Adolescent idiopathic scoliosis: is there a relationship between Risser staging and the proximal humerus ossification system?

PURPOSE: To evaluate whether there is a mismatch between Risser staging and the proximal humerus ossification system (PHOS); and to analyze the correlation in the skeletal maturity stages between the two humeral epiphyses. METHODS: Data from patients aged 10 to 18 years with adolescent idiopathic scoliosis (AIS) seen between 2018 to 2021 were analyzed. In an anteroposterior (AP) spine radiograph the ossification process was evaluated using the Risser classification method and bilateral PHOS (if both humeral epiphyses were visualized). A mismatch between methods was defined as a Risser 0-1 (relatively skeletally immature) with a PHOS 4-5 (skeletally mature), or a Risser 2-5 (relatively skeletally mature) with a PHOS 1-3 (skeletally immature). The McNemar test was used to calculate the significance of the mismatch. RESULTS: A mismatch between Risser and PHOS stages was observed in 28.5% of 105 patients, which was statistically significant (p < 0.001). Of the 49 patients with a Risser 0-1, 55.1% (n = 27) had a PHOS 4-5. None of the patients with a Risser 2-5 had a PHOS 1-3. In the 47 patients in whom both humeri were visualized, the absolute correlation between the left and right PHOS values was 95.7%. CONCLUSION: Of AIS patients who are relatively skeletally immature according to Risser staging, more than half may be skeletally mature when measured with PHOS. In patients with a Risser 0-1, it is recommended to measure skeletal maturity in an AP spine radiograph using the PHOS method, which may more accurately guide treatment decision-making, without the need to visualize both humeral epiphyses in this radiographic projection. LEVEL OF EVIDENCE: IV.

Hip Morphology in Early-stage LCPD: Is There an Argument for Anatomic-specific Containment?

BACKGROUND: Early containment surgery has become increasingly popular in Legg-Calvé-Perthes Disease (LCPD), especially for older children. These procedures treat the proximal femur, the acetabulum, or both, and most surgeons endorse the same surgical option regardless of an individual patient's anatomy. This "one-surgery-fits-all" approach fails to consider potential variations in baseline anatomy that may make one option more sensible than another. We sought to describe hip morphology in a large series of children with newly diagnosed LCPD, hypothesizing that variation in anatomy may support the concept of anatomic-specific containment. METHODS: A retrospective review of a prospectively collected multicenter database was conducted for patients aged 6 to 11 at diagnosis. To assess anatomy before significant morphologic changes secondary to the disease itself, only patients in Waldenström stages IA/IB were included. Standard hip radiographic measurements including acetabular index, lateral center-edge angle, proximal femoral neck-shaft angle (NSA), articulotrochanteric quartiles, and extrusion index (EI) were made on printed anteroposterior pelvis radiographs. Age-specific percentiles were calculated for these measures using published norms. Significant outliers (≤10th/≥90th percentile) were reported where applicable. RESULTS: A total of 168 patients with mean age at diagnosis of 8.0±1.3 years met inclusion criteria (81.5% male). Mean acetabular index for the entire cohort was 16.8±4.1 degrees; 58 hips (34.5%) were significantly dysplastic compared with normative data. Mean lateral center-edge angle was 15.9±5.2 degrees at diagnosis; 110 (65.5%) were ≤10th percentile indicating dysplasia (by this metric). Mean NSA overall was 136.5±7.0 degrees. Fifty-one (30.4%) and 20 (11.9%) hips were significantly varus (≤10th percentile) or valgus (≥90th percentile), respectively. Thirty-five hips (20.8%) were the third articulo-trochanteric quartiles or higher suggesting a higher-riding trochanter at baseline. Mean EI was 15.5%±9.0%, while 63 patients (37.5%) had an EI ≥20%. CONCLUSIONS: The present study finds significant variation in baseline anatomy in children with early-stage LCPD, including a high prevalence of coexisting acetabular dysplasia as well as high/low NSAs. These variations suggest that the "one-surgery-fits-all" approach may lack specificity for a particular patient; a potentially wiser option may be an anatomic-specific containment operation (eg, acetabular-sided osteotomy for coexisting dysplasia, varus femoral osteotomy for valgus NSA). LEVEL OF EVIDENCE: Level IV.

