SEARCH · PubMed Health
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.
Patients receiving growth hormone or thyroid hormone are likely to develop a slipped capital femoral epiphysis during the period of spurt in growth. While pin fixation of these hips has been the popular method of treatment, it is possible to treat Grade I slips successfully by nonoperative methods provided that protection from weight-bearing is maintained until fusion of the epiphysis is complete.
Problems of free bone transplantation, as well as those of bone transplantation by microvascular anastomoses are exemplified by a case of free fibula transplantation--the epiphysis being conserved--by microvascular anastomoses. If revascularisation of the bone transplant is immediately achieved, the chance for survival of bone tissue is improved and there is a chance that the epiphysis will retain the capacity to grow. By multiple surgical interventions the stability of the abnormally mobile forearm was reestablished and considerable lengthening of the shortened skeleton was achieved. By tendon and nerve transplantations simple grasp could be restored to the hand which originally was without function.
The brain gland epiphysis, participated in the regulation of the endocrine functions of mammals, is rudimentary third eye of lower vertebrates. In the process of evolution the gland has lost it own photoreceptor functions, but saved very close contacts with visual system. By means of it biologically active combinations and, first of all, melatonin hormone, the epiphysis support control over transmission of visual information and participate in realization of biological effects of light on organism.
The authors present preliminary results of thermographic examination of the hip and distal epiphysis of the femur after surgery of the proximal end of the femoral bone with the use of AGA 680 apparatus and IBM 486 PC data processing. The material included 10 children aged 3-11 years and evaluated 1 month to 3 years postoperatively. In 9 patients remarkable temperature increase within operated hip, less evident in bilateral surgery due to the smaller temperature difference. In 7 cases ipsilateral distal femoral epiphysis showed temperature increase; the phenomenon less perceptible in bilateral surgery again. The more time passed between surgery and examination the smaller was the temperature increase.
The purpose of this study was to determine if metabolically altered cartilage could be distinguished from normal cartilage in the epiphysis by magnetic resonance imaging. Epiphysis from ten New Zealand White rabbits and five newborn lambs were imaged before and after heat-killing. The physiological change produced was documented with tritiated thymidine and radioactive sulfate autoradiography. Magnetic resonance imaging could detect differences in the tissues produced by heat-killing. The changes were most pronounced in the marrow, less pronounced in the epiphyseal cartilage and least pronounced but still detectable in the growth plate.
We retrospectively reviewed 28 pin-removal procedures in 20 patients with slipped capital femoral epiphysis, who were all treated by in-situ pinning with Kowles pins. Failure to extract the pins occurred in 8 cases (28.6%), and in another 8 cases (28.68%), pin retrieval was only possible after major excavation of the lateral femoral cortex. In view of these data we do not recommend routine removal of Knowles pins used for in-situ pinning of slipped capital femoral epiphysis.
A prospective clinical and laboratory study was performed in thirty-four patients (twenty-two blacks, ten Puerto Ricans, and two whites) who had slipped capital femoral epiphysis in fifty-two hips. Although the majority of the laboratory studies were normal, all patients showed significant elevations of the serum immunoglobulins and C3 component of complement, with the highest values recorded for IgA. Urinary glycosaminoglycans were elevated in the few patients studied and increased proportionally with the duration of the disease. Nine (25 per cent) of the thirty-four patients had chondrolysis in thirteen hips. The male:female ratio in these nine patients was 0.8:1, compared with the ratio of 1.4:1 in all thirty-four patients. No additional biochemical abnormality was found in the patients with chondrolysis except for a greater elevation of the IgM fraction. These preliminary and tentative data suggest either that slipping of an epiphysis produces an antigen which induces an autoimmune state or that slipping is a localized manifestation of a generalized process resembling some form of connective-tissue disorder or inflammatory state. There is presumably a genetically determined sub-group of patients with this disorder who may have chondrolysis.
The extraorganic arteries and veins of the pineal gland were studied by methods of injections with staining masses in 166 preparations of the brain of placentry mammals and 15 preparations of the human brain. The difference in the external structure and the topography of the organ in representatives of different orders of mammals is described. An increased amount of additional sources of blood supply, of the extraorganic arteries to the following organ, extraorganic and intracapsular anastomoses between them and of extraorganic veins in higher mammals (primates) as compared with lower mammals (insectivorous) was found. The epiphysis veins are described. The later were note to fall not only into the great cerebral vein, but to be tributaries of internal cerebral and basal veins or to fall immediately into direct or transverse sinuses of the dura mater in a quite a number of representatives of different animal species. An increased intensity of the body supply of the organ, indirectly pointed out by an increased number and diameter of extraorganic arteries and veins might be explained by different levels of the functional activity of the epiphysis in higher mammals as compared with lower mammals.
