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.

Influence of age and sex on bone development and athletic career longevity of Thoroughbred racehorses in Brazil - preliminary study / Influência do gênero e da idade no estágio de desenvolvimento ósseo e longevidade atlética de equinos da Raça Puro Sangue Inglês de corridas no Brasil - estudo preliminar

The impact of high-speed exercise on the musculoskeletal system of young racehorses has been extensively discussed because of concerns regarding animal health and welfare. This study investigated the correlation between age, degree of ossification of the distal radial epiphysis, sex, and career longevity of Thoroughbred racehorses in Brazil from 2012 to 2015. We performed a retrospective evaluation of 286 dorsopalmar radiographs of the left radiocarpal region of young horses and their racing performance. Distal radial epiphyseal closure was classified into three degrees: A, B, or C. Performance data included the number of races raced, athletic career length, and the number of races per month. The variables were subjected to regression analysis. At the time of radiographic examination, male horses were significantly older than females, and horses with epiphyseal closure degrees differed with age. Age at first race was 33.08±3.81 months, the average of races raced was 18.32±15.14 races, athletic career duration was 20.37±13.82 months, and the number of races raced per month was 0.93±0.46 races. Age influenced (P>0.001) the distal radial epiphyseal closure on racehorses, but sex did not (P=0.218 for males and P=0.275 for females). An inverse association was observed between age at the first race, the number of races raced per month, and athletic career duration. The frequency of race and the age at the first race influenced athletic career duration.

O impacto do exercício de alta velocidade no sistema musculoesquelético de cavalos de corrida jovens tem sido amplamente discutido devido a preocupações com a saúde e o bem-estar animal. Este estudo investigou a correlação entre idade, grau de ossificação da epífise radial distal, sexo e longevidade da carreira de cavalos Puro Sangue Inglês de corrida no Brasil de 2012 a 2015. Realizamos uma avaliação retrospectiva de 286 radiografias dorsopalmar da região radiocarpica esquerda de cavalos jovens e seu desempenho de corrida. O fechamento epifisário radial distal foi classificado em três graus decrescentes: A, B ou C. Os dados de desempenho incluíram o número de corridas disputadas, duração da carreira atlética e o número de corridas por mês. As variáveis foram submetidas à análise de regressão. No momento do exame radiográfico, os cavalos machos eram significativamente mais velhos que as fêmeas, e os cavalos com diferentes graus de fechamento epifisário diferiram com a idade. A idade na primeira corrida foi de 33,08±3,81 meses, a média de corridas disputadas foi de 18,32±15,14 corridas, a duração da carreira atlética foi de 20,37±13,82 meses e o número de corridas realizadas por mês foi de 0,93±0,46 corridas. A idade influenciou (P>0,001) o fechamento da epífise radial distal em cavalos de corrida, mas o sexo não (P=0,218 para machos e P=0,275 para fêmeas). Uma associação inversa foi observada entre a idade na primeira corrida, o número de corridas disputadas por mês e a duração da carreira atlética. A frequência de corrida e a idade na primeira corrida influenciaram a duração da carreira atlética.

Growth plate stress distribution implications during bone development: a simple framework computational approach.

Mechanical stimuli play a significant role in the process of long bone development as evidenced by clinical observations and in vivo studies. Up to now approaches to understand stimuli characteristics have been limited to the first stages of epiphyseal development. Furthermore, growth plate mechanical behavior has not been widely studied. In order to better understand mechanical influences on bone growth, we used Carter and Wong biomechanical approximation to analyze growth plate mechanical behavior, and explore stress patterns for different morphological stages of the growth plate. To the best of our knowledge this work is the first attempt to study stress distribution on growth plate during different possible stages of bone development, from gestation to adolescence. Stress distribution analysis on the epiphysis and growth plate was performed using axisymmetric (3D) finite element analysis in a simplified generic epiphyseal geometry using a linear elastic model as the first approximation. We took into account different growth plate locations, morphologies and widths, as well as different epiphyseal developmental stages. We found stress distribution during bone development established osteogenic index patterns that seem to influence locally epiphyseal structures growth and coincide with growth plate histological arrangement.

Intra-articular Radial Head Fractures In the Skeletally Immature Patient: Complications and Management.

