Effect of patellar resurfacing surgery on bleeding in total knee arthroplasty.

OBJECTIVE: Postoperative bleeding is one of the most important factors affecting clinical and functional results in total knee arthroplasty. Therefore, many studies have been conducted on bleeding in arthroplasty patients. However, there are very few reports investigating the effect of patellar surface replacement on bleeding in knee arthroplasty. We, therefore, aimed to investigate the effect of patellar surface replacement on postoperative bleeding. METHODS: In this retrospective study, 30 with patellar resurfacing were compared with 39 without patellar resurfacing among patients who had undergone total knee replacement due to primary osteoarthritis. Demographic data, amount of transfusion, preoperative and postoperative hemoglobin and hematocrit values, and total, visible, and hidden blood loss values were recorded. RESULTS: No statistical difference was found between the two groups in terms of demographic values. There was no significant difference between the groups in terms of the amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion in patients who had and had not undergone patellar resurfacing. A positive significant correlation was found between postoperative drainage volume and total blood loss. CONCLUSION: Patellar component application in patients who had undergone total knee arthroplasty does not change the blood loss of the patients.

Effect of patellar resurfacing surgery on bleeding in total knee arthroplasty

SUMMARY OBJECTIVE: Postoperative bleeding is one of the most important factors affecting clinical and functional results in total knee arthroplasty. Therefore, many studies have been conducted on bleeding in arthroplasty patients. However, there are very few reports investigating the effect of patellar surface replacement on bleeding in knee arthroplasty. We, therefore, aimed to investigate the effect of patellar surface replacement on postoperative bleeding. METHODS: In this retrospective study, 30 with patellar resurfacing were compared with 39 without patellar resurfacing among patients who had undergone total knee replacement due to primary osteoarthritis. Demographic data, amount of transfusion, preoperative and postoperative hemoglobin and hematocrit values, and total, visible, and hidden blood loss values were recorded. RESULTS: No statistical difference was found between the two groups in terms of demographic values. There was no significant difference between the groups in terms of the amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion in patients who had and had not undergone patellar resurfacing. A positive significant correlation was found between postoperative drainage volume and total blood loss. CONCLUSION: Patellar component application in patients who had undergone total knee arthroplasty does not change the blood loss of the patients.

An investigation of the effect of acrylamide on fracture healing in rats.

BACKGROUND: The aim of this study was to investigate the effects of acrylamide (AA) on fracture healing histologically, biochemically, and radiologically in a rat femur fracture model. METHODS: Scanning electron microscopy (SEM) imaging and Fourier transform infrared spectroscopy (FTIR), and UV (ultraviolet)-Vis (visible) spectrophotometer examination were performed for acrylamide characterization. In this study, after the femur fracture model was created, the groups were formed to include eight rats in each group (G) as follows: G1: 15th-day control, G2: 15th-day AA, G3: 30th-day control, G4: 30th-day AA. In G2 and G4, 5mg/kg acrylamide was administered 3 times a week by gastric gavage. The fracture was evaluated radiologically according to Lane-Sandhu scoring and histologically according to Huo scoring. The weight changes of the rats were recorded. Albumin, total protein, cholesterol, HDL, LDL, triglyceride, ALP, LDH, vit. D, PTH, Ca, P, WBC, Hb, Plt values were examined in the blood samples. The data were analyzed using the SPSS program. RESULTS: The characterization properties of acrylamide were confirmed. No significant weight change was observed in the rats during the study. When blood values were compared, a statistically significant difference was determined between albumin, total protein, phosphorus, white blood cell (WBC), and hemoglobin groups (p=0.41, p=0.00, p=0.003, p=0.019, and p=0,017, respectively). According to the histological score comparisons, G3 was significantly different from G1, G2, and G4 (p<0.05), and G4 was significantly different from G1 and G2 (p<0.05). According to Lane-Sandhu scoring, there was a significant difference between G2 and G3 and G4 (p: 0.0, p: 0.034), G1 and G3 (p: 0.001), respectively. CONCLUSION: AA adversely affects fracture healing even at low doses, as in the present study. According to the results of this study, the authors recommend a diet poor in acrylamide during fracture treatment. Therefore, further human studies are required to find out the complex effect of AA on bone healing and the body.

Effect on mortality of treatment method and surgery time for hip fracture patients aged over 65 years.

