal procedure, however, could achieve better deformity correction regardless of the interphalangeal joint position. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Child, Preschool↗
PubMed1996

Hyaluronan synthesis by epiphysial chondrocytes is regulated by growth hormone, insulin-like growth factor-1, parathyroid hormone and transforming growth factor-beta 1.

In a previous study, we presented evidence that the synthesis of hyaluronan by hypertrophic chondrocytes is one of the principal factors driving the interstitial expansion of the growth plate (Pavasant et al., J. Cell Sci. 109: 327-334, 1996). To test this possibility further, we used two different approaches to examine the effects of hormones on the production of hyaluronan in the growth plate. In the first approach, we examined the growth plate of the lit/lit mouse that lacks growth hormone and found that its hypertrophic lacunae were smaller and contained less hyaluronan than those of wild type mice. Moreover, the ratios of hyaluronan staining density to total area of the lacunae were similar for the lit/lit and the wt/wt mice, indicating that the amount of hyaluronan is directly related to lacuna size. In the second approach, we examined the effects of hormones on segments of the epiphysial growth plate placed in organ culture. Under normal culture conditions, a band of hyaluronan staining progressed across the length of the growth plate, reflecting the maturation of chondrocytes into the hypertrophic stage. When insulin-like growth factor-1, a factor known to promote chondrocyte maturation, was added to the culture medium, the production of hyaluronan and the enlargement of the lacunae were stimulated. In contrast, when either parathyroid hormone or transforming growth factor-beta 1, both of which inhibit chondrocyte differentiation, was added to the medium of cultured segments, new pericellular hyaluronan was not detected and the lacunae did not enlarge. Taken together, these results indicate that factors that either stimulate or inhibit the maturation of epiphysial chondrocytes have a corresponding effect on the production of hyaluronan. This, in turn, further supports the importance of hyaluronan in the process of lacuna enlargement.

Animals↗
PubMed1983

The effects of 24R,25-dihydroxycholecalciferol and of 1 alpha,25-dihydroxycholecalciferol on ornithine decarboxylase activity and on DNA synthesis in the epiphysis and diaphysis of rat bone and in the duodenum.

The effect of cholecalciferol metabolites on ornithine decarboxylase activity and on DNA synthesis in developing long bones was investigated in vitamin D-depleted rats. In the epiphysis there was a 6.4-fold increase in ornithine decarboxylase activity 5 h after a single injection of 24R,25-dihydroxycholecalciferol but not of 24S,25-dihydroxycholecalciferol or other vitamin D metabolites. In comparison, in the diaphysis and duodenum, 1 alpha,25-dihydroxycholecalciferol, but not other vitamin D metabolites, caused a 3-3.5-fold increase in the enzyme activity. The enzyme activity in the tissues examined attained a maximal value at 5 h after the injection of the metabolites. The activity of ornithine decarboxylase in the epiphysial region increased dose-dependently as the result of a single injection of 24R,25-dihydroxycholecalciferol and attained a maximal value at a dose between 30 and 3000 ng. In addition, administration of 24R,25-dihydroxycholecalciferol, but not 24S,25-dihydroxycholecalciferol or other metabolites, caused within 24 h a 1.7-2.0-fold increase in [3H]thymidine incorporation into DNA of the epiphyses of tibial bones. In comparison, 1 alpha,25-dihydroxycholecalciferol caused a 1.5-fold increase in [3H]thymidine incorporation into DNA of the diaphyses and of the duodenum. The present data indicate that 24R,25-dihydroxycholecalciferol is involved in the regulation of epiphyseal growth, whereas 1 alpha,25,dihydroxycholecalciferol stimulates the proliferation of cells in the diaphysis of long bones and in the intestinal mucosa.

24,25-Dihydroxyvitamin D 3↗
PubMedDate not supplied

[Spontaneous necrosis of the upper femoral epiphysis in prepuberty (puberty "Perthes")].

The author differentiates between prepubertal necrosis of the upper femoral epiphysis and Perthes' disease in children. A number of clinical and roentgenological factors are decisive in distinguishing between the two conditions. Prepubertal epiphysial necrosis is always quickly followed by severe hip deformity which, in contrast to Perthes' disease, cannot be corrected by any therapeutical means. Early osteoarthritis must be expected in all cases. The author discusses several therapeutic possibilities which have not yet been tested and which, in case which are diagnosed early, could have a positive effect.

Adolescent↗
PubMed1981

[Boundaries between the physiological and the beginnings of pathology in the development of the proximal femoral epiphysis (author's transl)].

This article describes the physiological development of the proximal femoral epiphysis and its variable aspects. It also includes a discussion of the transition to the pathological changes characteristic of dysplasia of the head of the femur and of Legg-Calvé-Perthes' disease, basing on a latent ischaemic phase in the development of the proximal femoral epiphysis, resulting from hypoplastic vascular development.

