Effects of Multiple Drilling on the Ischemic Capital Femoral Epiphysis of Immature Piglets

PURPOSE: This study investigated the effects of multiple drilling on the immature capital femoral epiphysis following ischemic injury in a piglet model. MATERIALS AND METHODS: Ischemic necrosis of capital femoral epiphysis was induced bilaterally in 12 piglets using a cervical ligation method. Three weeks later, medial, central, and lateral 3 drill holes were made on the left femoral head using 0.062" K-wire. At 3, 6, 9, and 12 weeks following the multiple drilling, femoral heads were harvested from each three piglets. On histologic examination, percent of revascularization, percent of osteoblast surface, capital femoral epiphyseal quotient and proximal femoral growth plate height were evaluated. Untreated right femoral heads served as control. RESULTS: While percent of revascularization of left capital femoral epiphysis with multiple drilling was significantly higher than untreated control side (p<0.001), percent of osteoblast surface, capital femoral epiphyseal quotient and proximal femoral growth plate height showed no significant difference. CONCLUSION: This study indicates that multiple drilling could promote revascularization of ischemic capital femoral epiphysis, and multiple drilling does not appear to produce bony physeal bars at short-term, if using small diameter drill. However, multiple drilling alone does not seem to prevent femoral head deformity or to promote new bone formation.

Morphological Study of Femoral Head and Acetabulum Using MRI in Legg-Calve-Perthes Disease / 대한정형외과학회잡지

PURPOSE: We used MRI to evaluate the morphological relationship of the femoral head and acetabulum with changes of hip position in LCP disease. MATERIALS AND METHODS: The MRIs of 35 patients (17 pillar B, 18 pillar C; mean age: 7.8 years old) were reviewed in neutral, abduction, abduction-internal rotation, abduction-internal rotation-flexion, and adduction positions. The measurements included epiphyseal extrusion index (EEI), head coverage (HC), and medial gap ratio (MGR). The congruence of the hip joint and adjacent soft tissue changes were also studied. RESULTS: Decreased EEI and increased HC in both pillar B and C from neutral to the abduction and abduction- internal rotation positions were statistically significant (p<0.05). However, in decreased MGR, statistical significance was seen only in pillar B. The increase of MGR in pillar C, from neutral to adduction, did not show statistical significance due to the tension of the soft tissues lying lateral to the hip joint. CONCLUSION: This study supports the basic concept of containment treatment in pillar B and suggests a rationale for valgus femoral osteotomy in cases of pillar C with hinge abduction.

The Prognostic Assessment of Legg-Calve-Perthes Disease / 대한정형외과학회잡지

The management of LcP disease is dependent on the prognosis yet. This may be difficult to predict for the individual child, particularly at the onset of the disease when radiological sign may be minimal. But some form of conservative treatment is generally commenced before the prognosis become apparent. The purpose of this study was to determine the validity of Catterall's grouping and value of other radiological and clinical factors in predictiong prognisis and also the correlation between the clinical and radiological results at the conclusion of the pathological precess in LCP disease. Between the clinical and radiological results at the conclusion of the pathological process in LCP disease. Between June 1986 and July 1995, 64 childrens with LCP disease were tearted in Kyungpook University Hospital, 44 hips of 40 childrens who had adequate clinical and radiological data were reviewed. The average follow-up period was 5.4 years. The results obtained were followings: 1.The mean age at first visit or diagnosis was 6.7 years. 2. Of 40 childrens, 4 childrens had bilateral involvement. Boys were more predominat. 3. The degree of uncovering of femoral head and medial joint space at the presentation seemed to be prognostic factor for the end results. 4. Catterall & lateral pillar classification seemed to be difficult at presentation of the disease but also an important guide to determine the prognosis.