PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “EPIPHYSIS”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 235 records · Page 13Linked to original sources
PubMed1996

Avulsion of the patellar ligament with combined fracture luxation of the proximal tibial epiphysis: case report and review of the literature.

Disruption of the extensor mechanism of the knee joint at the insertion site of the patellar tendon into bone is a somewhat common injury. Avulsion of the patellar ligament associated with fractures of the proximal tibial epiphysis is an extremely rare injury. Only three cases have been published in association with avulsion fracture of the tibial tubercle. We are reporting a case that has previously not been reported to our knowledge: an avulsion of the ligament in a closed fracture of the proximal tibial epiphysis with integrity of the tibial tubercle. We propose a three-type classification of an avulsion patellar ligament injury.

Accidents, Traffic↗
PubMedDate not supplied

Slipped capital femoral epiphysis.

Slipped capital femoral epiphysis (SCFE) is an unusual disorder in which the epiphysis of the proximal femur slips through the growth plate in a posterior direction. Significant derangement of hip function results and can be accompanied by two complications: avascular necrosis and chondrolysis. The cause remains elusive although many theories have been advanced. This article provides an overview of the disease process, diagnostic guidelines, and current treatment considerations. A case study is included.

Child↗
PubMed1975

Acute slipped capital femoral epiphysis.

Of 12 cases of acute slipping of the capital femoral epiphysis (representing 11 patients), results were satisfactory in nine cases and poor in three cases at follow-up (in two of the three cases with poor results, reduction was lost postoperatively). Five of nine patients with prodromal symptoms were seen by a physician but were undiagnosed or untreated before the acute slipping. An additional patient had roentgenographic evidence of an early (asymptomatic) slipping capital femoral epiphysis one year before the acute slipping. Preferred treatment is gentle manipulation and fixation with multiple threaded pins, followed by crutch walking for three to four months. Spica casting is not recommended because of an increased incidence of acute articular cartilage necrosis and the possibility of late recurrence of slipping.

Acute Disease↗
PubMed2004

Chondrolysis following slipped capital femoral epiphysis.

Medical records and radiographs of 17 known cases of slipped capital femoral epiphysis, treated with in-situ pin fixation and complicated by chondrolysis were reviewed. Fourteen of these 17 hips that developed chondrolysis had definite evidence of pin penetration of the femoral head. One hip had intra-articular pin penetration of the femoral neck. In the remaining two hips, the pins were placed within the anterolateral quadrant of the femoral head and within 2 mm of the articular surface. Overall, this is an 88% incidence of definite intra-articular pin penetration on postoperative radiographs, and a 100% rate if the two probable cases are included. This suggests a correlation between pin penetration and the development of chondrolysis following slipped capital femoral epiphysis.

Bone Nails↗
PubMed2004

Intertrochanteric versus subcapital osteotomy in slipped capital femoral epiphysis.

We reviewed 15 flexion intertrochanteric osteotomies and 11 subcapital osteotomies done for chronic, severe, stable slipped capital femoral epiphysis at one institution with a minimum 2 years followup. The goal was to determine which procedure achieved better deformity correction and which procedure was safer. Radiographically, the two groups were equivalent in compensating for epiphyseal slip. Flexion intertrochanteric osteotomy was more effective in restoring proximal femoral anatomy, as determined by articulotrochanteric distance and trochanter-center of head distance. The incidence of complications, including osteonecrosis and chondrolysis, was low for both groups, but the reoperation rate was greater in the subcapital osteotomy group than in the flexion intertrochanteric group. Flexion intertrochanteric osteotomy seems to be an effective, safe, and reproducible realignment osteotomy for treatment of chronic, severe, stable slipped capital femoral epiphysis.

Adolescent↗
PubMed2003

Capital femoral epiphysis and growth plate of the asymptomatic hip joint in unilateral Perthes disease.

Radiograms of 173 children with unilateral Perthes disease were reviewed with particular reference to the presence of flattening and irregularity of the 'unaffected' epiphyses. The slope and shape of the growth plate were also evaluated. About 35% of children with Perthes disease showed changes of the unaffected proximal femur in the first radiograms of the hip joints. These consisted of small epiphysis, flattening of the epiphysis, contour irregularities (20%), and changes in the growth plate (15%). The radiographic abnormalities were not accompanied by any clinical symptoms of the asymptomatic hip joint and they receded with age during treatment.

Age Factors↗
PubMedDate not supplied

Sugioka's Modified Hungria-Kramer intertrochanteric osteotomy in the treatment of severe slipped capital femoral epiphysis.