Five patients with slipped capital femoral epiphysis were conclusively diagnosed as being hypothyroid. One was a cretin, who was diagnosed and begun on thyroid medication at four months of age but subsequently many years later developed the slip. Suspicion of hypothyroidism should exist for the clinician who finds himself with a child below age 12 with a delayed bone age, borderline mental status and a slipped capital femoral epiphysis. His attention in addition to the orthopedic management of the slip, should be directed towards laboratory studies to rule out hypothyroidism.
The radiolucent cartilage space of eighty-three patients with unilateral or bilateral slipped capital femoral epiphysis was measured by a standardized technique. In the majority of patients, whether unilateral or bilateral involvement, there was bilateral narrowing of the cartilage space. In the unaffected hip of unilaterally involved patients, there was a progressive narrowing as skeletal maturity was attained. A concomitant anatomical study of cadaver hips, removed at autopsy from adolescent patients, showed a progressive narrowing of the cartilage as the proximal femur matured. Black females showed most narrowing (minimum cartilage space width), had the narrowest final cartilage space widths, and took the longest to attain this final width. While other racial, sexual and therapeutic groups failed to demonstrate statistically significant differences, the general trend was for females, Blacks, and patients treated by osteotomy to have more joint space narrowing. However, rewidening occurred in most of these affected joint spaces, in contrast to the progressive linear decrease observed in unaffected hips and anatomical specimens. On the basis of this study, we feel that cartilage space narrowing may be anticipated in the post-operative period in most patients treated for slipped capital femoral epiphysis. This narrowing appears to improve with time. Narrowing of greater than one-half the original width, in association with pain and limitation of joint function, probably represents "cartilage necrosis," or pathologic joint space narrowing. Unless the narrowing remains less than one-half to two-thirds of the initial cartilage space for more than twenty-four to thirty-six months, probably no specific surgical treatment should be undertaken, other than observation and protected weight bearing during any painful phase. Plotting the roentgenographic cartilage space width during the three month to thirty-six month phase may be useful in monitoring and predicting the outcome.
Fifteen moderate to severe acute slipped capital femoral epiphyses were manipulated in 15 patients to correct significant deformities; in each case, torsion played a critical role in the reduction. Nine of 15 patients with acute slips underwent controlled, open reduction from the anterolateral approach, stabilizing the epiphysis while the metaphysis was internally rotated, flexed, and abducted; none had osteonecrosis or chondrolysis. The other 6 acute slips were treated with traction using internal rotation to achieve closed reduction; 2 of these 6 closed reductions progressed to osteonecrosis, and both were reduced in an uncontrolled situation. Of the 15 acute slips, 6 involved torsion as the primary force. Based on the importance of torsion in all the reductions and the prevalence of torsion as an etiologic factor in the initial slips, it is postulated that torsion is an important contributing component in the etiology of slipped capital femoral epiphysis. Despite 2 cases of osteonecrosis in unstable hips, these 15 manipulative reductions were 87% successful. If the 2 inadvertent closed reductions are eliminated, then the success rate is 100%.
From 1987 to 1992, 161 children were treated at The Children's Hospital of Philadelphia for slipped capital femoral epiphysis. Of these, 23 patients (23 hips) had Grade III slips (> 50%). Fixation was achieved by 1 or 2 screws in all patients. Twenty-one of 23 patients were available for followup (average followup, 2.8 years). Four slips were acute, 11 were acute-on-chronic, and 6 were chronic. At the most recent followup, radiographs were taken and a Harris Hip Score was assigned for each patient. Stabilization without progression of slip at followup was achieved in all patients. Screw placement was satisfactory per the criteria of Stambough in all patients. Four children (19%) had major complications: Three (1 acute slip and 2 acute-on-chronic slips) had avascular necrosis of the femoral head; One (chronic slip) had chondrolysis. There were no immediate postoperative complications. The mean Harris Hip Score for these 4 patients was 85 points, versus a mean score of 94 points for all 21 patients. Chronic Grade III slipped capital femoral epiphysis can be treated safely and effectively by screw fixation. Five of 6 patients had satisfactory results; the only exception had evidence of chondrolysis preoperatively. Acute and acute-on-chronic Grade III slipped capital femoral epiphyses treated with screw fixation are less predictable. In 15 patients, reduction occurred in 9 hips despite deliberate avoidance of forceful manipulative maneuvers. Avascular necrosis developed in 3 (33%) of these 9 hips. Reduction of the acute component of the slip during screw fixation, whether deliberate or not, indicates gross instability. It is hypothesized that avascular necrosis may be associated with injury to the epiphyseal vasculature occurring at the time of the acute slip.
