Modified Dunn Technique for Unstable Slipped Capital Femoral Epiphysis: A Midterm Single Center Experience / Técnica de Dunn modificada no escorregamento da epífise femoral proximal com instabilidade: Experiência unicêntrica de médio prazo

Abstract Objective To evaluate the safety and reproducibility of the surgery for unstable slipped capital femoral epiphysis (SCFE) through the modified Dunn technique in a single center cohort from Brazil. Methods We retrospectively analyzed a cohort of patients submitted to this procedure by a single surgeon who was a hip preservation specialist. Demographic data and radiographic angles were evaluated for the relative risk (RR) of avascular necrosis (AVN) using a log-binomial regression model with simple and random effects. Results Among the 30 patients (30 hips) with a mean age of 11.79 years at the time of the operation, there were 17 boys and 18 left hips, which were operated on in a mean of 11.5 days after the slip. The mean follow-up was of 38 months. The preoperative Southwick angle averaged 60.69° against 4.52° postoperatively (p< 0.001). A larger preoperative slip angle was associated with the development of AVN (RR: 1.05; 95% confidence interval [95%CI]: 1.02-1.07; p< 0.01). The overall AVN rate was of 26.7%. Function was good or excellent in 86% of uncomplicated hips, and poor in 87.5% of the partients who developed AVN, as graded by the Harris Hip Score. There was no statistical relationship between epiphyseal bleeding and AVN development (p= 0.82). Conclusion The modified Dunn technique is associated with restoration of the femoral alignment and function after unstable SCFE, when uncomplicated. Moreover, it was shown to be reproducible in our population, with a rate of 26% of femoral head necrosis.

Resumo Objetivo Avaliar a segurança e a reprodutibilidade da cirurgia para escorregamento da epífise femoral proximal (EEPF) com instabilidade por meio da técnica de Dunn modificada em uma coorte unicêntrica no Brasil. Métodos Analisamos de forma retrospectiva uma coorte de pacientes submetidos a esse procedimento por um único cirurgião especialista em preservação do quadril. Avaliamos os dados demográficos e os ângulos radiográficos quanto ao risco relativo (RR) de necrose avascular (NAV) por meio do modelo de regressão log-binomial com efeitos simples e aleatórios. Resultados Entre os 30 pacientes (30 quadris) com idade média de 11,79 anos no momento da cirurgia, havia 17 meninos e 18 quadris esquerdos. O procedimento ocorreu em média 11,5 dias após o escorregamento. O tempo médio de acompanhamento foi de 38 meses. O ângulo de Southwick pré-operatório foi, em média, de 60,69° contra 4,52° após o procedimento (p< 0,001). O maior ângulo de escorregamento pré-operatório foi associado ao desenvolvimento de NAV (RR: 1,05; intervalo de confiança de 95% [IC95%]: 1,02-1,07; p< 0,01). A frequência geral de NAV foi de 26,7%. De acordo com a Escala de Quadril de Harris (Harris Hip Score), a função foi boa ou excelente em 86% dos quadris sem complicações, e ruim em 87,5% dos casos com NAV. Não houve relação estatística entre sangramento epifisário e desenvolvimento de NAV (p= 0,82). Conclusão A técnica de Dunn modificada restaura o alinhamento femoral e a função articular após o EEPF com instabilidade na ausência de complicações. Além disso, mostrou-se passível de reprodução em nossa população, com frequência de necrose da cabeça femoral de 26%.

Metallic screw fixation versus absorbable screw fixation after open reduction in treatment of distal tibial epiphyseal fractures in adolescents / 中华创伤骨科杂志

Objective:To compare the efficacy between metallic screw fixation and absorbable screw fixation after open reduction in the treatment of adolescent distal tibial epiphyseal fractures.Methods:A retrospective study was conducted to analyze the data of 82 patients with closed distal tibial epiphyseal fracture who had been admitted to Department of Pediatric Orthopedics, Shengjing Hospital Affiliated to China Medical University from January 2013 to December 2020. There were 61 males and 21 females (aged from 8 to 15 years), and 39 left sides and 43 right sides. The Salter-Harris classification: type Ⅱ in 25 cases, type Ⅲ in 8 cases, and type Ⅳ in 49 cases. They were divided into 2 groups according to different internal fixation methods. Group A (42 cases) was subjected to open reduction and metallic screw fixation and group B (40 cases) to open reduction and absorbable screw fixation. Preoperative data, operation time, total treatment cost and complications during follow-up were recorded and compared between the 2 groups. In both groups at the last follow-up, anteroposterior and lateral ankle radiographs were taken for radiographic evaluation of the injury to the distal tibial epiphysis and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to assess the ankle function.Results:The 2 groups were comparable because there were no significant differences in all their preoperative demographic data ( P>0.05). Group A was followed up for 18.0(16.0, 21.3) months while group B for 16.0(13.0, 20.0) months. The treatment cost for group A [27, 000 (25, 000, 33, 000) Yuan] was significantly higher than that for group B [23, 000 (19, 000, 27, 000) Yuan] ( P<0.05). The operation time was (112.4±34.3) min for group A and (101.0±41.1) min for group B, showing no significant difference ( P>0.05). The lateral distal tibial angle was 89.5 (88.0, 91.0)° on the affected side and 89.7°±1.8° on the unaffected sides in group A; it was 90.0 (88.3, 90.8)° on the affected side and 89.5°±1.8° on the unaffected side in group B. The anterior distal tibial angle was 81.9°±1.8° on the affected side and 81.8°±1.5° on the unaffected side in group A; it was 82.0 (81.0, 83.0)° on the affected side and 82.1°±2.2° on the unaffected side in group B. There was no significant difference in the above comparisons at the last follow-up in radiographic evaluation of the distal ankle joint between the affected and the unaffected sides in either group or between groups( P>0.05). There was a significant difference between the 2 groups in the rate of superficial skin infection [11.9% (5/42) versus 0% (0/40)] ( P<0.05), but there was no significant difference in the incidence of premature physeal closure between the 2 groups [11.9% (5/42) versus 5.0% (2/40)] ( P>0.05). The last follow-up revealed no significant difference in the AOFAS ankle-hindfoot score between group A [(90.6±4.9) points] and group B [(92.1±4.6) points] ( P>0.05). Conclusions:In the treatment of adolescent distal tibial epiphyseal fractures, compared with metallic screw fixation, absorbable screw fixation may lead to comparable efficacy in fixation, functional recovery and imaging evaluation, but no increased risk of premature physeal closure. Moreover, it spares the need for secondary surgical removal, and reduces operation time and treatment cost.