From May 1990 to November 1997, 24 cases of severe slipped capital femoral epiphysis were treated by an osteotomy that is a modification of the Hungria-Kramer intertrochanteric osteotomy proposed by Sugioka (Hungria-Kramer-Sugioka osteotomy or HKS osteotomy). The degree of displacement as seen on the frog-leg lateral radiograph of the proximal femur was measured according to the deviation of the longitudinal axis of the epiphysis from the center line of the neck (Fish classification). All hips were considered as grade III and underwent HKS osteotomy. Sugioka's radiographic study (true AP view with the limb internally rotated until the patella is perpendicular to the x-ray beam, and lateral view with the hip in 90 degrees flexion and 45 degrees abduction) was performed before surgery to show that the real direction of the slip was posterior in relation to the neck. Clinical results were assessed according to Merle-D'Aubigné and Postel system modified by Charnley (hip score system that takes into consideration pain, gait, and joint motion). Roentgenographic results were considered good if none of the following was present: joint space decreased by more than 2 mm (chondrolysis), avascular necrosis of the femoral head, neck-shaft angle of less than 120 degrees, nonunion at the osteotomy site, and a epiphyseal plate still open. Follow-up varied from 31 to 120 months (average 65.1 months).

Adolescent↗
PubMedDate not supplied

Torsional strength of double- versus single-screw fixation in a pig model of unstable slipped capital femoral epiphysis.

Slipped capital femoral epiphysis was produced in 9 matched pairs of fresh-frozen pig femurs (1-year-old pigs) by twisting the femoral head about the femoral neck axis. Each matched pair was fixed with a single steel cannulated screw on one side and 2 screws contralaterally, after which the perichondrium was removed before retesting. Double-screw fixation without the perichondrium provided 43% of the stiffness and 74% of the strength of the intact physis in torsion and approximately double the stiffness and strength of single-screw fixation (P<0.004). This information may be of use to the surgeon concerned about rotational stability in unstable slipped capital femoral epiphysis.

Animals↗
PubMedDate not supplied

Biomechanical stability of single-screw versus two-screw fixation of an unstable slipped capital femoral epiphysis model: effect of screw position in the femoral neck.

PURPOSE: To biomechanically evaluate single screw and varying 2 screw fixations for an unstable slipped capital femoral epiphysis (SCFE) model using physiologically relevant loading. STUDY DESIGN: In vitro biomechanical study. METHODS: Twenty-four immature porcine proximal femurs were prepared to simulate a mild-to-moderate unstable SCFE. The femurs were randomized into 4 fixation groups: single screw, 2 screws horizontally placed, 2 screws vertically placed, and 2 oblique screws. Biomechanical testing determined maximum load to failure (N), load (N) at 2, 4, 6, and 8 mm of femoral head displacement, and stiffness (newtons per millimeter) for each group. RESULTS: No significant differences were found among the 3 different 2 screw configurations. The 2 screw constructs were 66% stiffer and 66% stronger than the single screw construct. In addition, whereas there was no difference at 2 mm of femoral head displacement, each subsequent displacement (4, 6, and 8 mm) demonstrated significantly higher failure loads when 2 screws were used for stabilization. CONCLUSIONS: Slipped capital femoral epiphysis stabilization with 2 screws leads to increased stability over single screw fixation; however, none of the 3 configurations/placement patterns of the 2 screw constructs seemed to be superior in fixation stability. CLINICAL RELEVANCE: These data support the use of a 2 screw construct in acute/unstable SCFE fixation. The biomechanical benefit of 2 screws needs to be considered in the face of greater potential for inadvertent penetration into the joint with an increased number of screws.

Animals↗
PubMedDate not supplied

Multidetector computed tomography of fracture-separation of the distal humeral epiphysis.

A case of fracture-separation of the distal humeral epiphysis that was diagnosed using unenhanced multidetector computed tomography is reported. Fracture-separation of the distal humeral epiphysis is a rare injury of young children that is difficult to identify on routine radiographs and is frequently misdiagnosed at the time of initial evaluation.

Female↗
PubMed1996

Chondrolysis and avascular necrosis: complications of slipped capital femoral epiphysis.

Chondrolysis and avascular necrosis (AVN) are serious complications after slipped capital femoral epiphysis (SCFE). Chondrolysis, or acute cartilage necrosis of the capital femoral epiphysis, can occur in treated and untreated SCFE. Its exact etiology has not been conclusively determined, and there may be some connection with hardware penetration into the joint and its development. Because chondrolysis can occur in both treated and untreated hips, an immune mechanism has been postulated. Although some evidence of immune reaction has been confirmed in the joint, no screening test has yet been developed to determine susceptible individuals. AVN is clearly related to impeded blood supply to the femoral head and to severely slipped unstable acute slips. Forceful reduction of the femoral head must be avoided. However, some slips are so unstable that reductions occur merely with positioning of the patient for operation. Improperly placed fixation devices may also play a role in the development of AVN. Chondrolysis and AVN may not be completely avoidable in the treatment of SCFE.

Animals↗
PubMed2000

Slipped capital femoral epiphysis: is the displacement always posterior?

