Experimental limb lengthening by epiphyseal distraction

Kirshner wires were placed either side of the right distal femoral epiphysis and a constant tension device applied a distracting force across the plate in rabbits. Growth increase was measured between the wires and found to be about 150% greater than the concurrent normal growth between 2 control (undistracted) wires on the left; such growth increase can occur in the absence of fracturing. The forces required to do this were between 1/5 and 1/10 of those shown to cause fracturing in vitro. The growth increase was shown to be associated with hyperplasia and hypertrophy of the plate, as well as an increased rate of cell division and sulfated polysaccharide synthesis. This was in turn shown to be associated with an increase in new bone formation.

Epiphysiodesis for limb length inequality: results and indications

In view of the minimum morbidity, low incidence of complciations, and averall success rate, epiphysiodesis is an excellent method for correction of moderate limb length discrepancies. Skeletally immature patients with discrepancies between 2.5-8 cm with adult height predicted to be in the normal range (5 feet or greater) are good candidates for epiphysiodesis. Preoperative evaluation over several years prior to operation, utilizing the principles of Green-Anderson or the straight line graph, provide an accurate means of predicting future growth and determination of time of operation. Technique of epiphysiodesis is reliable and technical complications resulting from its use are few. Patient with a paralytic basis for shortening do best functionally with an end result undercorrection of 1.5 cm; equalization or overcorrection is to be avoided in these patients. Nonparalytic patients do best if limb lengths are equalized, with 1.5 cm of overcorrection or under-correction equally well tolerated.

Proximal femoral focal deficiency: Treatment and classification in forty-two cases

A review of the surgical experiences in 42 patients with proximal femoral focal deficiency has led us to propose a new classification system. This simplified system consists of 4 definite classes based on the roentgenographic appearance of the proximal shaft, and includes distinct prognosis and treatment groups. Early and accurate prognostication facilitates rational prosthetic design and appropriate surgical treatment in all degrees of involvement. In the less severely involved classes, emphasis is placed on the utilization of the proximal shaft signs of Fixsen and Lloyd-Roberts to identify those hips with an unfavorable prognosis.

[The treatment of diaphyso-epiphyseal tumours by local resection with the preservation of joint movement. A report of four cases (author's transl)]

Four cases of epiphyseal tumours were treated by the authors by local resection. In two cases, there was a giant-cell tumour of the lower end of the femur, in one case a giant-cell tumour of the lower end of the radius and in one case a juxta-cortical sarcoma of the lower end of the radius. In the two cases involving the knees, resection preserved the articular surface and the subchondral bone. Reconstruction was achieved by a cortical autograft. In all cases, painless joint movement was preserved with satisfactory muscle power.

[Epiphysiodesis in the treatment of discrepancies in length of the lower extremities (author's transl)]

Thirteen children treated only by epiphysiodesis for inequality in the length of lower limbs were reviewed after maturity. The intention was to estimate the value of the predictions of growth used in this work and the effectiveness of the operation. The result of this procedure depends upon the accuracy in predicting the further growth in order to determine at what age the operation should be performed. The imperfect results of epiphysiodesis are attributable to prediction errors and to operation delay in some cases. Prediction can be made using only roentgenographic measurement of the femur and the tibia, skeletal age and growth charts of Green and Anderson. It is not necessary to make use of others factors such as the size of the child.

Fractures of the distal femoral epiphyses. Factors influencing prognosis: a review of thirty-four cases

In a review of thirty-four fractures through the distal femoral epiphyseal plate followed for an average of four years, limb-length discrepancy of 2.0 centimeters or more (measured roentgenographically) occurred in 36% and varus or valgus deformity measured as a difference of 5 degrees or more between the involved and uninvolved extremities occurred in 33%. Reconstructive procedures (osteotomy, epiphyseodesis, or both) were required in 20%. Limitation of knee motion (eleven patients), ligament laxity (eight patients), and quadriceps atrophy (five patients) were also observed. Prognoses made on the basis of the Salter-Harris classification alone were not reliable. The development of deformity appears to be related to the degree of initial displacement of the fracture, the exactness of the reduction, and the type of fracture.

Bone growth in foals and epiphyseal compression

Limb angulation in foals may be due to defects in epiphyseal growth plates. The present state of knowledge concerning rate of growth in foals and differences in growth of different epiphyseal plates is reviewed and the importance of accurate knowledge of these parameters in treatment of angulation by unilateral retardation of an epiphyseal growth plate is stressed. Retardation of epiphyseal plate growth by compression wiring is described and its advantages in comparison with staplings are suggested. Compression wiring was used in 3 cases in which age, bone width and the degree of angulation were known so that the probable rate of bone growth could be assessed and the necessary unilateral bone increment could be calculated. It is suggested that further measurements of these parameters prior to growth plate retardation would give a more accurate comparison of the benefits of stapling and compression wiring.

