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PubMed1991

Stereotyped pathway selection by growth cones of early epiphysial neurons in the embryonic zebrafish.

In this report we have examined the development of one of the earliest projections in the embryonic zebrafish brain, that from the epiphysis. Epiphysial axons and growth cones were labelled anterogradely in whole-mounted brains, using either the carbocyanine dye, diI, or horseradish peroxidase (HRP). Some embryos were also either stained with anti-acetylated tubulin or HNK-1 antibodies to reveal other axons in the brain, or were secondarily sectioned for light and electron microscopy. The epiphysial axons have a very specific projection pattern and virtually all axons grow precisely to their target regions without error. The first epiphysial growth cone extends ventrally from the epiphysis into the dorsoventral diencephalic tract at 19-20 h post-fertilisation (h PF). Several hours later, it turns rostrally to grow alongside axons in the tract of the postoptic commissure. The morphology of the leading growth cone changes in predictable ways at different locations along its pathway and these changes correlate with differences in the local environment that it encounters. In contrast to other published descriptions of other developing systems, the epiphysial growth cone is no more complex either when pioneering a pathway, or when encountering divergent axonal pathways. Indeed, it is most complex (i.e. has the greatest number of processes) when it first starts to follow the tract of the postoptic commissure. The presence and selective retention of filopodia within other axonal pathways suggests that growth cones have access to these pathways but do not select them. These observations support the notion that local guidance cues exist within the early scaffold of brain tracts. Subsequent epiphysial axons form a tight fascicle within the dorsoventral diencephalic tract, but abruptly defasciculate from each other upon turning rostrally into the tract of the postoptic commissure. Epiphysial growth cones that enter this tract at abnormal locations still turn in the appropriate direction. Therefore, guidance cues are not restricted solely to the normal intersections but may be distributed along the length of the tracts. The epiphysial growth cones and axons have very characteristic spatial relations to other axons in the tracts of the developing brain. They are restricted to the dorsal region of the tract of the postoptic commissure and the rostral region of the postoptic commissure. At early developmental stages, the epiphysial axons are the only axons within the dorsoventral diencephalic tract and they are located very superficially within the neuroepithelium. At later stages, they are displaced to deeper regions of the neuropil by non-epiphysial axons.

Animals↗
PubMedDate not supplied

Wedge-shaped distal tibial epiphysis in the pathogenesis of equinovalgus deformity of the foot and ankle in tibial lengthening for fibular hemimelia.

Fibular hemimelia is associated with an equinovalgus deformity of the foot and ankle and different degrees of wedging of the distal tibial epiphysis. This deformity is often a major problem during lengthening of the shortened tibia. To determine the significance of the wedge-shaped distal tibial epiphysis in the pathogenesis of the equinovalgus deformity of the foot and ankle during and after lengthening, we reviewed 20 patients who had undergone tibial lengthening by either the Wagner or the Ilizarov technique. The mean duration of follow-up after removal of the fixator was 5.2 years (range, 2.3-9.7 years). Three types of wedge-shaped distal tibial epiphyses were identified. A mildly wedged (type I) epiphysis was found in seven patients, a moderately wedged (type II) epiphysis was found in seven patients, and a severely wedged (type III) epiphysis, in six patients. Premature fusion of the lateral part of the distal tibial physis and growth retardation of the tibia were common after lengthening in patients with the type II or type III epiphysis. After lengthening, all patients with a type II or type III epiphysis had a recurrence or aggravation of foot deformities that existed before lengthening. This usually necessitated various secondary operative procedures to obtain a plantigrade foot. We believe that after lengthening, one should anticipate varying degrees of mild growth retardation and minimal foot deformity in patients with type I epiphysis, worsened asymmetric growth retardation and progressive foot deformity in patients with type II epiphysis, and severe growth retardation and severe foot deformity in patients with type III epiphysis.

Adolescent↗
PubMed2003

Factors influencing the development of osteonecrosis in patients treated for slipped capital femoral epiphysis.