The initial direction of displacement on slipped capital femoral epiphysis is generally accepted to be posterior as a consequence of retroversion of the femoral neck. We report the case of a 15-year-old boy with slipped capital femoral epiphysis in the medial direction, confirmed by three-dimensional computerized imaging. This was associated with an elongated neck without retroversion of the femoral neck. We suggest a correlation between elongated femoral neck with increased offset of the hip and the medial direction of slip. This case also underlines the need for precise definition of deformity prior to undertaking surgical treatment.

Adolescent↗
PubMed2004

Stress fractures of the femoral neck in child with open capital femoral epiphysis.

Stress fracture of the femoral neck has been considered a typical injury of two age groups: active youths and elderly people with osteoporosis. Its occurrence in children with an open capital femoral epiphysis is rare, and only 11 cases have been reported. Here we report two cases, in a 12-year-old boy and a 5-year-old girl (among the youngest patients on record). This fracture can be classified as a compression fracture or a tension fracture. Although tension fractures are not uncommon in military recruits and young athletes, all 13 cases (including our two cases) of femoral neck stress fracture associated with an open capital epiphysis were compression fractures that were treated conservatively.

Child↗
PubMed2005

Preoperative assessment for intertrochanteric femoral osteotomies in severe chronic slipped capital femoral epiphysis using computed tomography.

We propose here to focus on preoperative assessment for intertrochanteric femoral osteotomies in severe slipped capital femoral epiphysis (SCFE) using computed tomography. This intertrochanteric osteotomy was preoperatively customized for each chronic SCFE patient treated, and has been performed on 22 patients with an average posterior slip angle of 55 degrees. The osteotomy is planned with images from computed tomography as follows. The angle between a provisional axis on one image and the axis of the lateral aspect of the femur on the other image is defined as alpha. When the alpha angle varies from 20 to 30 degrees, a simple flexion osteotomy is selected for correction along the axis of the lateral femur; when the alpha angle is more than 30 degrees, a flexion osteotomy along with some valgus correction should be considered; when the alpha angle is less than 20 degrees, varus correction should be added. The postoperative posterior slip angle, head-shaft angle (P < 0.05) and epiphyseal height ratio (P < 0.005) in the group using our method were superior to the Southwick group. Postoperative hip motion was nearly the same as the unaffected side. The average leg length discrepancy was 0.9 cm (range, from 0 to 2.0 cm). Reduced blood loss (P < 0.001) and shorter operation time (P < 0.001) were also noted, compared with the Southwick group. We concluded that the intertrochanteric femoral osteotomy based on this strategy minimizes the surgical complexity, resulting in a more anatomic reduction of the capital femoral epiphysis.

Adolescent↗
PubMed2005

Valgus slipped capital femoral epiphysis.

Abnormally high stresses involving the capital femoral physis were found in a series of valgus slipped capital femoral epiphysis cases. Using a single leg stance model we studied 10 hips in seven patients in which the epiphysis was lateral and posterior in relation to the femoral neck and calculated that shear stresses were high enough to be associated with failure of the physis. Valgus neck shaft angles and lateral tilt of the physes were seen in all cases.

Adolescent↗
PubMed1984

A 30-year experience with bone graft epiphysiodesis in the treatment of slipped capital femoral epiphysis.

A retrospective review was carried out of all cases treated by bone graft epiphysiodesis for slipped capital femoral epiphysis at Children's Hospital Medical Center of Akron between the years 1950 and 1980. Only those cases followed for a minimum of 1 year following treatment were included in the review and evaluated as to their status of avascular necrosis, acute cartilage necrosis, or other complications attendant to the surgical approach. One hundred seventy-six patients representing 207 hips underwent bone graft epiphysiodesis over this 30-year period. One hundred fifty-nine patients representing 185 hips were followed a minimum of 1 year and were included in this study. There were 25 cases of acute slipping representing 26 hips and 134 patients representing 159 hips involved with the chronic slipping process. In the acute group of patients representing 26 hips, there were two cases of avascular necrosis and one case of acute cartilage necrosis. In the chronic group of 159 hips, there were four cases of reslipping, one due to graft resorption, one due to placement of the graft short the growth plate, and two that went on to acute slipping. All cases were salvaged with good results. There was one case of avascular necrosis in the chronic group; not a single case of acute cartilage necrosis was encountered. Owing to the rapid nature of growth plate closure following bone graft epiphysiodesis, the avoidance of hardware removal or pin penetration, and the extremely low incidence of overall complications, we suggest that bone graft epiphysiodesis is at least as good as multiple pin fixation in the treatment of slipped capital femoral epiphysis.

Adolescent↗
PubMed1984

Treatment of slipped upper femoral epiphysis: 80 cases operated on over 10 years (1968-1978).

Guidelines are proposed for the treatment of slipped upper femoral epiphysis based on the analysis of 80 cases. Treatment is strictly surgical, but the procedure to be employed depends on the degree of displacement. Major operations are reserved for maximum tilting of the epiphysis: Dunn's operation when the growth plate is still open, trochanteric osteotomy once it has closed. Complications of treatment are epiphyseal necrosis and stiffness.

Adolescent↗