Extensive burn injury causes bone collagen network alteration and growth delay related to RANK-L immunoexpression change.

PURPOSE: Extensive burn injury mainly affects children, and hypermetabolic state can lead to growth delay. This study aimed to investigate bone histopathological and morphometric aspects, collagen fibers network and the immunoexpression of biological markers related to bone development in a young experimental model for extensive burn. MATERIALS AND METHODS: A total of 28 male Wistar rats were distributed into Control (C) and subjected to scald burn injury (SBI) groups. Sham or injured animals were euthanized 4 or 14 days post-lesion and proximal epiphyses of the femur were submitted to histological, morphometric (thickness epiphyseal plate), and RUNX-2 and receptor activator of nuclear factor kappa- ß ligand (RANK-L) immunoexpression methods. RESULTS: Histopathological femoral findings showed delayed appearance of the secondary ossification center in SBI, 14 days post-injury. Collagen fibers 4 days after injury were observed in articular cartilage as a pantographic network with a transversally oriented lozenge-shaped mesh, but this network was thinner in SBI. Fourteen days after the injury, the pantographic network of collagen presented square-shaped mesh in C, but this aspect was changed to a wider mesh in SBI. Morphometric analysis of epiphyseal plate revealed that the SBI group had less thickness than the respective controls (p<0.05). RUNX-2 showed no difference between groups, but RANK-L score was higher in all SBI groups. CONCLUSIONS: Extensive burn injury causes delayed bone growth and morphological changes. Alterations in collagen network and enhancement in immunoreactivity of RANK-L result in increased osteoclastogenesis.

Análisis de la displasia epifisaria hemimélica (enfermedad de Trevor) de tobillo / Analysis of dysplasia epiphysealis hemimelica (Trevor's disease) of the ankle

La displasia epifisaria hemimélica o enfermedad de Trevor es una deformidad osteocartilaginosa en la región epifisaria. Es poco frecuente y predomina en el sexo masculino. Se desarrolla en la infancia cuando los cartílagos de crecimiento están abiertos, y afecta principalmente el tobillo y la rodilla. Su origen es desconocido. Se presentan tres casos con distinto grado de compromiso y las alternativas terapéuticas. Un solo caso quirúrgico por equino irreductible. Se detallan la técnica quirúrgica, el manejo posoperatorio y el resultado de anatomía patológica. Se recomienda operar sólo a pacientes con alguna limitación funcional o severa deformidades por el alto índice de recidiva. Nivel de Evidencia: IV

Dysplasia epiphysealis hemimelica or Trevor's disease is an osteocartilaginous deformity in the epiphyseal region. It is an uncommon entity, and predominates in the male sex. It develops during childhood, when growth cartilages are open, and mainly affects the ankle and knee. Its origin is unknown. Three cases with different degree of involvement and therapeutic alternatives are presented. Only one surgical case due to irreductible equinovarus. Surgical technique, postoperative management and result of pathological anatomy are explained. We recommend surgery only for patients with some functional limitation or severe deformities due to its high rate of relapse. Level of Evidence: IV

What Happens to the Articular Surface After Curettage for Epiphyseal Chondroblastoma? A Report on Functional Results, Arthritis, and Arthroplasty.