BACKGROUND: This study aimed to evaluate the effects on mortality of implant selection used and time to surgery in patients aged over 65 years operated for hip fractures. METHODS: A total of 301 patients aged over 65 years were investigated in this study. Patients were divided into three groups as follows: Group 1 cemented hemiarthroplasty (CH), Group 2 cementless hemiarthroplasty (CLH), and Group 3 proximal femoral nail (PFN). Time of surgery, fracture and demographic information were retrospectively recorded. RESULTS: After removing 59 patients with missing information, this study included 242 patients. Mean age of patients was 80.5 years. When patient groups were examined according to treatment method, Group 1 (n=146) comprised 60.3%, Group 2 (n=54) comprised 22.3% and Group 3 (n=42) comprised 17.4% of the study group. There was no significant difference in survival between the patients operated in the first 48 hours and the patients operated later (p=0.834). There was an effect on the survival of treatment implant selection (p=0.016). Patients with CH were observed to survive longer than patients with CLH and PFN. CONCLUSION: Operation in the first 48 hours was not observed to affect mortality. Additionally, while sex and age were found to be effective on mortality, implant selection was also concluded to affect mortality.

Total hip arthroplasty after hip joint gunshot injury.

BACKGROUND: Gunshot injury of the hip joint was reported to constitute 2-17% of all extremity firearm injuries. However, there are few studies in the literature related to gunshot injuries of the hip joint. The aim of the current study was to present the results of 10 cases treated with arthroplasty following a gunshot injury to the hip joint together with the recommended treatment algorithm. METHODS: Patients with a previous medical history of hip joint region gunshot injury who underwent total hip arthroplasty were retrospectively evaluated. Those with incomplete medical records or who were lost to follow-up were excluded. Patients were classified according to the severity of the previous gunshot injury to the hip joint region. Harris hip score (HHS) and Short Form-12 quality of life score were the main outcome measurements. Postoperative complications encountered during follow-up were recorded. RESULTS: The mean age of the patients at the time of surgery was 29.9 years. The mean preoperative HHS was 25.2 points and it was 65.8 at the final follow-up. Patients with bullet fragments in the hip joint, classified as group 1, had better HHS, whereas those with contaminated hip joint with intestinal flora, classified as group 3, had worst HHS. CONCLUSION: Hip arthroplasty after hip joint gunshot injury is a good treatment choice in young patients to reduce pain and regain functions. However, very high infection rates can be seen in patients with accompanying intestinal injury.

FOXP3 rs3761548 polymorphism is associated with knee osteoarthritis in a Turkish population.

AIM: Functional polymorphisms located in FOXP3 intron 1 was recently found to be associated with rheumatoid arthritis (RA). Although RA is an autoimmune disease, there is supporting evidence that activated maladaptive responses including pro-inflammatory pathways play roles in osteoarthritis (OA), similar to RA. The aim of this study was to explore the relationship between rs2232365 (-924A/G) and rs3761548 (-3279A/C) polymorphisms as well as possible changes in the 600 bp promoter region of FOXP3 and knee OA. METHODS: Patients with primary knee OA (n = 300) and healthy individuals (n = 300) were examined for rs3761548 and rs2232365 FOXP3 gene polymorphisms by the polymerase chain reaction-restriction fragment-length polymorphism method. The 600 bp promoter region (between -500 and +100) of the gene was also sequenced with direct sequencing in 50 knee OA patients and 50 healthy individuals. RESULTS: There were no sequence variants in the promoter region tested both in OA patients and healthy controls. The SNP rs2232365 showed no association with OA susceptibility and severity and the results of other genetic models were also nonsignificant. On the other hand, rs3761548 AC (P = 0.003), AA + CC (P = 0.0014) as well as AC + AA (P = 0.40) genotypes showed association with Grade 4 knee OA patients. CONCLUSION: Our findings indicated that the association between FOXP3 rs2232365 polymorphism and knee OA tended to yield negative results but the FOXP3 rs3761548 C allele was associated with elevated risk of OA in Grade 4 knee OA patients in a Turkish population.

A serious case of anthrax associated with compartment syndrome.

Compartment syndrome linked to skin anthrax is a rare complication that may develop and it should be noted that the disease may progress in spite of medical drug treatment. Our case was a farmer who was exposed after slaughtering a dead animal, a time delay for treatment hided this history and then developed compartment syndrome. In anthrax cases with delayed treatment and aggressive progression, circulation in the extremities should be carefully noted. We believe that the cases with compartment syndrome progressing in spite of medical drug treatment may be assessed for fasciotomy as a treatment approach.