Fractura de la epífisis distal del fémur

Introducción: Las lesiones traumáticas de las epífisis son frecuentes en la edad pediátrica. La articulación de la rodilla es una de las más involucradas, en especial, la epífisis distal del fémur. Objetivo: Actualizar y brindar información sobre las fracturas de la epífisis distal del fémur. Método: La búsqueda y análisis de la información se realizó en un periodo de 61 días (1 de abril al 31 de mayo de 2022) y se emplearon las siguientes palabras: "physeal injuries", "physeal injuries and knee", "physeal fractures around the knee", "distal femoral physeal fracture", a partir de la información obtenida se realizó una revisión bibliográfica de un total de 153 artículos publicados en las bases de datos PubMed, Hinari, SciELO, y Medline, mediante el gestor de búsqueda y gestor de referencias EndNote, de ellos: se utilizaron 34 citas seleccionadas para realizar la revisión, 33 de los últimos cinco años. Desarrollo: Se mencionaron las características anatómicas más importantes relacionadas con el mecanismo de producción. Se hizo referencia a la clasificación de Salter Harris. Se expusieron las principales modalidades de tratamiento tanto conservadoras como quirúrgicas basadas en la clasificación. Con relación a las complicaciones se describieron las más reportadas en la literatura. Conclusiones: Las fracturas de la epífisis distal del fémur son lesiones complejas. Para su mejor entendimiento es importante conocer los mecanismos de producción, así como la clasificación basada en el grado de severidad. La terapéutica tanto conservadora como quirúrgica tiene indicaciones precisas basadas en el desplazamiento y grado de afección de la epífisis.

Introduction: Traumatic injuries of the epiphysis are frequent in the pediatric age groups. The knee joint is one of the most involved, especially, distal femoral epiphysis. Objective: Update and provide information concerning fractures of the distal femoral epiphysis. Method: Search and analysis of information was gathered over a period of 61 days (April 1 to May 31, 2022) and the following words were used as a key: physeal injuries, physeal injuries and knee, physeal fractures aroundtheknee, distal femoral physeal fracture. Based on the information obtained, a bibliographic review was made of a total of 153 articles published in the PubMed, Hinari, SciELO and Medline databases, using the search engine and reference manager EndNote: 34 selected citations were used for the review, 33 of them from the last five years. Development: The most important anatomical characteristics related to the mechanism of production were mentioned. The Salter Harris classification was pointed too. The main treatment modalities, both conservative and surgical, based on the classification, were presented. Regarding complications, the most reported in the literature were described. Conclusions: Fractures of the distal femoral epiphysis are complex injuries. For a better understanding, it is important to know the mechanisms of production, as well as the classification based on the degree of severity. Both conservative and surgical therapeutics have precise indications based on the degree and displacement of epiphysis affection.

Introdução: As lesões traumáticas das epífises são frequentes na idade pediátrica. A articulação do joelho é uma das mais acometidas, principalmente a epífise distal do fêmur. Objetivo: Atualizar e fornecer informações sobre fraturas da epífise distal do fêmur. Método: A busca e análise das informações foi realizada em um período de 61 dias (1º de abril a 31 de maio de 2022) e foram utilizadas as seguintes palavras: "lesões fisárias", "lesões fisárias e joelho", "fraturas fisárias ao redor o joelho", "fratura da fisária distal do fêmur", com base nas informações obtidas, foi realizada uma revisão bibliográfica de um total de 153 artigos publicados nas bases de dados PubMed, Hinari, SciELO e Medline, utilizando o gerenciador de busca e o gerenciador de referências EndNote , das quais: 34 citações selecionadas foram usadas para conduzir a revisão, 33 dos últimos cinco anos. Desenvolvimento: Foram mencionadas as características anatômicas mais importantes relacionadas ao mecanismo de produção. Foi feita referência à classificação de Salter Harris. As principais modalidades de tratamento, tanto conservador quanto cirúrgico com base na classificação, foram expostas. Em relação às complicações, foram descritas as mais relatadas na literatura. Conclusões: As fraturas da epífise distal do fêmur são lesões complexas. Para um melhor entendimento, é importante conhecer os mecanismos de produção, bem como a classificação com base no grau de severidade. Tanto a terapia conservadora quanto a cirúrgica têm indicações precisas baseadas no deslocamento e no grau de acometimento da epífise.