Results of treatment for slipped capital epiphysis with one-time head-neck transfiction and subtrochanteric corrective osteotomy in 21 patients (21 hips) operated at Institute of Orthopaedics and Rehabilitation in Poznań between 1973 and 1991 have been presented. Indication for this type of operation was acute-on-chronic slip and magnitude of epiphyseal slip not less than 1/3 of neck width. The follow-up ranged from 4 to 21 years (mean 11y). Using Hall and Southwick criteria modified by Szypryt results in 7 cases were rated excellent, good in 10, fair in 1 and poor in 3 cases. Radiologically 3 cases were excellent, 6 were good, 7 fair and 5 cases were rated poor. Aseptic necrosis of the femoral head occurred in 1 case, chondrolysis in 2 and superficial infection in 1 case. The method proved to be safe in treatment for slipped capital femoral epiphysis.
Modern data on the functional features of epiphysis classify it as a cerebral stress-limiting structure. The anti-stress effect produced, first and foremost by melatonine, the main epiphysis hormone, is achieved through modification of the central neural mediation processes, synchronization of the circadian rhythmicity, optimization of the endocrine and immune status of an organism. Control of the stress-limiting activity is promising for alleviation of neuroses and psychic depressions.
This is a 3-year follow-up report of an eosinophilic granuloma of bone occurring in a growing epiphysis. The lesion occurred in a 6-year-old boy and is only the third such case reported in the literature. Eosinophilic granuloma should be considered in the differential diagnosis of lytic lesions of the epiphysis in childhood.
Slipped capital femoral epiphysis is an uncommon disease among children in Japan. Eighty-one hips in 68 patients collected in the eastern half area of Japan were examined and studies in reference to the incidence, clinical characteristics, and results of treatment. The estimated yearly incidence rate in boys was 0.3 to 0.5 per 100,000 in the population between 10 and 14 years old. The higher incidence of boys (a 5.8 to 1 predilection for males) was characteristic. The disease was extremely rare in girls. Although Japanese children are generally neither as tall nor as heavy as Americans or Europeans, these patients were relatively taller and also much heavier than average. One of the reasons why children of Japan are not susceptible to slipped epiphysis may be explained by the Japanese physique. Satisfactory results were found in less than half the cases. Poor results were mainly caused by complications such as avascular necrosis and acute cartilage necrosis. The incidence of the latter complication was 20.7 per cent in 58 hips followed longer than a year and a half. The method of treatment seems not necessarily related to the development of chondrolysis. This complication is caused by an unknown genetic factor.
A compensating osteotomy for correction of the varus and retroversion components of severe slipped capital femoral epiphysis is presented. It is safer than a cuneiform osteotomy done through the callus of the slipped epiphysis because the line of osteotomy is distal to the major blood supply of the posterior retinaculum. The threaded Steinmann pins used for fixation sross both the osteotomy site and the epiphyseal plate, and therefore not only are the mechanical relationships restored, but further slipping is prevented also.
The infradian rhythmic of the behavioral parameters, urination, body mass and temperature in epiphysectomized rats exposed to a variable magnetic field of a frequency of 8 Hz and induction of 5 microT influence was studied. It was found that the removal of epiphysis leads to the reorganization of power spectra of biorhythms, a rise of their amplitudes, and the development of desynchronosis. Further exposure of epiphysectomized rats to a variable magnetic field partially normalizes the amplitude-phase relations and decrease the disbalance of the processes. These data indicate the important role of epiphysis in the magnetoreception and formation of the temporal structure of the organism and suggest the existence of other structures sensitive to variable magnetic field.