BACKGROUND: Chondroblastoma is an uncommon, benign, but locally aggressive bone tumor that occurs in the apophyses or epiphyses of long bones, primarily in young patients. Although some are treated with large resections, aggressive curettage and bone grafting are more commonly performed to preserve the involved joint. Such intralesional resection may result in damage to the growth plate and articular cartilage, which can result in painful arthritis. Prior studies have focused primarily on oncologic outcomes rather than long-term joint status and functional outcomes. QUESTIONS/PURPOSES: (1) What local complications can be expected after aggressive intralesional curettage of epiphyseal chondroblastoma? (2) What is the joint survival of a joint treated in this way for chondroblastoma? (3) What additional procedures are used in treating symptomatic joint osteoarthritis after treatment of the chondroblastoma? (4) What are the functional outcomes in this group of patients? METHODS: A retrospective study of our prospectively collected database between 1975 and 2013 was done. We found 64 patients with a diagnosis of chondroblastoma of bone. After applying our selection criteria, 53 patients were involved in this study. We excluded seven patients with tumors initially treated with en bloc resection (five located in the extremities and two in the axial skeleton) and two patients with apophyseal tumors. One patient who underwent nonsurgical treatment and one patient lost to followup were also excluded. The mean age was 18 years (range, 11-39 years); the minimum followup was 2 years with a mean followup 77 months (range, 24-213 months). We analyzed all patients with a diagnosis of epiphyseal chondroblastoma of the limb treated with aggressive curettage and joint preservation surgery. During the period in question, our general indications for curettage were patients with active, painful tumors and those with more aggressive ones that remained intracompartmental, whereas initial wide en bloc resection was indicated in patients who had tumors with an extracompartmental extension breaching the adjacent joint cartilage and massive articular destruction. The tumor location was the distal femur in 14 patients, proximal tibia in 11, proximal humerus in 10, proximal femur in eight, the talus in seven, and elsewhere in the lower extremity in three. Local complications including joint degeneration and tumor recurrence were evaluated. Based on radiographic analysis, secondary osteoarthritis was classified by using the Kellgren-Lawrence grading system from Grade 0 to Grade IV. Patients who underwent joint replacement resulting from advanced symptomatic osteoarthritis were considered to have had joint failure for purposes of survivorship analysis, which was estimated using the Kaplan-Meier method. Functional results were evaluated with the Musculoskeletal Tumor Society functional score by the treating surgeon, who transcribed the results on the digital records every 6 months of followup. RESULTS: Twenty-two patients (42%) developed 26 local complications. The most common local complication was osteoarthritis in 20 patients (77% [20 of 26 complications]); tumor recurrence was observed in four patients; an intraarticular fracture and superficial infection treated with surgical débridement and antibiotics developed in one patient each. Joint survival was 90% at 5 years (95% confidence interval [CI], 76%-100%) and 74% at 10 years (95% CI, 48%-100%). Proximal femoral tumor location was associated with lower survivorship of the joint than other locations showing a 5-year survival rate of 44% (95% CI, 0%-88%; p = 0.000). Of the 20 patients with osteoarthritis, four were symptomatic enough to undergo joint replacement, all of which were for tumors in the proximal femur. The mean Musculoskeletal Tumor Society functional score was 28 of 30 points (93%). CONCLUSIONS: Osteoarthritis was a frequent complication of aggressive curettage of epiphyseal chondroblastoma, and tumors located in the proximal femur appeared to be at particular risk of secondary osteoarthritis and prosthetic replacement. Because chondroblastoma is a tumor that disproportionately affects younger patients, the patient and surgeon should be aware that arthroplasty at a young age is a potential outcome for treatment of proximal femoral chondroblastomas. LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Survival, recurrence, and function after epiphyseal preservation and allograft reconstruction in osteosarcoma of the knee.