Treatment of Bifocal Cyst Hydatid Involvement in Right Femur with Teicoplanin Added Bone Cement and Albendazole.

Although bone involvement associated with cyst hydatid is rarely seen, it can cause unintended results such as high recurrence rate, infection, sepsis, or amputation of relevant extremity. Because of this reason, its treatment is difficult and disputed. In the case of bifocal bone cyst hydatid in right femur, along with albendazole treatment, result of resecting cyst surgically and its treatment with teicoplanin with added bone cement is given. In conclusion, since the offered treatment method both supports bone in terms of mechanical aspect and also can prevent secondary infection, the method is thought to be a good and safe treatment approach.

Investigation of mechanical strength of teicoplanin and ciprofloxacin impregnated bone cement on Day 1 and Day 15.

OBJECTIVE: The aim of this study was to compare the mechanical effects of different concentrations of teicoplanin and ciprofloxacin addition in bone cement. METHODS: In an experimental design, 3 different doses of teicoplanin and ciprofloxacin (800, 1600 and 3200 mg) were added to bone cement. Mechanical tests using compression and four-point bending tests were performed on Day 1 and after antibiotic leaching in water at 37°C on Day 15. Specimens that contained no antibiotics served as controls. Mechanical strength for each antibiotic concentration on Day 1 and Day 15 were evaluated. RESULTS: Both teicoplanin and ciprofloxacin significantly decreased the mean strength values in compression and four-point bending tests at Days 1 and 15 (p<0.05). While teicoplanin significantly decreased the mean strength values at high doses in both tests at Days 1 and 15 (p<0.05), ciprofloxacin did not significantly change these values. When the effects of two drugs compared, there were significant differences at the 3200 mg dose at Day 1 and at 1600 and 3200 mg doses at Day 15 in the compression testing and at 3200 mg at Day 15 in the four-point bending test. CONCLUSION: Teicoplanin and ciprofloxacin addition may adversely affect the biomechanical strength of bone cement. Ciprofloxacin addition seems to have less of a negative effect on strength than teicoplanin.

The effect of low dose teicoplanin-loaded acrylic bone cement on biocompatibility of bone cement.

Antibiotic-loaded acrylic bone cement (polymethylmethacrylate, PMMA) is used to prevent or treat infection in total joint replacement surgery. The purpose of this study was to investigate biocompatibility and cytotoxicity of the teicoplanin-loaded acrylic bone cement. Cytotoxicity examination of acrylic bone cement balls and 400 mg teicoplanin added acrylic bone cement balls conducted by MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay. SEM (Scanning electron microscopy) was used to observe adhesion and spreading of cells on surface of the balls. Cytotoxicity examination conducted by MTT assay on acrylic bone cement balls and teicoplanin-added acrylic bone cement balls revealed no cytotoxicity. SEM analysis put forward that cells started to proliferate and adhere on surface of the samples in both groups as a result of 48-hour incubation and that the cell proliferation over acrylic bone cement and teicoplanin-added acrylic bone cement was similar. As a consequence, there was no cytotoxicity in acrylic bone cement and teicoplanin-added acrylic bone cement groups according to results of MTT assay. On the other hand, results of SEM showed that biocompatibility of both groups was similar. In conclusion, teicoplanin-loaded bone cement did not change biocompatibility of bone cement in studied dose.

Arthroscopic-assisted surgical treatment for developmental dislocation of the hip before the age of 18 months.

PURPOSE: The purpose of this study is to evaluate the results of arthroscopy assisted surgical treatment of developmental dislocation of the hip (DDH). METHODS: Arthroscopic assisted surgical treatment was performed on nine hips of nine female children with DDH using our method, published previously, between January 2001 and December 2005. Their ages ranged from 9 to 16 months. Percutaneous adductor tenotomies were performed in seven cases. A spica cast and abduction splint were used for 11-17 weeks postoperatively. Acetabular index and Shenton line were used for preoperative and postoperative radiologic evaluation. Also, the cases were evaluated postoperatively with respect to range of motion restriction, and the leg length discrepancy. RESULTS: The average follow-up was 47.7 months (range 22-79 months). Acetabular index measurements of cases in the preoperative/postoperative periods were as follows: preoperative mean angle 39.9° (range 34°-52°)/postoperative mean angle 26° (range 22°-34°). Hip joint restriction and leg length discrepancy were not observed postoperatively. However, two patients had acetabular dysplasia. Acetabular dysplasia was completely resolved in one patient in the third year of follow-up, whereas Salter innominate osteotomy, required in another patient, was in the second year of follow-up. The latter patient was the oldest case (16-month-old) in our series. CONCLUSIONS: Based on the results of this study, treatment of developmental hip dysplasia with arthroscopic-assisted surgical treatment technique may be safe and effective method. Further clinical studies will be required to confirm this study.