BACKGROUND: Intra-articular (IARH) and extra-articular (EARH) radial head fractures in skeletally immature patients are rare injuries that have not been well studied. The objective of this study was to investigate the rate of complications associated with IARH fractures relative to EARH fractures in pediatric patients treated at a tertiary referral children's hospital. METHODS: With IRB approval, Current-Procedural Terminology codes were used to identify all patients who underwent management of radial head and/or neck fractures between 2005 and 2012. A retrospective chart review was used to collect variables related to: demographics, fracture type, treatment method(s), complications, need for physical/occupational therapy, and the need for subsequent surgery. Mid-P exact tests and logistic regression analyses were used to compare differences in the incidence of complications, need for physical therapy (PT), and need for revision surgery between the IARH and EARH fracture groups. RESULTS: Among the 311 patients included in the cohort, 12 (3.86%) were affected by IARH fractures and 299 (96.14%) were affected by EARH fractures. The mean age at the time of injury was 11.46 (±3.09) years and 8.32 (±3.31) years in the IARH and EARH group, respectively. The estimated incidence of complications was significantly (P<0.0001) higher in the IARH group (50 per 100) compared with the EARH group (1.34 per 100). A significantly (P<0.0001) greater proportion of the subjects with IARH fractures also required revision surgery (25% IARH vs. 0% EARH) and PT (50% IARH vs. 19.59% EARH). CONCLUSIONS: Compared with EARH fractures, IARH fractures were associated with a significantly higher rate of complications, greater need for PT, and greater need for surgical intervention. The significant complication rate associated with pediatric IARH fractures necessitates an increased awareness of this fracture pattern and prompt, aggressive diagnostic and treatment modalities. LEVEL OF EVIDENCE: Therapeutic studies: Level III.

Nonanatomic anterior cruciate ligament reconstruction with double-stranded semitendinosus grafts in children with open physes: minimum 15-year follow-up.

BACKGROUND: Nonanatomic anterior cruciate ligament (ACL) reconstruction (ACLR) with double-stranded semitendinosus grafts in children with open physes has been described as a successful surgical technique in short-term follow-up clinical reports. PURPOSE: To evaluate the clinical outcomes of nonanatomic ACLR in children with open physes and a minimum of 15 years' follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twelve patients with an average age of 10.7 years (range, 8.3-12.4 years) underwent ACLR between 1991 and 1998. All patients were classified as Tanner development stage 2 or lower. The surgical technique involved transphyseal tibial tunnel drilling and over-the-top (OTT) femoral fixation using a double-stranded graft for all patients. Clinical outcomes were evaluated in terms of the manual Lachman test, pivot-shift test, return to sports activity, and International Knee Documentation Committee (IKDC) score at the end of growth and at a minimum 15-year follow-up (range, 15-22 years). RESULTS: No clinically significant growth disturbance was observed. Ten patients had a grade A IKDC score, and 2 patients had a grade B IKDC score at the end of growth. There was no progression of laxity or modification of knee stability with growth. Three patients (25%) had ACL reruptures during sports activities after growth plate closure. All patients with reruptured ACLs underwent additional reconstructive surgery. CONCLUSION: Anterior cruciate ligament reconstruction using the OTT technique in the femur and the transphyseal technique in the tibia produces good results with regard to growth plate closure but a high failure rate in adulthood.

The multiple effects of thyroid disorders on bone and mineral metabolism.

Differently from most hormones, which commonly are specialized molecules able to influence other cells, tissues and systems, thyroid hormones (TH) are pleiotropic peptides, whose primordial function is difficult to identify. The complex action of TH on human economy can be easily witnessed by examining the diverse consequences of TH excess and deficiency during development and after maturity. In particular, different manifestations in bone modeling and remodeling reflect the circumstantial consequences of thyroid disturbances, which are age dependent. While hyperthyroidism during childhood enhances bone mineralization and accelerates epiphyseal maturation, in adults it induces bone loss by predominant activation of osteoclast activity. Furthermore, the syndrome of TH resistance is a multifaceted condition in which different sites exhibit signs of hormone excess or deficiency depending on the configuration of the TH receptor isoform. The investigation of the impact of TH resistance on the skeleton still remains to be elucidated. We present here a thorough review of the action of TH on bone and of the impact of thyroid disorders, including hyper- and hypothyroidism and the syndrome of TH resistance, on the skeleton.

The multiple effects of thyroid disorders on bone and mineral metabolism / Os múltiplos efeitos das disfunções tireoidianas sobre o metabolismo osteomineral

Differently from most hormones, which commonly are specialized molecules able to influence other cells, tissues and systems, thyroid hormones (TH) are pleiotropic peptides, whose primordial function is difficult to identify. The complex action of TH on human economy can be easily witnessed by examining the diverse consequences of TH excess and deficiency during development and after maturity. In particular, different manifestations in bone modeling and remodeling reflect the circumstantial consequences of thyroid disturbances, which are age dependent. While hyperthyroidism during childhood enhances bone mineralization and accelerates epiphyseal maturation, in adults it induces bone loss by predominant activation of osteoclast activity. Furthermore, the syndrome of TH resistance is a multifaceted condition in which different sites exhibit signs of hormone excess or deficiency depending on the configuration of the TH receptor isoform. The investigation of the impact of TH resistance on the skeleton still remains to be elucidated. We present here a thorough review of the action of TH on bone and of the impact of thyroid disorders, including hyper- and hypothyroidism and the syndrome of TH resistance, on the skeleton.