BACKGROUND: Bone tumor resections for limb salvage have become the standard treatment. Recently, intercalary tumor resection with epiphyseal sparing has been used as an alternative in patients with osteosarcoma. The procedure maintains normal joint function and obviates some complications associated with osteoarticular allografts or endoprostheses; however, long-term studies analyzing oncologic outcomes are scarce, and to our knowledge, the concern that a higher local recurrence rate may be an issue has not been addressed. QUESTIONS/PURPOSES: We wanted to assess (1) the overall survival in patients treated with this surgical technique; (2) the percentage of local recurrence and limb survival, specifically the incidence of recurrence in the remaining epiphysis; (3) the frequency of orthopaedic complications, and, (4) the functional outcomes in patients who have undergone intercalary tumor resection. METHODS: We analyzed all 35 patients with osteosarcomas about the knee (distal femur and proximal tibia) treated at our center between 1991 and 2008 who had resection preserving the epiphysis and reconstruction with intercalary allografts. Minimum followup was 5 years, unless death occurred earlier (mean, 9 years; range, 1-16 years), and no patients were lost to followup. During the study period, our indications for this approach included patients without metastases, with clinical and imaging response to neoadjuvant chemotherapy, that a residual epiphysis of at least 1 cm thickness could be available after a surgical margin width in bone of 10 mm was planned, and 16% of patients (35 of 223) meeting these indications were treated using this approach. Using a chart review, we ascertained overall survival of patients, oncologic complications such as local recurrence and tumor progression, limb survival, and orthopaedic complications including infection, fracture, and nonunion. Survival rates were estimated using the Kaplan-Meier method. Patient function was evaluated using the Musculoskeletal Tumor Society (MSTS)-93 scoring system. RESULTS: Overall survival rate of the patients was 86% (95% CI, 73%-99%) at 5 and 10 years. Five patients died of disease. No patient had a local recurrence in the remaining bony epiphysis, but three patients (9%; 95% CI, 0%-19%) had local recurrence in the soft tissue. The limb survival rate was 97% (95% CI, 89%-100%) at 5 and 10 years. Complications treated with additional surgical procedures were recorded for 19 patients (54%), including three local recurrences, two infections, 11 fractures, and three nonunions. In 10 of these 19 patients, the allograft was removed. Only five of the total 35 study patients (14%) lost the originally preserved epiphysis owing to complications. The mean functional score was 26 points (range, 10-30 points, with a higher score representing a better result) at final followup. CONCLUSIONS: Although the recurrence rate was high in this series, the small sample size means that even one or two fewer recurrences might have resulted in a much more favorable percentage. Because of this, future, larger studies will need to determine whether this is a safe approach, and perhaps should compare epiphyseal preservation with other possible approaches, including endoprosthetic reconstruction and/or osteoarticular allografts. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Prevalência de ostecondrose em potros da raça Puro Sangue Inglês / Osteochondrosis prevalence in thoroughbred foals / Prevalencia de la osteocondrosis en potros de raza sangre pura de carrera

A osteocondrose (OC) é uma patologia que ocorre no núcleo da epífise durante a fase de crescimento do animal podendo em alguns casos comprometer o seu futuro atlético. A etiologia é multifatorial e pode acometer várias articulações sendo que a mais comumente envolvida é a do curvilhão, femuro tibiorotuliana e a do boleto. Foram examinados radiograficamente 101 potros, sendo 50 fêmeas e 51 machos da raça PSI com idade entre nove e treze meses.Ambos os tarsos foram radiografados nas posições Oorsomedial-Pálmarolateral Oblíqua (OMPLO) e Dorsolateral-Pálmaromedial Oblíqua (OLPMO). Para avaliar a presença de OCO na articulação do tarso foram realizadas análises estatísticas exploratórias. Observou-se prevalência de OCO em 4% dos animais (n=4) e 96% (n=97) não apresentaram a doença. O entre os animais sadios, 5% apresentaram projeções ósseas, denominadas gota de orvalho, na extremidade distal da crista troclear medial do talus . A presença de OCO foi observada na crista intermédia da tíbia (50%) e na cristatroclear lateral (50%) do osso tibiotársico. Nenhum animal estudado apresentou sintomatologia clínica. A erradicação total da enfermidade é improvável, tendo em consideração a sua complexidade. O diagnóstico precoce da doença através de exame radiográfico é muito importante devido às perdas econômicas causadas pela OC na criação equina.Além disso, é importante associar uma seleção genética e um maior controle dos fatores ambientais predisponentes.(AU)

Osteochondrosis (OCO) is a disease which occurs in the center of epiphysis during ttíe growth of the animaland in some cases compromises its athletic future. The etiology is multifactorial and may involve multiple joints; hock,stifle and fetlock being the joints most commonly affected. X-rays of 101 thoroughbred foals, 50 females and 51 malesaged between nine and thirteen months were examined. Both hocks were radiographed in DMP-LO and OLPMO positions.Exploratory statistical analyses were performed to evaluate the presence of OCO. The prevalence of OCO wasobserved in 4% of animais (n=4) and 96% (n=97) did not show the disease. 5% of healthy animais had bone projectionsin the distal end of the medial trochlear ridge of the talus. The presence of OCO was observed in distal intermediate ridgeof the tibia (50%) and in the lateral trochlear ridge of the tibiotarsal bone (50%). None of the animais studied showed clinical symptoms. In view of the OCO complexity the total eradication of OCO is improbable. Early diagnosis of disease through radiographic examination is very important because of the economic losses caused by OCO in equine breeding. Further more, it is important to involve genetic selection and greater control of predisposinq environmental factors. (AU)