A post-treatment retrospective evaluation of slipped capital femoral epiphysis / Avaliação pós-tratamento de epifisiólise proximal do fêmur: estudo retrospectivo

ABSTRACT Objective: To analyze the cases of slipped capital femoral epiphysis (SCFE) submitted to surgery at the Pediatric Orthopedics Surgery service of the Hospital Risoleta Tolentino Neves (HRTN), Belo Horizonte/MG, between 2016 and 2019. Methods: Patients treated for SCFE at the HRTN between January/2016 and January/2019 participated in this study. The following data were collected: gender, age, affected side, procedure performed, and postoperative complications. Results: Twenty-one patients were treated at HRTN during the specified period. Among these, most were female (57%) with mean age of 12 years. At the initial diagnosis, about 80% of the patients presented with chronic/acute-on-chronic epiphysis. The left hip was slightly more affected than the right (6:5), with a bilateral rate of 47%, and avascular necrosis was the most frequent complication, occurring in 33% of cases. Conclusion: Slipped femoral capital epiphysis is associated with high morbidity; thus, early diagnosis, endocrine disorder investigation, and appropriate surgical treatment are key for improving these patients' clinical and functional outcome. Level of Evidence II, Retrospective study.

RESUMO Objetivo: Analisar os casos de epifisiólise do fêmur proximal operados pelo serviço de Ortopedia Pediátrica do Hospital Risoleta Tolentino Neves (HRTN), Belo Horizonte/MG, entre os anos de 2016 e 2019. Métodos: Foram analisados retrospectivamente os pacientes submetidos a tratamento cirúrgico de epifisiólise no Hospital Risoleta Tolentino Neves entre janeiro/2016 a janeiro/2019. Os dados coletados para análise foram: sexo, idade, lado acometido, cirurgia realizada, complicações pós-operatórias. Resultados: De janeiro de 2016 a janeiro de 2019, foram tratados 21 pacientes no HRTN. Houve predomínio do sexo feminino (57%), com média de idade de 12 anos. Cerca de 80% dos pacientes apresentaram quadro de epifisiólise crônica/ crônica-agudizada no primodiagnóstico. O lado esquerdo foi ligeiramente mais acometido em relação ao direito (6:5), com bilateralidade de 47%. A necrose avascular foi a complicação mais frequente, em 33% dos casos. Conclusão: Trata-se de quadro de alta morbidade associada, devendo haver um diagnóstico precoce, investigação de distúrbios endócrinos e tratamento cirúrgico adequado, visando uma melhora do prognóstico clínico e funcional do paciente. Nível de Evidência II, Estudo retrospectivo.

Dolor de cadera en adolescentes: estudio y tratamiento / Hip pain in adolescent: assessment and treatment

En adolescentes que consultan por dolor de cadera o pelvis, es crucial una adecuada historia clínica para orientarnos sobre la etiología del dolor y comprender los mecanismos que lo generan. Es importante conocer y realizar un exhaustivo examen físico, con especial énfasis en la cadera, incluyendo pruebas específicas para diferentes patologías, además de comprender las indicaciones de los diferentes estudios de imágenes, para así lograr un correcto diagnóstico.Entre las causas más frecuentes de coxalgia en adolescentes debemos considerar la epifisiolisis, el pinzamiento femoroacetabular con o sin roturas del labrum, las lesiones avulsivas de la pelvis, la coxa saltans, entre otras. Aunque son poco frecuentes, patologías sistémicas como reumatológicas y oncológicas también deben ser descartadas en adolescentes. Un diagnóstico de certeza nos permitirá realizar una adecuada estrategia de tratamiento, a fin de lograr una rehabilitación precoz y evitar futuras complicaciones.

In adolescents presenting with hip or pelvis pain, an adequate medical history is crucial to guide the etiology and understand the mechanisms that generate it. It is important to know and carry out an exhaustive physical examination, with special attention to the hip, including specific tests for different pathologies, in addition to understand the indications of the different imaging studies, in order to achieve a correct diagnosis. Among the most frequent causes of hip pain in adolescents, we must rule out slipped capital femoral epiphysis, femoroacetabular impingement with or without labral tears, avulsion lesions of the pelvis, snapping hip, among others. Although rare, systemic pathologies such as rheumatologic and oncologic diseases must also be ruled out in adolescents. An accurate diagnosis will allow us to carry out an adequate treatment strategy, in order to achieve early rehabilitation and avoid future complications.