Biomechanical properties of ciprofloxacin loaded bone cement.

OBJECTIVE: The purpose of this study was to investigate the biomechanical properties of bone cement used in joint replacement surgery after the addition of ciprofloxacin. METHODS: The first group received bone cement only and served as a control for the 4 groups where 500 mg, 1000 mg, 1500 mg and 2000 mg of ciprofloxacin were added to yield 40 g of bone cement. Axial compression tests were conducted using a 50,000 Newton capacity tension-compression testing device. RESULTS: While axial compression strength at failure was 80.2±4.3 MPa in the control group, values in the ciprofloxacin-treated groups decreased with rising concentration of ciprofloxacin to 74.5±5.4 MPa, 70.6±4.8 MPa, 70.5±4.7 MPa, and 69.3±3.4 MPa. CONCLUSION: Bone cement with addition of 500 to 1500 mg ciprofloxacin maintained mechanical axial strength values above 70.0 MPa recommended by American Society for Testing and Materials and can be safely used in joint replacement surgery.

[Radiation synovectomy therapy combined with surgical synovectomy in chronic nonspecific synovitis of the knee joint]. / Diz ekleminin kronik nonspesifik sinovitlerinde cerrahi sinovektomi ile kombine radyasyon sinovektomi tedavisi.

OBJECTIVES: This study aims to investigate the effectiveness of the radiation synovectomy (RS) procedure combined with the surgical synovectomy in the treatment of chronic nonspecific synovitis, which are resistant to medical treatment. PATIENTS AND METHODS: Between March 2004 and October 2009, 17 knees of the 17 patients (15 males, 2 females; mean age 42.5 years; range 27 to 70 years) who underwent synovectomy surgery, followed by RS procedure with the 90Y at six weeks were included. At the end of a mean 48.7 months (range; 15-126 months) follow-up period, the Lysholm Knee Scale scores were used for functional assessment before and after RS procedure. The nocturnal pain, resting pain, activity pain and effusion were evaluated with the visual analog scale. The patient satisfaction was recorded as excellent, very good, good and poor. RESULTS: At the end of the follow-up period, all patients had satisfaction scores of excellent and very good. There was a statistically significant difference between all assessment scores before and after treatment (p<0.05). It was found that none of the cases had radionuclide leakage from the joint in their control scintigraphy following RS procedure. No significant complication was seen except for deep vein thrombosis developed in one case. CONCLUSION: Our study results showed that RS procedure combined with the surgical synovectomy is an effective and safe treatment method for the treatment of cases of chronic nonspecific synovitis which recurs despite medical treatment.

The long-term effects of extracorporeal shock waves on the epiphysis of the adolescent rat.

BACKGROUND: Extracorporeal shock waves (ESW) have been successfully used to treat musculoskeletal injuries, tendinopathy, and plantar fasciitis. Different side effects of high-energy ESWT on bones, tendons, nerves, epiphysis, and cartilage have been discussed. Although the effects of ESW on the epiphysis in animal models have been described, no studies have investigated the long-term effect of ESW on the immature epiphysis in an animal model. The purpose of this study was to investigate the long-term effects of ESW on the immature epiphysis in rats. METHODS: Sixteen 4-week old Wistar albino rats, average weight 116.3 grams (109.6-120.2 g) were used for these experiments. The rats were randomly divided into two groups, the ESW 1500 pulses (ESW1500p) group (n = 8) and the ESW 3000 pulses (ESW3000p) group (n = 8). In the ESW1500p group, 1500 pulses, at 4 bar, of 1-Hz shockwaves were applied, once, to the left knees of the rats. In the ESW3000p group, 3000 pulses, at 4 bar, of 1-Hz shockwaves were applied, once, to the left knees of the rats. The right knees (n = 16) of the rats in the two groups were used as the controls. The animals were sacrificed after an 8-month follow-up period. Femoral epiphyses were assessed by use of histology. The femoral length (FL), tibial length (TL), and femoral supracondylar medio-lateral width (MLW) were measured. RESULTS: There was no statistically significant difference between FL, TL, and MLW for the three groups (P > 0.05). The average histological scores were 8.8 (7-10), 17.8 (15-22), and 2.7 (0-4) in the ESW1500p, the ESW3000p groups, and the controls, respectively. The average histological score for the ESW3000p group was significantly higher than those for the ESW1500p group and the controls (P < 0.001). The average histological score for the ESW1500p group was significantly higher than that for the controls (P < 0.001). CONCLUSIONS: The histological findings of this study indicate that ESW increased the cellularity and basophilia of the extracellular matrix (ECM) in the adolescent rat epiphysis and there were no negative effects on extremity measurements in the long term.