Osteocondrosis (OC) es una enfermedad que se produce en el núcleo de Ia epífisis durante el período de crecimiento del animal y puede, en algunos casos, comprometer su futuro como animal para deportes. Su etiología es multifactorial y puede afectar varias articulaciones, siendo Ias mas comunmente afectadas el corvejón, el menudillo y Ias palanquillas. Se examinaron radiográficamente 101 potros, 50 hembras y 51 machos de raza PSI de edades entrenueve y trece meses. Ambos tarsos fueron radiografiados en posiciones dorsomedial-pálmarolateral obliqua (OMPLO)y oblicua dorsolateral-pálmaromedial (OLPMO). Para evaluar Ia presencia de OC en Ia articulación tarsal se hicieronanálisis estadísticos exploratorios. Se observó Ia presencia de OC en 4% de los animales (n = 4) Y 96% (n = 97) nomostró enfermedad alguna. Entre los animales sanos, 5% tenían protuberancias óseas, lIamadas "gota de orvalho", enIa extremidad distal de Ia cresta troclear media dei astrágalo. Se observó Ia presencia de OC en Ia cresta media de Iatibia (50%) y en Ia crista troclear lateral dei hueso tibiotarsal (50%). Ninguno de los animales estudiados demostrósíntomatologia clínica. La erradicación total de Ia enfermedad es poco probable, tendiendo en cuenta su complejidad. EI diagnóstico precoz de Ia enfermedad mediante el exámen radiográfico es muy importante dadas a Ias pérdidas sconómicas causadas por OC en Ia cria de caballos. Por otra parte, es importante asociar Ia selección genética y un mayorcontrol de los factores ambientales que puedan ser predisponentes. (AU)

Prevalência de ostecondrose em potros da raça Puro Sangue Inglês / Osteochondrosis prevalence in thoroughbred foals / Prevalencia de la osteocondrosis en potros de raza sangre pura de carrera

A osteocondrose (OC) é uma patologia que ocorre no núcleo da epífise durante a fase de crescimento do animal podendo em alguns casos comprometer o seu futuro atlético. A etiologia é multifatorial e pode acometer várias articulações sendo que a mais comumente envolvida é a do curvilhão, femuro tibiorotuliana e a do boleto. Foram examinados radiograficamente 101 potros, sendo 50 fêmeas e 51 machos da raça PSI com idade entre nove e treze meses.Ambos os tarsos foram radiografados nas posições Oorsomedial-Pálmarolateral Oblíqua (OMPLO) e Dorsolateral-Pálmaromedial Oblíqua (OLPMO). Para avaliar a presença de OCO na articulação do tarso foram realizadas análises estatísticas exploratórias. Observou-se prevalência de OCO em 4% dos animais (n=4) e 96% (n=97) não apresentaram a doença. O entre os animais sadios, 5% apresentaram projeções ósseas, denominadas gota de orvalho, na extremidade distal da crista troclear medial do talus . A presença de OCO foi observada na crista intermédia da tíbia (50%) e na cristatroclear lateral (50%) do osso tibiotársico. Nenhum animal estudado apresentou sintomatologia clínica. A erradicação total da enfermidade é improvável, tendo em consideração a sua complexidade. O diagnóstico precoce da doença através de exame radiográfico é muito importante devido às perdas econômicas causadas pela OC na criação equina.Além disso, é importante associar uma seleção genética e um maior controle dos fatores ambientais predisponentes.