BACKGROUND: Osteonecrosis is a serious complication of the treatment of slipped capital femoral epiphysis. The purpose of the present study was to identify factors influencing the development of osteonecrosis. METHODS: Two hundred and forty patients who had been treated for slipped capital femoral epiphysis between 1965 and 1999 were retrospectively evaluated. Treatment included stabilization with a spica cast or fixation with one to four pins or screws. Radiographs that had been made at the time of presentation, before and after the operation, and at consecutive follow-up examinations were reviewed. Osteonecrosis was defined retrospectively on the basis of radiographic evidence of sclerosis and collapse of the femoral head. The risk of development of osteonecrosis was correlated with various clinical and radiographic parameters. RESULTS: All twenty-one patients in whom osteonecrosis developed had presented with an unstable slipped capital femoral epiphysis. None of the 204 patients who had presented with a stable slipped capital femoral epiphysis, regardless of grade, had development of osteonecrosis. In the group of patients who had presented with an unstable slipped capital femoral epiphysis, the risk of development of osteonecrosis increased with the severity (grade) of the slip. Osteonecrosis was more likely to develop in patients who had been treated with multiple pins than in those who had been treated with a single cannulated screw. CONCLUSIONS: Patients who have a stable slipped capital femoral epiphysis are not at risk for the development of osteonecrosis when treated with pinning in situ. Patients who have an unstable slipped capital femoral epiphysis have a decreased risk of osteonecrosis when treated with pinning in situ. Complete or partial reduction of an unstable slipped capital femoral epiphysis increases the risk of development of osteonecrosis. Pinning in situ without reduction with a single cannulated screw is the method of choice for the treatment of a slipped capital femoral epiphysis.

Bone Nails↗
PubMedDate not supplied

[The formation of the human epiphysis and its dynamic development at the stage of early embryonic differentiation].

We studied the epiphysis of human embryos at stages from 18 to 63 mm of occipital-sacral length (OSL). We found that the epiphysis is formed by migration of cells from the roof of the diencephalon in the dorso-caudal direction. At this time, the epiphysis undergoes active vascularization, initially through pinealocytes filling the space between capillaries, and then by the ingrowth of the bundle of nerves and vessels into the epiphysis. The nerve entering the epiphysis, together with vessels, subsequently becomes a source of innervation for the epiphysis of the adult human. Analysis of qualitative correlations between epiphysis development and linear growth of the embryo has demonstrated that the rate of the increase of epiphyseal volume is significantly higher than the rate of the increase of the embryo's occipital-sacral length. Asynchrony in the rate of growth of epiphysis and embryo is highly individual, since increase in volume per 1 mm of length may differ at different stages by a factor of two or even more.

Cell Differentiation↗
PubMed1991

[Appearance of the femur head epiphysis in healthy children and in children with hip dysplasia].

In a retrospective study we evaluated 4341 sonographic examinations of 1160 healthy children and 209 children with congenital hip dysplasia with special reference to the appearance of the femoral head epiphysis. In healthy children the epiphysis appeared between the first and seventh month. In more than 95% of the children, the epiphysis was sonographically present after the seventh month. In children with congenital hip dysplasia the first appearance of the femoral hip epiphysis had a retardation of one to two months. In most of the healthy children the epiphysis appeared in the fourth month, and after the ninth month in almost all of the normal hip joints the epiphysis is present. In children with normal hip joint configuration and missing femoral head epiphysis at three months, the final ultrasound examination should not be done before the seventh month. Thus, clinically unnecessary ultrasound examination in 6-week intervals can be reduced.

Epiphyses↗
PubMed2006

Radiological evaluation of unstable (acute) slipped capital femoral epiphysis treated by pinning with Kirschner wires.

Treatment of slipped capital femoral epiphysis is still controversial with regard to the implants used for stabilization and the need for prophylactic treatment of the contralateral, unaffected, side. The objective of this study was to ascertain whether prophylactic transfixation of the epiphysis with Kirschner wires in patients with unstable slipped capital femoral epiphysis resulted in significant disturbance of the growth plate and impairment of further growth of the femoral neck and head. Between 1990 and 1999, 29 patients with unstable slipped capital femoral epiphysis were simultaneously treated with internal fixation of the epiphysis and metaphysis with 3-4 Kirschner wires on the affected and the not (yet) affected side. After a mean follow-up of 3.5 years, we evaluated the hip joints radiologically, analysing different roentgenological parameters (CCD angle, femoral head diameter, length of the femoral neck and sphericity of the femoral head). CCD angle, femoral head diameter and length of the femoral neck showed statistically significant (P<0.001, Student's t-test) differences between the affected and unaffected, but prophylactically pinned, sides. Asphericity of the femoral head was found in six cases only on the affected side, whereas all hips, which were operated prophylactically, showed spherical femoral heads at follow-up (P<0.02, Pearson's chi test). These results indicate that the slip itself may cause impairment of the femoral growth plate in patients with unstable slipped capital femoral epiphysis and not stabilization with Kirschner wires. Compared with other series from the literature using different implants (screws, nails), prophylactic transfixation of the epiphysis and metaphysis with Kirschner wires is less compromising to the growth plate on the not (yet) affected side.