Arthroscopic Treatment of Femoroacetabular Impingement in Slipped Capital Femoral Epiphysiolysis: A Case Report / Tratamento artroscópico do impacto femoroacetabular na epifisiólise capital femoral proximal: Relato de caso

Abstract Slipped capital femoral epiphysiolysis (SCFE) may result in femoroacetabular impingement (FAI) of the hip in up to one third of the cases. Residual deformity of the cam-type, or "pistol-grip", is associated with chondrolabral injury, resulting in pain, functional disability, and early osteoarthritis. The arthroscopic treatment with osteochondroplasty proved to be beneficial in a selected case of FAI secondary to SCFE.

Resumo A epifisiólise capital femoral proximal (ECFP) pode resultar em impacto femoroacetabular (IFA) do quadril em até um terço dos casos. A deformidade residual em came ou "cabo de pistola" está associada a lesão condrolabral, resultando em dor, incapacidade funcional, e osteoartrose precoce. O tratamento artroscópico com osteocondroplastia mostrou-se benéfico em um caso selecionado de IFA secundário a ECFP.

Capital femoral physeal dysplasia in cats submited to ostectomy of the femoral head and neck / Displasia femoral capital em felinos submetidos a ostectomia da cabeça e colo femoral

ABSTRACT: This report described pathological fracture of the femoral head (physeal dysplasia) in four male cats (three mixed breed and one Bengal), with an average age of 16 months, treated by an ostectomy of the femoral head and neck. Three cats were neutered and one entire. All presented with mild intermittent lameness in the pelvic limbs. Displacement of the femoral epiphysis and resorption of the femoral neck were present and excision of the femoral head and remaining neck was performed in all cases. Hstological examination showed mild foci of compaction and trabecular fibrosis with deposition of fibrous connective tissue, permeated by granulation tissues, consistent with the original diagosis. Limb function improved in all patients from 2 to 4 weeks postoperatively. Diagnosis of physeal dysplasia is challenging and treatment is different from acute traumatic fractures. Femoral head and neck excision was considered a good alternative in these patients.

RESUMO: Este trabalho descreve a fratura patológica da cabeça do femur (displasia fiseal) em quatro machos (três raças mistas e um Bengal), com idade média de 16 meses, que foram tratados com ostectomia da cabeça e colo femorais. Três gatos eram castrados e um inteiro. Todos apresentaram leve claudicação intermitente nos membros pélvicos. O deslocamento da epífise femoral e a reabsorção do colo femoral estavam presentes, a excisão da cabeça e colo femoral foi realizada em todos os casos. O exame histológico mostrou focos de compacteção e fibrose trabecular com deposição de tecido conjuntivo fibroso, permeado por tecidos de granulação, consistentes com o suposto diagnóstico. A função dos membros melhorou em todos os paciente entre dois a quatro semanas pós-operatório. O diagnóstico da displasia fiseal pe desafiador e o tratamento é diferente das fraturas traumáticas agudas. A excisão de cabeça e colo femoral é considerada uma boa alternativa nesses pacientes.

Epifisiólisis femoral proximal, una entidad desapercibida en atención primaria / Proximal Femoral Epiphysiolysis, an Unnoticed Entity in the Primary Care / Epifisiólise próxima! do fémur: uma entidade desapercebida em atenção primária

Resumen: La epifisiólisis femoral proximal o deslizamiento capital femoral es un trastorno de la cadera que se caracteriza por un desplazamiento de la epífisis sobre la metáfisis a través de la fisis (cartílago de crecimiento), quedando la epífisis posterior e inferior. Es una entidad relativamente frecuente en atención primaria y prehospitalaria que genera dolor y limitación de cadera; sin embargo, por su sintomatología vaga es usualmente infradiagnosticada o es diagnosticada tardíamente generando consecuencias a largo plazo. Si se tienen en cuenta los factores de riesgo asociados a una adecuada exploración física y el uso imágenes diagnósticas se lograría hacer un diagnóstico oportuno y una disminución de la tasa de complicaciones.

Abstract: Proximal femoral epiphysiolysis or slipped capital femoral is a hip disorder characterized by a displacement of the epiphysis over the metaphysis through the physis (growth plate), leaving the epiphysis in a posterior and inferior position. It is a relatively frequent entity in primary and prehospital care that generates hip pain and limitation. However, due to its vague symptoms, it is usually underdiagnosed or diagnosed late, generating long-term consequences. If the risk factors associated to an adequate physical examination and the use of diagnostic images are taken into account, a timely diagnosis and a reduction in the rate of complications would be achieved.

Resumo: A epifisiólise proximal do fêmur ou escorregamento epifisário proximal do fêmur é um transtorno do quadril que é caracterizado por um deslocamento da epífise sobre a metáfise por meio da fise (placa de crescimento), ficando a epífise posterior e inferior. É uma entidade relativamente frequente em atenção primária e pré-hospitalar que gera dor e limitação do quadril; contudo, por sua sintomatologia vaga, é usualmente subdiagnosticada ou é diagnosticada tardiamente, o que leva a consequências em longo prazo. Se os fatores de risco associados com uma adequada exploração física e com o uso de imagens diagnósticas forem considerados, é possível realizar um diagnóstico oportuno e diminuir a taxa de complicações.