Surgical synovectomy combined with yttrium 90 in patients with recurrent joint synovitis.

Radiation synovectomy (RS) is one of many therapeutic options used for recurrent joint synovitis. Our aim was to analyze the effect of the surgical synovectomy combined with yttrium 90 ((90)Y) in the treatment for recurrent joint synovitis. A surgical combined RS procedure was used on 32 knees of 30 patients. They were divided into two groups. Group 1 consisted of 7 knees of 7 patients (5 women and 2 men) with a mean age of 40.7 years in whom RS was combined with the open synovectomy. Group 2 consisted of 25 knees of 23 patients (21 men and 2 women) with a mean age of 45.5 years in whom RS was combined with the arthroscopic synovectomy. Arthroscopic synovectomy or open surgery biopsy was carried out for all cases who diagnosed of having synovitis. A scintigraphic examination was conducted within 24 h after the RS procedure to investigate the systemic leakage of (90)Y in all patients. The outcome of treatment was assessed based on self-reporting using the visual analogue scale (VAS) of night pain, rest pain, activity pain, effusion, and satisfactory scores. The average follow-up period was 4.15 years. There was a significant difference between before and after treatment in terms of outcome parameters' VAS scores in both groups (p < 0.05). But there was no statistically significant difference between open and arthroscopic synovectomy groups in terms of outcome parameters (p > 0.05). Satisfactory outcome was excellent in 3 patients (42.8 %) in group 1 and 8 patients (32 %) in group 2. Surgical synovectomy with combined (90)Y could treat recurrent joint synovitis successfully. There was no statistically significant difference between open and arthroscopic synovectomy techniques combined with RS procedure.

Long segment instrumentation of thoracolumbar burst fracture: fusion versus nonfusion.

OBJECTIVE: The treatment of thoracolumbar burst fracture is a controversial issue. Although spinal fusion has been a touchstone of spinal fixation, nonfusion technique have become raising its popularity recently. Some studies suggested that nonfusion had several advantages over fusion. The aim of this prospective study was to compare long segment posterior instrumentation with fusion versus long-segment posterior instrumentation without fusion. METHODS: For this purpose, 42 consecutive patients were assigned to two groups. Group 1 included 21 patients treated by long segment instrumentation with fusion (WF), whereas Group 2 included 21 patients treated by long segment instrumentation without fusion (WOF). Long segment instrumentation was hook fixation (claw hooks attached to second upper vertebra and infralaminar hooks attached to first upper vertebra) above and pedicle fixation (pedicle screws attached to first and second lower vertebrae) below the fractured vertebra. RESULTS: Measurements of local kyphosis, sagittal index and anterior vertebral height compression showed that both group had similar outcome at final follow-up. Moreover, there was no difference between the two groups according to low back outcome score. Also, implant failure rate (4.7%) was quite low in both groups. However, WF group had prolonged operative time, increased blood loss and donor site morbidity. CONCLUSIONS: Radiological and clinical parameters demonstrated that spinal fusion is not necessary in long segment posterior instrumentation for the management of thoracolumbar burst fractures.

[School screening for scoliosis in Sivas, Turkey]. / Sivas il merkezinde skolyoz için okul taramasi.