Child↗
PubMed2000

Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis.

On the basis of intraoperative observations in 13 consecutive adolescents (14 hips) with slipped capital femoral epiphysis (SCFE), we found that when the anterior femoral metaphysis was level with or extended past the epiphysis, it caused labrum and cartilage damage. As a result of an impingement between the metaphysis and the superomedial acetabular rim, the labrum revealed erosions, scars or tears. Further jamming of the metaphysis into the joint damaged the adjacent acetabular cartilage, varying from a partial- to a full-thickness cartilage loss. In all patients, the femoral head cartilage was intact; no avascular necrosis was present. Our findings suggest that arthrosis in SCFE can be triggered by early mechanical damage of the acetabular cartilage.

Acetabulum↗
PubMed1993

Vascular characteristics of the cartilage and subchondral bone of the distal radial epiphysis of the young foal.

The vascular features of the distal epiphysis of the radius of 27 foals aged from 3 weeks premature to 120 days postpartum were determined. The limbs were perfused with barium, and the distal radius was sawn into sagittal slabs which were decalcified, cut into thin slices and radiographed. More arteries approached areas of thick cartilage than thin cartilage. In thick cartilage, vessels in a lattice network were observed, and adjacent to these vessels was sinusoidal filling in the epiphyseal subchondral bone, which had a similar pattern to sinusoidal filling in the metaphysis. The sinusoidal filling adjacent to thick cartilage was at the predisposition site for epiphyseal osteomyelitis lesions in foals. This particular type of bone infection occurs commonly in the foal, but much less commonly in other species. The vascular features of the immature epiphysis may account for the predominance of epiphyseal osteomyelitis in the foal.

Journal Article↗
PubMed2002

Gray-scale and Doppler ultrasound imaging features of vascular canals in human femoral condylar epiphysis.

PURPOSE: To describe the gray-scale and color Doppler ultrasound imaging features of vascular canals in human femoral condylar epiphysis. MATERIAL AND METHODS: Vascular canals in the femoral condylar epiphysis were examined using gray-scale and Doppler US. The study was performed in 45 volunteers (aged <1 month-72 years) who comprised 1 subject with short stature, 1 subject with Klippel-Trenaunay-Weber syndrome and 43 subjects with normal growth. RESULTS: In the 8-year-old and younger group (n=34), vascular canals were observed in 32 subjects (94%), whereas vascular canals were not observed in the 9-year-old and older group (n=11). Vascular canals were visualized as hyperechoic lines and dots. With Doppler US, blood flow in the vascular canals was observed in 20 of the 32 subjects (62.5%). Spectral Doppler analysis was possible in 15 subjects, in all of whom only arterial waveforms were observed. CONCLUSION: US was helpful to delineate the vascular canals and flow therein. The detection and evaluation of vascular canals and blood flow therein may prove useful in understanding growth.

Adolescent↗
PubMedDate not supplied

Anterior slip of the capital femoral epiphysis. Report of a case and discussion.

A rare case of anterior slip of the capital femoral epiphysis demonstrates that the mechanism of the posterior, inferior slip of the capital femoral epiphysis is a combination of weight bearing in the frontal plane and muscle pull in the horizontal plane. Sudden violent motions cause some of the unusual positions of acute slip.

Acute Disease↗
PubMed2004

Slipped capital femoral epiphysis in a child with sickle cell disease.

Slipped capital femoral epiphysis in a child with sickle cell disease has not been reported previously. The diagnostic challenges, role of imaging techniques, and the medical treatment of this patient are discussed. The presentation of acute hip or leg pain in a child with sickle cell disease should alert the treating physician to the possibility of a vaso-occlusive crisis as the likely source of the child's pain. The goal of the current case report is to emphasize the need to maintain a high index of suspicion for other potential causes of hip, thigh, or knee pain such as slipped capital femoral epiphysis in an adolescent. Preoperative and postoperative care for a child with sickle cell disease needs to be modified to minimize the risks of vaso-occlusive complications.

Adolescent↗
PubMedDate not supplied

Open bone peg epiphysiodesis for slipped capital femoral epiphysis.

The records of 43 patients who underwent 64 open bone peg epiphysiodeses for slipped capital femoral epiphysis were retrospectively reviewed. There were 18 unstable and 46 stable slips. The average duration of follow-up was 35 months (range, 12-100). Healing occurred in all cases at an average of 17 weeks after surgery. At the time of healing, 27 hips (42%) showed a change in the degree of slip. At the most recent visit, the head-shaft angle had improved in 19 hips (30%), although the majority of hips showed resorption of the anterior neck prominence. The degree of remodeling showed no correlation with time to healing, duration of follow-up, or the status of the triradiate cartilage. The average operating time and blood loss per hip were 122 +/- 34 min and 426 +/- 238 ml, respectively. Complications included four hips with avascular necrosis and three with chondrolysis, three infections, four delayed wound healings, seven cases of transient anterolateral thigh hypesthesia, and 44 hips with hetertopic ossification. Because of the potential morbidity of this procedure, we no longer perform it as a primary operation for stable slipped capital femoral epiphysis.