Evaluation of the Southwick Angle in Two Hundred Hips of Asymptomatic Children and Adolescents / Avaliação do ângulo de Southwick em duzentos quadris de crianças e adolescentes assintomáticos

Abstract Objectives To measure the mean value of the Southwick angle using two different methods, the manual (1) and digital (2) methods, and to establish a normality value. Methods A primarily descriptive study with 100 children and adolescents. Individuals with orthopedic complaints regarding the hips and/or knees or gait alterations were excluded. For each patient, an X-ray was performed on the lateral incidence of Lowenstein, totaling 100 radiographs and 200 hips. The Southwick angle was measured in two different ways by the same researcher: the conventional method (1), tracing the lines with pencils and measuring the angle with the use of a goniometer and negatoscope, and through the GNU Image Manipulation Program (GIMP) image editor (open source), version 2.7.0 (2), in which the lines were plotted and the angles of both hips were gauged on each radiograph. Later, we sought to evaluate the correlation between the two methods and to verify the mean Southwick angle by categorically correlating it by gender, age group and body mass index (BMI) in asymptomatic children and adolescents. All radiographs were authorized by the children and adolescents' parents/legal guardians. The study was approved by the ethics committee of the institutions in which the research was conducted. Results The mean of the Southwick angles obtained by the conventional method was of 8.7º (±2.0º), and, by the digital method, it was of 9.9º (±1.8º). The angle obtained by the two methods was statistically significant (p < 0.001). The majority of the studied population (95%) had a body mass index (BMI) > 18.5, and the mean of the angles was within the previously established value (∼ 10º). Conclusion For the first time, using a substantial sample size, a normal value for the Southwick angle measured in asymptomatic individuals was demonstrated. In addition, the image editor proved to be a reliable method to measuring the Southwick angle.

Resumo Objetivos Medir o valor médio do ângulo de Southwick utilizando dois métodos diferentes, manual (1) e digital (2), e estabelecer um valor de normalidade. Métodos Estudo primariamente descritivo, realizado com 100 crianças e adolescentes. Foram excluídos indivíduos que apresentavam queixa ortopédica nos quadris e/ou joelhos, ou alterações de marcha. Para cada paciente, foi realizada uma radiografia na incidência lateral de Lowenstein, totalizando 100 radiografias e 200 quadris. O ângulo de Southwick foi medido de duas formas pelo mesmo pesquisador: pelo método convencional (1), traçando-se as retas com lápis e medindo o ângulo com o uso de goniômetro e negatoscópio, e por meio do editor de imagem GNU Image Manipulation Program (GIMP; código aberto), versão 2.7.0 (2), no qual foram traçadas as linhas e aferidos os ângulos de ambos os quadris em cada radiografia. Posteriormente, buscou-se avaliar a correlação entre os dois métodos e verificar o ângulo médio de Southwick correlacionando-o categoricamente por gênero, faixa etária e índice de massa corpórea (IMC) em adolescentes e crianças assintomáticos. Todas as radiografias foram autorizadas pelos responsáveis. O estudo foi aprovado pelo comitê de ética das instituições em que a pesquisa foi realizada. Resultados A média do ângulo de Southwick obtida pelo método convencional foi de 8,7º (±2,0º), e pelo método digital, foi de 9,9º (±1,8º). O ângulo obtido pelas duas formas teve significância estatística (p < 0,001). A maioria da população estudada (95%) tinha índice de massa corpórea (IMC) > 18,5, e a média dos ângulos esteve dentro do valor previamente estabelecido como normal (∼ 10º). Conclusão Demonstrou-se, pela primeira vez, utilizando uma amostra substanciosa, um valor normal do ângulo de Southwick medido em indivíduos assintomáticos. Além disso, o editor de imagem mostrou ser um método confiável para mensuração do ângulo de Southwick.

Prevalence of rickets: a clinical study

Background: Rickets is a growing bone disease that is common in children and adolescents. It is triggered by the inability of the osteoid to calcify in a growing individual. Even in countries with ample sun exposure, rickets is a common health problem which leads to frequent morbidities. Inadequate information on its prevalence and risk factors is available. For the study of prevalence and prominence of clinical characteristics of rickets in children aged between 0 - 10 years.Methods: The present research was a cross-sectional analysis. This study was conducted over a period of one year' from June 2018 to June 2019. Department of Pediatrics, Malla Reddy Medical College, Hyderabad, India. This prospective study was conducted on 100 children presenting with signs of rickets in the pediatric department of Malla Reddy Medical College, Hyderabad. The detailed history thorough clinical examination, anthropometric measurements and ratios of each child enrolled in the study was taken. The social and demographic data was also obtained through a structured questionnaire.Results: The prevalence of rickets was found to be more prevalent in males with (70%) than in females (30%). Rickets prevalence was around 46% in the study which is higher compared to other studies. Most of the cases around 85% belonged to the age group of 0-5 years. Rachitic rosaries were the most prominent sign amongst all.Conclusions: Because of its greater prevalence among infants, Rickets continue to be a major health problem. Rachitic rosaries and thickened epiphysis are the most common clinical signs. Since Rickets are a disease which can be prevented, vitamin D should be supplemented.