OBJECTIVES: We investigated the prevalence of scoliosis among primary school students in Sivas, Turkey. METHODS: To determine the prevalence of scoliosis among primary school students in the age bracket of 10 to 15 years, 11 primary schools were selected with systematic sampling. A total of 3,175 students (1,538 girls, 1,637 boys) of grades 6 to 8 were selected from 16,103 students using a stratified sampling method. Examination for scoliosis was made by the forward bend test and palpation of the spine. RESULTS: Fifteen children (0.47%) were found to have scoliosis, including 10 girls (66.7%) and five boys (33.3%). The prevalence of scoliosis was significantly higher in girls (0.65% vs. 0.31%; p<0.05). The mean lateral curvature of the spine was 6.9 degrees (range 5 degrees to 20 degrees ), being 7.9 + or - 4.6 degrees in girls, and 5.4 + or - 0.9 degrees in boys. The mean age was 13.5 + or - 1.2 years (range 12-15 years). The severity of the curvature showed no significant relationship with gender and age groups (p>0.05). The levels of involvement were lumbar vertebrae in 73.3% (n=11), thoracic vertebrae in 13.3% (n=2), and thoracolumbar vertebrae in 13.3% (n=2). Spinal curvature was to the right side in 12 cases (80%), and to the left in three cases (20%). Girls and boys did not differ significantly with respect to the severity and direction of the curvature (p>0.05). During a two-year follow-up of children with scoliosis, no progression of the curvature was observed, including one child who wore a Milwaukee brace. CONCLUSION: School screenings may be performed as part of prevalence studies; however, routine school screening for scoliosis is debatable.

Pigmented villonodular synovitis managed by Yttrium 90 after debulking surgery.

The goal of this study was to evaluate outcome of patients with pigmented villonodular synovitis (PVNS) managed by Yttrium90 (90Y) after debulking surgery. Seven patients (3 males and 4 females) with PVNS were studied retrospectively. Mean follow-up was 47.8 months (range 24-97 months). Mean age was 44.8 years (range 20-68 years. Debulking surgeries via arthroscopic synovectomy were performed in 4 cases and in 3 cases via mini arthrotomy. After 90Y injection was applied. Magnetic resonance imaging (MRI) included measurement of synovial thickness in preoperative and at last control. Main musculoskeletal tumor society score was 26 (range, 23-29), main MTS rating was 70.4% (range, 38.5-86.2%). Mean preoperative synovial thickness was 14.9mm range 20-12mm. Synovial thickness was completely disappeared at last MRI examination. There was diffuse joint effusion preoperatively, decreasing at last control. No cases of PVNS recurrence were found. Although we had a small number of cases, we believe that combination of debulking surgery with intra-articular injection of 90Y for PVNS of knee joint is an effective and safe treatment method.

Treatment of skin necrosis after radiation synovectomy with yttrium-90: a case report.

Chronic synovitis, unresponsive to systemic medical therapy including agents, anti-inflammatory drugs and remission-inducing agents, and intra-articular administration of corticosteroids can be treated with surgical, chemical and radiation synovectomy. We reported a case of a 23 years old male. Skin radiation necrosis (4 x 5 cm) developed after an injection of Yttrium-90 (Y-90). Full-thickness skin graft had been applied but we were not able to succeed. Skin radiation necrosis was treated with Limberg's flap. As a result we recommend flap surgery instead of skin graft in skin radiation necrosis.

Effect of high-energy extracorporeal shock waves on the immature epiphysis in a rabbit model.

INTRODUCTION: We investigated the effect of high-energy extracorporeal shock wave (ESW) on immature tibial epiphysis in a rabbit model. MATERIALS AND METHODS: Twenty New Zealand white immature rabbit were used in this study. Animals were divided into two groups and they received 14 kW, 0.6 mJ/mm(2), 1,500 or 3,000 shots for three times with an interval of 7 days. After 6 weeks all rabbits were killed. The all tibia epiphysis were assessed by histology. The epiphyseal plaque thickness of right tibiae of the 3,000-shot ESW group was significantly higher than those of the 1,500-shot ESW group and the left tibia epiphyses of the 1,500- and 3,000-shot ESW groups as controls (P < 0.05). RESULTS: The epiphyseal plaque thickness of right tibiae of the 1,500-shot ESW group was significantly higher than that of the left tibia epiphyses of the 1,500- and 3,000-shot ESW groups as controls (P < 0.05). DISCUSSION: We demonstrated that high-energy ESW stimulated the growth of immature rabbit epiphysis. The long-term effect of shock wave on the immature rabbit epiphysis deserves further study.