Osteochondrosis (OCO) is a disease which occurs in the center of epiphysis during ttíe growth of the animaland in some cases compromises its athletic future. The etiology is multifactorial and may involve multiple joints; hock,stifle and fetlock being the joints most commonly affected. X-rays of 101 thoroughbred foals, 50 females and 51 malesaged between nine and thirteen months were examined. Both hocks were radiographed in DMP-LO and OLPMO positions.Exploratory statistical analyses were performed to evaluate the presence of OCO. The prevalence of OCO wasobserved in 4% of animais (n=4) and 96% (n=97) did not show the disease. 5% of healthy animais had bone projectionsin the distal end of the medial trochlear ridge of the talus. The presence of OCO was observed in distal intermediate ridgeof the tibia (50%) and in the lateral trochlear ridge of the tibiotarsal bone (50%). None of the animais studied showed clinical symptoms. In view of the OCO complexity the total eradication of OCO is improbable. Early diagnosis of disease through radiographic examination is very important because of the economic losses caused by OCO in equine breeding. Further more, it is important to involve genetic selection and greater control of predisposinq environmental factors.

Osteocondrosis (OC) es una enfermedad que se produce en el núcleo de Ia epífisis durante el período de crecimiento del animal y puede, en algunos casos, comprometer su futuro como animal para deportes. Su etiología es multifactorial y puede afectar varias articulaciones, siendo Ias mas comunmente afectadas el corvejón, el menudillo y Ias palanquillas. Se examinaron radiográficamente 101 potros, 50 hembras y 51 machos de raza PSI de edades entrenueve y trece meses. Ambos tarsos fueron radiografiados en posiciones dorsomedial-pálmarolateral obliqua (OMPLO)y oblicua dorsolateral-pálmaromedial (OLPMO). Para evaluar Ia presencia de OC en Ia articulación tarsal se hicieronanálisis estadísticos exploratorios. Se observó Ia presencia de OC en 4% de los animales (n = 4) Y 96% (n = 97) nomostró enfermedad alguna. Entre los animales sanos, 5% tenían protuberancias óseas, lIamadas "gota de orvalho", enIa extremidad distal de Ia cresta troclear media dei astrágalo. Se observó Ia presencia de OC en Ia cresta media de Iatibia (50%) y en Ia crista troclear lateral dei hueso tibiotarsal (50%). Ninguno de los animales estudiados demostrósíntomatologia clínica. La erradicación total de Ia enfermedad es poco probable, tendiendo en cuenta su complejidad. EI diagnóstico precoz de Ia enfermedad mediante el exámen radiográfico es muy importante dadas a Ias pérdidas sconómicas causadas por OC en Ia cria de caballos. Por otra parte, es importante asociar Ia selección genética y un mayorcontrol de los factores ambientales que puedan ser predisponentes.

Effect of hyperlipidemia on femoral biomechanics and morphology in low-density lipoprotein receptor gene knockout mice.

The objective of this study was to evaluate the effect of hyperlipidemia on the biomechanical and morphological properties of the femur of low-density lipoprotein receptor gene knockout mice (LDLr-/-) mice. Ten wild-type mice (C57BL6) and 10 LDLr-/- mice generated on a C57BL6 background were used. Male 3-month-old animals were divided into four groups (n = 5): group W (wild type) and group L (LDLr-/-) receiving low-fat commercial ration, and group WH (wild type) and group LH (LDLr-/-) receiving a high-fat diet. After 60 days, blood samples were collected for laboratory analysis of calcium, triglycerides, and cholesterol. The femur was excised for mechanical testing and morphometric analysis. LDLr-/- mice receiving the high-fat diet presented more marked alterations in the mechanical and morphological properties of femoral cortical and trabecular bone. Changes in the plasma levels of calcium, triglycerides, cholesterol, and fractions were also more pronounced in this group. The present results demonstrate that hyperlipidemia causes alterations in the structure and mechanical properties of the femur of LDLr-/- mice. These effects were more pronounced when associated with a high-fat diet.

Study of the osteoconductive capacity of hydroxyapatite implanted into the femur of ovariectomized rats.