Acute Disease↗
PubMed1986

Distal femoral epiphysis: normal standards for thickness and application to bone dysplasias.

Flattening of the epiphysis of the long bones is seen in several bone dysplasias. It is the hallmark of multiple epiphyseal dysplasia and is an important sign in the diagnosis of spondyloepiphyseal dysplasias, diastrophic dysplasia, and pseudoachondroplastic dysplasia. The goal of this study was to determine norms for the height of the distal femoral epiphysis and to apply these standards to patients with bone dysplasias. Ratios of the distal femoral epiphysis height to both the distal femoral metaphysis width and the distal femoral epiphysis width were obtained from 640 radiographs of healthy children of different ages. Application of these standards to 41 patients with the bone dysplasias mentioned above proved useful in ascertaining decreased height of the distal femoral epiphysis. These standards are of particular value in subtle or early cases in which the thinning of the epiphysis may not be apparent upon simple observation. Obtaining three simple measurements from the anteroposterior knee radiographs allows determination of the presence or absence of flattening of the epiphysis.

Adolescent↗
PubMed2004

Slipped capital femoral epiphysis. The mechanical function of the periosteum: new aspects and theory including bilaterality.

This particular ailment has many designations in the literature but none is quite adequate. Here we use the terminology slipped capital femoral epiphysis (SCFE). The anatomy of the proximal femur in all mammals reflects their growth and function. The main forces acting on the head are perpendicular to the growth plate. The thick tear-proof perichondrium-periosteum on the femoral neck is like a stocking attached to the epiphysis and the trochanter region. Growth in length causes a strong tensile stress in the periosteum, pressing the epiphysis against the metaphysis and thus stabilizing the vulnerable growth plate-the periosteum theory. Several factors may diminish the stability of the growth plate. SCFE begins with fissures, which coalesce to a fracture in the growth plate, invisible on a radiograph. As the slip progresses, an increasing angulation between the epiphysis and the remainder of the femur occurs. Weight and muscular forces displace the epiphysis posteriorly in a flexed hip. A rift in the ventral half of the periosteal stocking occurs at the border to the perichondrium and, after that, a longitudinal rift in the periosteum at the anterior midline of the femoral neck. This rift becomes broader as the epiphysis slips posteriorly, withdrawing the ruptured periosteum. Displacement of the epiphysis is due to a rotational slip and tilt, made possible by a compression fracture in the posterior part of the metaphysis. Parts of the periosteum function as reins steering the slip direction and counteracting the displacement. SCFE may be regarded as a pseudoarthrosis in the growing cartilage of the plate. The periosteum theory extended to a pseudoarthrosis theory has been supported by findings at surgery and on true lateral radiographs of usual and unusual cases of SCFE presented in this opus. On a true lateral view, the displacement can be measured as the slipping angle (SA) based on anatomical and geometrical considerations. SA values from 95 normal hips and from 22 contralateral asymptomatic hips from SCFE patients are presented in a histogram and bar graph. Statistically, SCFE is always bilateral, but in about 1/3 of the asymptomatic, contralateral hips, the physis ossifies and closes with SA below 13 degrees, and surgery is not necessary. It is most important that the position of the femur on the X-ray table is exactly defined in two dimensions: 1) the angle between the femoral shaft and the tabletop (angle of elevation), 2) the degree of rotation of the femur around its axis. A precisely defined positioning of the femur is a prerequisite for an exact reproducible measurement of the SA on a true lateral view and is also valuable for the evaluation of radiographic "signs". An aid, the Youth Hip Triangle (YHT), has been designed to facilitate positioning of the femur and measurement of SA. YHT is recommended for routine use in every X-ray facility. The method is quick, cost effective and makes it possible to diagnose SCFE in the contralateral hip before clinical signs or symptoms have occurred.

Adolescent↗
PubMed1994

[An experimental study of ischemic damage and repair on the femoral head epiphysis in growing rabbits].