A Prospective Study to Appearances of Ossification Centers in the Carpal Bones in Girls of Age Group 5 Years to 12 Years in Western Rajasthan Jodhpur Region

Background: Age estimation in living as well as dead is one ofthe most important task for a forensic practitioner. Verificationor determination of age is prerequisite for personalidentification in living as well as dead. In the present studyestimation of age in the individual of age varying between 5year to 12 years will, be conducted using the appearance ofossification of carpal bones in girls of the western Rajasthan(Jodhpur) region.Materials & Methods: The radiological prospective study of“appearances of ossification centers in the carpal bones in girlsof age group 5 years to 12 years in western Rajasthan jodhpurregion" was conducted in western Rajasthan jodhpur regionstudying in various schools of jodhpur district. The childrenwere selected for the study in the age group of 5 to12 yearsand are from the girls. All observation was noted on a commonstandard proforma and later the findings will tabulated to drawnecessary conclusion.Results: We found that triquetral appeared at age of 3-4 yearsand lunate at the age of 4-5 years. Trapezium, trapezoid andscaphoid carpals appeared between the age of 5 to 9 years.Conclusion: We concluded that Triquetral and lunate carpalsappear after capitate and hamate. Their appearance wasslightly earlier in females than in males.

Prophylactic pinning should be considered in patients at risk for slipped capital femoral epiphysis / Journal of Rural Medicine

Background: The use of prophylactic contralateral pinning for slipped capital femoral epiphysis (SCFE) remains controversial. This study evaluated the outcome of SCFE treatment and examined the use of prophylactic pinning.Methods: The study included 44 patients (33 men, 11 women; 54 hips [right, 31; left, 23]), with mean age of 12.9 (7.3–29) years, who underwent treatment between 1986 and 2017, with follow-up for more than 6 months. Patients were divided into 3 groups: group 1 had bilateral SCFE at first presentation, group 2 developed contralateral side SCFE during follow-up, and group 3 had unilateral SCFE until final follow-up. Three patients who received prophylactic pinning were excluded. Univariate and multivariate logistic analyses were performed.Results: Overall, 93% (50/54) of hips underwent positional reduction and in situ fixation and 7.4% (4/54) underwent open reduction. Mean follow-up period was 4.8 (0.5–25) years. Groups 1, 2, and 3 had 7, 3, and 31 cases, respectively. Sex, age, and follow-up period showed no significant differences among the groups. The Rohrer index was significantly higher in group 1, the affected side posterior sloping angle (PSA) was significantly higher in group 3, and the contralateral side PSA and percentage with endocrinopathy were significantly higher in group 2. In multivariate logistic analysis, age, sex, Rohrer index, affected side PSA, and endocrinopathy were significantly correlated with bilateral SCFE.Conclusion: We recommend prophylactic contralateral side pinning in patients with risk factors of obesity, high PSA before slipping, and endocrinopathy. Careful observation until growth plate closure is required in patients without risk factors.

Alpha Angle as a Predictor of Impending Contralateral Slipped Capital Femoral Epiphysis in an Asian Population

BACKGROUND: Prophylactic pinning of the uninvolved side after unilateral slipped capital femoral epiphysis (SCFE) is controversial. The alpha angle, a measurement of femoral head-neck aspherity, was proposed as a predictor of progression of contralateral SCFE with a treatment threshold of greater than 50.5°. The aim of this study was to evaluate its validity in our cohort of patients. METHODS: A retrospective review of a 10-year series of patients who presented with unilateral SCFE was conducted. Minimum follow-up duration to identify contralateral progression was 18 months. Age, sex, ethnicity, and endocrinopathies were noted. Alpha angle measurements of the unaffected hip were performed by two independent observers. The average values of measurements were used for analysis. Univariate and multivariate logistic regression analyses were performed to identify predictors of contralateral progression. A receiver operating characteristic (ROC) curve was generated. RESULTS: There were 43 patients with unilateral SCFE. Seven patients (16.3%) developed contralateral SCFE. There were 31 males (72.1%) and 12 females (27.9%). The mean duration from index surgery to contralateral fixation was 43.9 weeks (range, 16.2 to 77 weeks). The mean alpha angle was significantly higher in the patients with contralateral progression (mean, 50.7°; standard deviation [SD], 5.4°; range, 43.8° to 58.5°) than in the patients without progression (mean, 43.0°; SD, 4.2°; range, 33.0° to 52.5°; p < 0.001). The alpha angle was also identified as a statistically significant predictor of contralateral progression on multivariate analysis (p = 0.02). The intraclass correlation coefficient for interobserver reliability was moderately strong at 0.76 (95% confidence interval, 0.55 to 0.87). The area under the ROC curve was 0.88. The treatment threshold of 50.5° had a sensitivity of 0.43, specificity of 0.94, and number needed to treat (NNT) of 2.7. The ideal treatment threshold derived from the ROC curve was 49.0°, which had a sensitivity of 0.71, specificity of 0.89, and an NNT of 1.7. CONCLUSIONS: Alpha angle is a potential predictor of contralateral hip involvement in children with SCFE who may benefit from prophylactic hip fixation. Results from our series suggest a treatment threshold be 49.0°. However, given the limited sample size and moderately strong interobserver reliability, larger studies are needed to validate our findings.