Osteoporosis is a global public health that affects postmenopausal women due to the deficiency of estrogen, a hormone that plays an important role in the microarchitecture of bone tissue. Osteoporosis predisposes to pathological bone fracture that can be repaired by conventional methods. However, depending on the severity and quantity of bone loss, the use of autogenous grafts or biomaterials such as hydroxyapatite might be necessary. The latter has received increasing attention in the medical field because of its good biological properties such as osteoconductivity and biocompatibility with bone tissue. The objective of this study was to evaluate using histologic and radiographic analyses, the osteogenic capacity of hydroxyapatite implanted into the femur of rats with ovariectomy-induced osteoporosis. Eighteen rats were divided into three groups with six animals in each: group nonovariectomized, bilaterally ovariectomized not receiving estrogen replacement therapy, and bilaterally ovariectomized submitted to estrogen replacement therapy. Defects were created experimentally in the distal epiphysis of the femur with a surgical drill and filled with porous hydroxyapatite granules. The animals were sacrificed 8 weeks after surgery. The volume of newly formed bone in the implant area was quantified by morphometrical methods. The results were analyzed by ANOVA followed by the Tukey test (P < 0.05). The hydroxyapatite granules showed good radiopacity. Histological analysis revealed less quantity of newly formed bone in the ovariectomized group not submitted to hormone replacement therapy. In conclusion, bone neoformation can be expected even in bones compromised by estrogen deficiency, but the quantity and velocity of bone formation are lower.

Experiencia con el manejo del deslizamiento de la epifisis femoral proximal con un tornillo canulado en el Hospital Universitario del Valle entre 1995-2002 / Treatment of slipped capital femoral epiphysis with a single connulated screw in the Hospital Universitario del Valle between the years 1995 - 2002

El deslizamiento de la epífisis femoral proximal (DEFP) es la patología de cadera más frecuente de niños y adolescentes entre los 8 y 15 años. A raíz de la aparición de trabajos en los cuales se demuestran buenos resultados clínicos con menores tasas de complicaciones utilizando un solo tornillo canulado, se analiza la experiencia lograda con el manejo de esta patología durante el período de enero de 1995 a diciembre del 2002. Se encontraron 49 casos luego de revisar los registros de cirugías ortopédicas del Hospital Universitario del Valle en Cali, Colombia. De estos, se obtuvieron 34 historias clínicas: 18 se descartaron por diferentes motivos especialmente por falta de información suficiente o falta de seguimiento. Se obtuvieron finalmente 14 pacientes con 18 deslizamientos (4 bilaterales) a los cuales se les aplicó un instrumento de medición utilizando Epi-Info 2000. Se procedió a realizar un estudio descriptivo tipo serie de casos incluyéndose variables epidemiológicas y clasificaciones clínicas y radiológicas. Once deslizamientos fueron agudos y de estos, 4 agudos sobre crónicos; hubo 7 deslizamientos crónicos. 10 de los 18 fueron deslizamientos inestables, ocho estables. Hubo 9 deslizamientos leves, 4 moderados y 5 severos de acuerdo a la clasificación radiográfica. La mediana de la duración de la cirugía fue de 75 minutos, el promedio de 84. Se sugiere un mejor conocimiento de esta patología para crear un mayor índice de sospecha. Igualmente se previene acerca de la realización de maniobras de reducción en deslizamientos severos y se enfatiza como tratamiento el uso de un solo tornillo canulado de 6.5 mm.

Epiphyseal primary location for osteosarcoma and Ewing sarcoma in patients with open physis.

Conventional osteosarcoma and Ewing sarcoma are the most common childhood malignant tumors of bone. These tumors arise in the metaphysis and diaphysis of long bones and may extend secondarily into the epiphysis. Primary epiphyseal location for these tumors is rare and may constitute a diagnostic and therapeutic challenge. The authors report two skeletally immature patients with an osteosarcoma and Ewing sarcoma limited to the epiphysis. Clinical, radiographic and histopathologic findings are discussed.

Osteochondral sequelae of meningococcemia: radiographic aspects.

The authors retrospectively analyzed the files of 11 patients with osteochondral sequelae of meningococcemia, which were referred to this service between 1988 and 1996. The purpose of this study was to radiographically evaluate bone and physeal injuries observed in these patients, deformities caused by them and correlate these findings with the current literature. During radiographic evaluation of patients with sequelae of meningococcemia, two distinct parameters should be observed: bone injury and physeal plate injury patterns. The most frequent bone injury pattern was lytic lesion and the most common physeal plate injury pattern was peripheral asymmetric physis destruction. The most frequent deformities were lower limb length discrepancy, angular deformities and digital amputations. Based upon the findings of the present research, a descriptive radiographic classification was proposed.