The vascular changes and repair processes in the femoral head epiphysis and growth plate in growing rabbits influenced by an interruption in the blood supply were investigated angiographically and histologically. Forty-one rabbits (six-week-old female Japanese White rabbit) were sacrificed for this study. The Interruption in the blood supply to the femoral head epiphysis was achieved by severing the nutrient arteries by electrocauterization in surgery. The revascularization process was examined by microangiography and histopathology of the epiphysis and growth plate at two-week intervals from 2 to 16 weeks after the surgery. The penetration of newly formed vessels into the bony epiphysis began at 4 to 6 weeks after the surgery. At 16 weeks, the vessels had penetrated into the growth plate. Granulation tissue without woven bone formation was seen on the loaded portion of the bony epiphysis, although woven bone was seen on the non-loaded portion. The articular cartilage diminished in thickness and cellular counts declined during the 16 weeks after the surgery. The degenerated columnar structure was replaced with mesenchymal tissue which intruded into the growth plate and connected epiphysis to the metaphysis at 8 weeks. The columnar structure of the growth plate was progressively disorganized with time, after 8 weeks. From these results, we concluded that the deformation of the femoral head epiphysis and premature closure of the growth plate were influenced by the vascular interruption of the nutrient arteries.

Angiography↗
PubMedDate not supplied

Slip progression after in situ single screw fixation for stable slipped capital femoral epiphysis.

The medical records and frog-leg lateral radiographs of 37 children with 46 stable slips treated with in situ single cannulated screw fixation at the Shriners Hospitals for Children, Lexington, from 1990 to 1998 were reviewed. The first postoperative frog-leg lateral radiograph was used to determine the head-shaft angle, the screw position, and the number of screw threads that engaged the epiphysis. The mean age at surgery was 12.3 years. The mean age when a frog-leg lateral radiograph first demonstrated physeal closure was 14.0 years. Nine slips (20%) demonstrated progression of more than 10 degrees from the first postoperative frog-leg lateral radiograph to the frog-leg lateral radiograph at first physeal closure. Slip progression appears inversely related to the number of screw threads engaging the epiphysis on the postoperative frog-leg lateral radiograph. The nine hips that progressed all had less than five screw threads engaging the epiphysis on the first postoperative frog-leg lateral radiograph. None of the 24 hips with five or more screw threads engaging the epiphysis on the first postoperative frog-leg lateral radiograph demonstrated progression. Slip progression was not related to screw position. Time to physeal closure was not related to screw position or the number of screw threads that engaged the epiphysis on the first postoperative frog-leg lateral radiograph. Screw advancement until five threads engage the epiphysis appears appropriate.

Adolescent↗
PubMed2006

Consequences of diagnostic delays in slipped capital femoral epiphysis.

Delay in diagnosis of slipped capital femoral epiphysis has important implications with regard to slip severity and long-term hip outcomes. The aims of this review were to identify the incidence of delayed diagnosis of slipped capital femoral epiphysis in the hospital to which the authors are affiliated, and the causes for such delays. A retrospective review was conducted of all patients admitted to the Women's and Children's Hospital in Adelaide between January 1997 and October 2004 with a diagnosis of slipped capital femoral epiphysis. The inpatient and outpatient medical records for each patient were analysed to clarify the history of presentation and identify those patients with a delayed diagnosis. All radiographs were reviewed and the severity of the slip graded according to Southwick's classification. One hundred and two patients were included in this review, of which 20 had a delayed diagnosis and 25 a late presentation. Of the 20 (19.6%) patients who had a delayed diagnosis in this series, a minimum of 2 weeks elapsed between presentation to a health professional and diagnosis of slipped capital femoral epiphysis. Eight patients had seen their local doctor but the diagnosis was not made. The remaining 12 patients with delayed diagnosis had not seen a medical practitioner and had self-referred to a chiropractor or a physiotherapist. All of these patients underwent hip manipulation prior to diagnosis. There was a significant relationship between delay in diagnosis and an increased slip severity, when compared with both the remainder of this series and the late presentation group. Knee or distal thigh pain in slipped capital femoral epiphysis remains the commonest pitfall in diagnosis for local doctors, as well as mild slips being missed on radiograms by inexperienced surgeons or radiologists. An increasing presentation of adolescents with this disorder to allied health professionals for initial management warrants a broader education strategy than has been previously advocated. Slipped capital femoral epiphysis remains an enigmatic disorder; consequently delayed diagnosis of this condition is not likely to disappear. Despite this, the medical community must strive toward early diagnosis through continued education and vigilance.

Adolescent↗