Diagnosis and treatment of slipped capital femoral epiphysis in children / 国际儿科学杂志

Slipped capital femoral epiphysis is a hip disease with an unclear etiology,characterized with displacement and rotation of the femoral neck relative to the femoral epiphysis.Currently,the treatment methods vary according to clinical classification,including non-surgical treatment,in situ fixation,subcapital re-alignment osteotomy,base-of-neck osteotomy and intertrochanteric osteotomy.Postoperative complications such as avascular necrosis of femoral head,instability of hip joint,and chondrolysis are common and extremely challenging to treatment,which seriously affect the quality of life in children.Therefore,it is of great significance to clarify the treatment of different types of slipped capital femoral epiphysis and to reduce complications.At present,arthroscopic adjuvant therapy is mininally invasive and effective.This article reviews the progress of treatment of the slipped capital femoral epiphysis and the reduction of complications in children.

Caso Clínico: Luxación Controlada de Cadera. Epifisiólisis de Cabeza Femoral / Case Report: Controlled Hip Dislocation. Slipped Capital Femoral Epiphysis

INTRODUCCIÓN: La epifisiólisis de la cabeza femoral es el desplazamiento de la epífisis con respecto a la metáfisis, en dirección anterosuperior; su etiología es desconocida, frecuente en adolescentes, periodo peripuberal, y con índice de masa corporal elevado, edad promedio entre 12 y 18 años. Su incidencia es variable, 0.2 (Japón) a 10 (Estados Unidos) por 100 000 habitantes. Se caracteriza por dolor progresivo en cadera, con irradiación a la ingle o rodilla, se asocia a cojera; con la detección precoz se puede instaurar un tratamiento adecuado, el más aceptado es la fijación in situ con tornillos centrales. CASO CLÍNICO: Paciente de sexo femenino 14 años de edad sin antecedentes patológicos, acudió al servicio de ortopedia infantil por presentar dolor lancinante crónico de cadera derecha de nueve meses de evolución que aumenta con la deambulación, diagnosticada por clínica y exámenes complementarios de imagen de epifisiólisis de cabeza femoral. Se realizó luxación quirúrgica de la cadera y reducción abierta anatómica con colocación de tornillos esponjosos. EVOLUCIÓN: Al tercer día de la cirugía, se decide alta hospitalaria; deambulación con muletas y sin apoyo durante un mes posquirúrgico. La osteosíntesis permaneció durante un año con controles mensuales y fisioterapia correspondiente; se ha evidenciado evolución favorable; arcos de movilidad de cadera conservados, deambulación normal, sin complicaciones. CONCLUSIÓN: El tratamiento inicial de un paciente con epifisiólisis de cabeza femoral estable depende del tiempo de evolución y se realiza fijando con tornillos o agujas mediante la luxación anatómica de la cadera y osteoplastia de remodelación del cuello femoral. La mayoría de los pacientes no desarrollan necrosis ni condrolisis y los resultados a largo plazo con la fijación in situ suelen ser excelentes, a diferencia de los pacientes con diagnóstico tardío.

BACKGROUND: The epiphysiolysis of the femoral head is the displacement of the epiphysis with respect to the metaphysis, in anterosuperior direction; it is etiology is unknown, frequent in adolescents, peripubertal period, and with high body mass index, average age between 12 and 18 years. It is incidence is variable, 0.2 (Japan) to 10 (United States) per 100 000 inhabitants. It is characterized by progressive pain in the hip, with irradiation to the groin or knee, is associated with lameness; with the early detection, an adequate treatment can be established, the most accepted one is the in situ fixation with central screws. CASE REPORT: A 14-year-old female patient with no pathological history attended the Children's Orthopedic Service due to the chronic lancinating pain of the right hip, which increases with walking, it is diagnosed by clinical examination and complementary exams of femoral head epiphysiolysis. Surgical dislocation of the hip and anatomical open reduction with placement of spongy screws was performed. EVOLUTION: On the third day of surgery, hospital discharge is decided; walking with crutches and without support during a postoperative month. The osteosynthesis remained for a year with monthly controls and corresponding physiotherapy; it has been evidenced favorable evolution; hip mobility arches preserved, normal ambulation, without complications CONCLUSIONS: The initial treatment of a patient with epiphysiolysis of stable femoral head depends on the evolution time and is done by fixing with screws or needles with of anatomical dislocation of the hip and osteoplasty of femoral neck remodeling. Most patients do not develop necrosis or chondro- lysis and long-term results with in situ fixation are usually excellent, unlike patients with late diagnosis.