Adolescent↗
PubMedDate not supplied

Pin removal in slipped capital femoral epiphysis: the unsuitability of titanium devices.

In an effort to predict which slipped capital femoral epiphysis fixation devices might cause fewer retrieval problems, 27 consecutive implant-retrieval procedures were reviewed, and mechanical tests using many currently available devices were performed. Problems occurred with both stainless steel and titanium devices if implanted for > 1 year. This tendency for increased problems was statistically significant for the titanium group, and analysis of a retrieved titanium screw showed evidence of osseointegration (direct bone-metal contact at > 90% of the interface) using backscattered image scanning electron microscopic analysis. These clinical data and data from mechanical testing suggest that stainless steel screws or trocar-tipped Steinmann pins are better suited for fixation of slipped capital femoral epiphysis.

Adolescent↗
PubMedDate not supplied

Prophylactic dynamic screw fixation of the asymptomatic hip in slipped capital femoral epiphysis.

Prophylactic dynamic screw fixation (DSF) of clinically and radiographically unaffected hips of 34 patients with a contralateral slipped capital femoral epiphysis and no evidence of an endocrinopathy or systemic disorder was performed using a single cannulated screw. Follow-up ranged from 2 to 12 years (average, 5.4 years). There was no case of perioperative complication and no avascular necrosis or chondrolysis occurred. No preslip or slip became apparent. In all 34 hips, no tendency toward premature closure of the epiphysis could be observed, no growth disturbance including greater trochanteric overgrowth, coxa brevis, or coxa vara was noted. This study supports the prophylactic treatment of the asymptomatic hip, using a simple and safe fixation method.

Adolescent↗
PubMedDate not supplied

Avascular necrosis of the distal fibular epiphysis: a new condition?

A 5-year-old boy was seen because of a right ankle sprain; radiographs showed a marginal anterior avulsion of the distal fibular epiphysis. After plaster immobilization, the patient continued with pain and subjective instability. New radiographs showed a lytic area in the same zone of the avulsion with surrounding sclerosis and a detached bone fragment. Biopsy showed bone necrosis. Two years later, without any traumatic event, the patient began to have a similar pain in the left ankle. Radiographs showed fragmentation of the anterior portion of the distal fibular epiphysis with surrounding sclerosis. Surgical treatment was performed by curettage and cancellous bone grafting; biopsy showed connective tissue, mucoid degeneration, and necrotic bone. After excluding any general disease, we believe that this bone necrosis could be considered an epiphyseal idiopathic avascular necrosis in children.

Ankle Joint↗
PubMedDate not supplied

Long-term follow-up study after corrective Imhäuser osteotomy for severe slipped capital femoral epiphysis.

The management of severe slipped capital femoral epiphysis (SCFE) is still controversial, because of a lack of long-term follow-up studies. Thirty-five patients (39 hips) with severe slipped capital femoral epiphysis, treated by corrective intertrochanteric Imhäuser osteotomy, were clinically and radiographically reexamined. The average age at the operation was 13.7 years (range, 8-17 years) and the reexamination was at an average of 23.4 years (range, 19-27 years) after the operation. At reexamination, 77% of patients were rated good to excellent clinically and 67% had good or excellent radiological results by the Southwick classification. Three patients had severe degenerative arthritic changes, and two patients developed avascular necrosis. We conclude that the Imhäuser osteotomy should be performed in severe deformities (>40 degrees gliding angle) associated with poor function. Because other studies show good long-term results after in situ pinning only, the indication for Imhauser osteotomy should be made carefully depending on clinical and radiological findings.

Adolescent↗
PubMedDate not supplied

A 50-year experience with bone graft epiphysiodesis in the treatment of slipped capital femoral epiphysis.

A "millennium" update of all cases of slipped capital femoral epiphysis treated by bone graft epiphysiodesis between 1950 and 2000 was conducted. All cases were followed for at least 1 year to evaluate the occurrence of re-slippage, avascular necrosis (AVN), chondrolysis, or complications secondary to the surgical approach. This study adds 109 patients and 133 hips to the initial report for a total of 268 patients and 318 hips. The patients include 43 patients with 45 acute slips and 225 patients with 273 chronic slips. The results include three cases of AVN, six cases of re-slippage, one case of chondrolysis, and no surgical approach complications in the acute group. In the chronic group, there were 4 cases of AVN, 17 cases of re-slippage, 4 cases of deep wound infection, and no cases of chondrolysis. The authors suggest that bone graft epiphysiodesis is a reasonable alternative in the treatment of slipped capital femoral epiphysis.

Bone Lengthening↗