The correction of genu valgum by epiphysial stapling

Forty-nine patients treated by epiphysial stapling for idiopathic genu valgum are reviewed. The children were aged from eleven to fourteen and a half years. The severity of the condition and subsequent correction were assessed by measuring the inter-malleolar distance. Results show that femoral stapling is the treatment of choice for most patients with inter-malleolar separation of up to 12-5 centimetres. The optimum age for stapling for both boys and girls is eleven and a half years. Stapling of both epiphyses is advised for those patients presenting late, for example, between thirteen and fourteen and a half years, or where the deformity is greater than 12-5 centimetres of separation. Correction rarely takes more than one year, and was cosmetically satisfactory in all cases. The operation is virtually free from complication except for a tendency for the scars to be broad and conspicuous. Stapling has proved to be a safe, effective and predicatable operation for idiopathic genu valgum.

[Treatment of juvenile fractures: general introduction (author's transl)]

As fractures sustained during childhood are "different", the treatment for them is also different than that for fractures in adults. In general the treatment is conservative. A childhood fracture has in its favor the enormous potential of the growing skeleton for healing and correction, while against it is the possibility of impaired growth following certain injuries in growth areas. There are quite specific indications for operative treatment; in other words, some fractures require internal fixation, e.g. genuine epiphyseal fracture, fracture of the neck of the femur, displacement of the head of the radius.

14C-glucose and 35S-metabolism of pig epiphysial cartilage and its variations after osteotomy

On in vitro incubation of articular and epiphysial cartilage of the ulna of the domestic pig 70 to 80 per cent of [U-14C] glucose was metabolised to 14C-lactate, but cartilage of the epiphysial plate produced up to five times as much 14C-CO2 as articular cartilage, and the specific radioactivity of 14C(or 35S)-chondroitin 4(6)-sulphate isolated from epiphysial cartilage (following 35S-sulphate incorporation) was about twice as high as that of articular cartilage. Six weeks after an osteotomy on both sides of the proximal epiphysial plate of the lift ulna, the glucose uptake, lactate production, and the specific radioactivity of the glycosaminoglycans displayed no significant differences when compared with those of the corresponding epiphysial plate of the control right ulna, whereas a 50 per cent increase in the oxidation of 14C-glucose to 14C-CO2 was observed.

Comminuted epiphyseal fracture of the distal tibia. A case report and review of the literature

Classification of epiphyseal injuries include only simple fractures and few cases of comminuted fracture of the distal tibial epiphysis, epiphyseal plate and adjacent metaphysis. On the basis of a review of the literature, as well as our own experience, it appears that that fracture is unstable and requires open reduction and internal fixation.

[Distraction epiphyseolysis. An experimental study for bone lengthening. Part II (author's transl)]

Histological findings of rabbit's tibia after distraction epiphyseolysis within the first days and weeks shown severe disturbances of growth. There is a transformation zone between epiphyseal bone plate and resting cells with early ossification. Furthermore there was a lasting interruption of the perichondral ring, especially with growth disturbance in longitudinal direction of the epiphyseal plate. Comparison to the traumatic epiphyseolysis in children and adolescents are discussed, also the reaction of lasting tension power on epiphyseal plates.

[The cryoeffect on the growing bone (morphological findings on the kneejoints of rabbits as an example) (author's transl)]

The cryoeffect on growing long bones is studied. The kneejoints including the bordering surrounding epiphyseal disks of the femur, tibia and fibula of 35 young (4-6 weeks old) and 6 adult rabbits were frozen by dipping the knee joints totally or partially into liquid nitrogen (-196 degrees C). The freezing time varies 3-5 min. After different times of survival maximally up to 397 days the animals are sacrified. The length of the cryosurgical treated and untreated extremities are measured and the kneejoints, especially the epiphyseal disks, are studied lightmicroscopically. Totally or partially frozen joints show after a complete necrosis in the phase of regeneration and reparation an uncoordinated overgrowth of cartilage-and bone cells and a proliferation of connective tissue with deformation of the epiphysis. The above mentioned facts and the disturbance of growth in length in young animals is mainly caused by the irregular function of the epiphysical disks after being treated cryosurgically. Also the epiphysical disks being only partially treated cryosurgically show growth disturbances and deformities. Deducing from the animal experiments clinical cryosurgery, has to be applied with extreme caution in the surrounding area of growing bone in children so that the centers of growing bone are not be frozen. Treating bones of adult rabbits cryosurgically there are only time limited reversible morphological findings so that clinically cryosurgery can be used in the surroundings areas of adult bones, especially joints, without any remarkable morphological long term findings.