Oblique Percutaneous In-Situ Cannulated Screw Fixation Of Stable Slipped Capital Femoral Epiphysis- Our Surgical Experience

Introduction: The percutaneous in-situ pinning perpendicular to the physis has been described as the standard technique for fixing mild to moderate stable Slipped capital femoral epiphysis. In this study we are going to discuss about our results using an alternative anterolateral oblique pinning technique for SCFE. Methods: We treated 10 patients by this technique from June 2015 to May 2017. The average age of the patients was 12 years with the range between 10 to 15 years. Only mild to moderate slips as measured by Southwick angle of less than 60 degrees in frog leg lateral view were included in this study. Results: None of the patients developed complications like screw penetration, AVN, chondrolysis, slip progression or breakage of screw. There was restriction of terminal 10 degrees abduction in 6 patients and obligatory external rotation on hip flexion in 3 patients. Conclusion: To conclude anterolaterally based insitu oblique screw fixation is a relatively easier technique providing better stability without risk of complications.

Femoral pseudoaneurysm as a complication of slipped capital femoral epiphysis treatment / Pseudoaneurisma femoral como complicação do tratamento cirúrgico de epifisiólise proximal do fêmur

ABSTRACT Slipped capital femoral epiphysis is a very frequently seen condition in orthopedics centers worldwide. Even in successfully treated cases, complications related either with the pathology per se or with the chosen synthesis method are not rare. This report presents a case of bilateral slipped capital femoral epiphysis treated with pinning, in which one of the limbs developed a very rare condition: the formation of a femoral pseudoaneurysm that ruptured.

RESUMO A epifisiólise proximal da cabeça femoral é uma patologia frequentemente tratada em centros de ortopedia. Mesmo nos casos de tratamento bem-sucedido, complicações relacionadas tanto ao fenômeno em si quanto à síntese escolhida não são raras. Os autores relatam um caso de epifisiólise da cabeça femoral bilateral, submetido a pinagem, que evoluiu com uma complicação raríssima em um dos membros: a formação de um pseudoaneurisma femoral, com posterior rotura.

Determinación forense de la edad en individuos vivos / Forensic determination of age in living individuals

ResumenEste artículo es una revisión bibliográfica, sobre la determinación de la edad en individuos vivos, desconocidos e indocumentados, en los que resulta fundamental debido a un proceso legal determinar si son mayores de edad. La estimación de la edad, es un estudio relativamente joven de la medicina forense, que tomó importancia en los años noventa, debido a los movimientos migratorios.

SummaryThis is a bibliographical review, on the determination of the age in alive, unknown and undocumented individuals, in which it is fundamental to determine if they are of age. The estimation of the approximate age, is a relatively young study of the forensic medicine, that took importance in the nineties, due to the migratory movements.

Lexema phy-sis en terminologia anatomica / Lexema phy-sis in terminologia anatomica

Múltiples palabras habituales utilizan raíces grecolatinas, como el caso de las estructuras mencionadas en Terminologia Anatomica. Un grupo de términos anatómicos originados en la Antigua Grecia emplean el lexema griego phy-sis o su homólogo ­fisis en español, es por ello que este trabajo tiene por objetivo analizar su significado y etimología en el diccionario de la Universidad de Salamanca, Diccionario de Términos Médicos de la Real Academia Nacional de Medicina y en el Diccionario Etimológico griego-latín del español, para contribuir a la comprensión y aprendizaje de Terminologia Anatomica en el estudio de la Anatomía Humana. Se propone que los estudiantes que cursan la asignatura de Anatomía Humana posean conocimientos básicos de latín y griego, para facilitar su aprendizaje y correcta aplicación de los términos.

Multiple common words use Greek and Latin roots, as is the case of structures mentioned in Terminologia Anatomica. For instance, a number of anatomical terms originating in ancient Greece, use the Greek lexeme ph-sis or its homologue -fisis in Spanish. Therefore, this work aims to analyze meaning and etymology of this term in the Universidad de Salamanca dictionary, the Royal National Academy of Medicine Dictionary of Medical Terms, and in the Spanish etymological Greek-Latin dictionary, to contribute to the understanding and learning of Terminologia Anatomica in the study of Human Anatomy. To facilitate learning and the correct use of Terminologia Anatomica, we propose that students in Human Anatomy course assignments acquire a basic knowledge of Latin and Greek.

Transphyseal separation of the distal humerus in newborns / 中华创伤杂志(英文版)

Obstetric traumatic separation of the distal humeral epiphysis is a very uncommon injury, which presents a diagnostic challenge. These case serials reviewed the functional outcomes of 5 patients who had sustained a fracture-separation of the distal humeral epiphysis at birth. The diagnosis was made at a mean time of 40.8 h after delivery. All the patients were treated with gentle close manipulation, reduction under fluoroscopy and above-elbow cast application. After discharge, the patients were followed up for a mean of 30 months. Clinico-radiological results were excellent in four patients. One case necessitated closed reduction and percutaneous K-wire fixation at one week follow-up due to failed reduction. Cubitusvarus deformity was the only complication noted in 1 case. Good functional outcome can be expected in newborns with fracture-separation of the distal humeral epiphysis wherein the physis is anatomically reduced.