Estudo das alteraçöes da placa epifisária distal do fêmur do rato após fratura ao nível da diáfise / Study of the alterations in the rat's distal growth plate of the femur after fracture at level of the diaphysis

Foi realizado trabalho experimental com ratos machos da raça Wistar, com quatro semanas de vida, nos quais foi executada uma fratura manual, sob anestesia, ao nível da diáfise do fêmur direito, a fim de estudar as alteraçöes da microestrutura da fise distal e as alteraçöes macroscópicas das peças. Após os animais serem sacrificados em grupos iguais ao final de uma, duas, quatro, seis e oito semanas pós-fratura, estudamos os fêmures controles e os fraturados mediante técnicas histológica e histoquímica, avaliaçäo das dismetrias através da mensuraçäo das peças com paquímetro e estudo radiológico. Os resultados demonstraram que do ponto de vista histológico, nos grupos fraturados na 4( e 6( semanas, ocorreu aumento da afinidade pelo alcian blue na placa epifisária, indicativo de maior produçäo de matriz extracelular nesse período. Em relaçäo à macroscopia, observamos hipercrescimento nos fêmures fraturados comparados com o lado contralateral, nos animais em que o periósteo manteve-se íntegro após a fratura.

Ocorrência de padröes radiológicos da epifisite do calcâneo em crianças assintomáticas / Occurrence of radiologic patterns related to calcaneum epiphysitis in asymptomatic children

Através de estudo radiográfico realizado em 250 crianças normais de ambos os sexos e de idades compreendidas na faixa de sete a 13 anos, na incidência lateral e axial posterior, colhemos dados sobre os aspectos da apófise posterior do calcâneo no intuito de estabelecer os parâmetros anatômicos normais. Os resultados obtidos permitem concluir que há ampla variaçäo de imagens e formas evolutivas da apófise posterior do calcâneo e que as imagens relacionadas pela literatura como elementos de diagnóstico da apofisite do calcâneo (doença de Haglund-Sever) ocorreram em grande número de crianças sem qualquer sintoma de enfermidade

Desepifisiodesis según langenskiold en lesiones con fusión del cartílago de crecimiento / Desephyphisiodesis acording to langenskiold in lesions with closure of the ephyfisial plate

Hemos encontrado que el a Desepifisiodesis según la técnica de Langenskiold de buenos resultados en el cierre traumático parcial prematuro de las líneas epifisarias de crecimiento. Revisamos 9 casos, de los cuales 7 tuvieron buenos resultados. El hecho de tomar grasa autógena para colocarla como injerto de relleno después de la resección del puente óseo, evita la formación de un nuevo puente óseo. Con este procedimiento no es necesario realizar diferentes osteotomías para corregir deformidades angulares, ya que se consigue un crecimiento homogéneo al evitar el puente óseo y la recidiva de la deformidad

Traumatic separation of epiphyses. An experimental study in rats.

Four types of physeal fracture-separations, defined by the Salter-Harris classification, were created experimentally in the proximal physis of the right tibia of immature rats. The four types are: Type I, pure epiphyseal separation; Type II, separation of the epiphysis with a metaphyseal fracture; Type III, partial epiphyseal separation with a vertical fracture of the epiphysis; and Type IV, vertical epiphyseal and metaphyseal fractures. A sham operation performed on the left tibia served as the control. The animals were killed at various intervals up to 25 days after the operation. The findings were assessed by roentgenographic, histologic, and vessel injection methods. For Types I and II morphometric analyses were also performed. The influence of various types of lesions on the growth rate and the healing process was documented. For Types I and II lesions there was a transitory growth arrest and an increased thickening of the zone of hypertrophic cells. The alterations regressed after Day 15, and by day 25, a nearly normal plate was seen. For Type III lesions an angular deformity of the tibia occurred that increased with time. For Type IV lesions, a step-off developed on the articular surface that became more severe with time. Early vascular anastomoses between the epiphysis and the metaphysis led to the formation of bone bridges in Type III and Type IV lesions.