Diferentemente da maioria dos hormônios, que usualmente são moléculas especializadas capazes de influenciar outras células, tecidos e sistemas, os hormônios da tireoide (HT) são peptídeos pleiotrópicos, cuja função primordial é difícil de identificar. A ação complexa dos HT na fisiologia humana pode ser facilmente reconhecida ao observar as diversas consequências do excesso e da deficiência de HT durante e após o pleno desenvolvimento. Em particular as diferentes manifestações na modelação e remodelação óssea refletem que as consequências esqueléticas das disfunções tireoidianas dependem das circunstâncias e variam com a idade. Enquanto o hipertireoidismo durante a infância aumenta a mineralização óssea e acelera a maturação epifisária, em adultos induz a perda óssea pela ativação predominante da ação osteoclástica. Além disso, a síndrome de resistência ao HT é uma condição multifacetada na qual diferentes tecidos apresentam sinais de excesso ou deficiência hormonal, dependendo da predominância da expressão das diversas isoformas do receptor de HT. O impacto da resistência ao HT sobre o esqueleto ainda é motivo de investigação. Apresentamos aqui uma revisão abrangente sobre as ações ósseas dos HT e o impacto no esqueleto dos distúrbios da tireoide, incluindo hipo e hipertireoidismo e síndrome de resistência ao HT.

In vitro effects of caffeine in growth cartilage of rats / Efeitos in vitro da cafeína na cartilagem de crescimento de ratos

OBJETIVO: Avaliar os efeitos in vitro da cafeína na proliferação, apoptose e expressão de transcriptos gênicos de diferenciação condrogênica na cartilagem de crescimento.MÉTODO: As epífises cartilaginosas de fêmures de ratos neonatos foram divididas em dois subgrupos: os tratados com cafeína e o grupo controle, ambos observados nos tempos de 0, 7, 14 e 21 dias. As epífises cartilaginosas de fêmures de cada subgrupo e de cada tempo foram submetidas à histomorfometria, análise imunoistoquímica, técnica de túnel e RT-PCR em tempo real.RESULTADO: A diminuição da atividade proliferativa e o aumento de condroblastos em apoptose aos 21 dias foram encontrados em ambos os subgrupos. Entretanto a diminuição da proliferação celular causada pela cafeína foi menor quando comparada ao grupo controle e aumentou significativamente a expressão de transcriptos gênicos para diferenciação condrogênica, representada pelo SOX-9 e pelo RUNX-2. Entretanto o cultivo in vitro com cafeína demostrou efeitos antagônicos: apesar dos efeitos positivos na proliferação e diferenciação de condroblatos, cafeína aumentou a apoptose, caracterizada pelo aumento da expressão de caspase-3 e do numero de células em apoptose (p< 0.05).CONCLUSÃO: A cafeína apresenta efeitos antagônicos in vitro na cartilagem em crescimento, aumentando a proliferação, diferenciação e apoptose celular. Estudo experimental.

OBJECTIVE: To evaluate the in vitro effetcs of caffeine on proliferation, apoptosis and gene transcripts expression of chondrogenic differentiation in growth cartilage.METHODS: The cartilaginous epiphyses of femurs of newborn rats, which were divided into two subgroups: treated with caffeine and control group, both observed over the time periods of 0, 7, 14 and 21 days. The cartilaginous epiphyses of femurs of each subgroup and each time span were subjected to histomorphometric, immunohistochemical analysis, Tunel technique and RT-PCR in real time.RESULTS: The decrease in proliferative activity and the increase of apoptotic chondroblasts at 21 days were found regardless of the subgroup. However, the decrease in cell proliferation caused by caffeine was lower than in the control group and significantly increased the expression of gene transcripts for chondrogenic differentiation, represented by SOX-9 and RUNX-2. However, the in vitro culture with caffeine revealed antagonistic effects: despite the positive effect on chondroblasts proliferation and differentiation, caffeine increased apoptosis, characterized by increased expression of caspase 3 and of the number of cells undergoing apoptosis (p<0.05).CONCLUSION: Caffeine presents antagonistic effects in vitro on growth cartilage, increasing the proliferation, differentiation and cell apoptosis. Experimental Study.

Crescimento e desenvolvimento de boto-cinza (Sotalia guianensis) do litoral do Espírito Santo / Growth and development of estuarine dolphin (Sotalia guianensis) from Espírito Santo coast

Estudou-se o desenvolvimento do boto-cinza (Sotalia guianensis) do litoral do Espírito Santo e verificou-se se a análise das radiografias da aleta peitoral pode ser utilizada para tal. Trinta e sete botos passaram pela determinação do comprimento total (CT), análise do grau de fusionamento das vértebras e radiografia das aletas peitorais. O CT ao nascimento foi de 103,3cm e o de animais maduros fisicamente 187,5cm. Observou-se correlação entre o CT, as epífises distais do rádio e da ulna e correlação entre o grau de fusionamento vertebral e a epífise distal do rádio. Concluiu-se que a análise radiográfica das aletas peitorais é uma boa maneira de avaliar o grau de maturação física do boto.(AU)

The aim of this study is to analyze the development of the estuarine dolphin from the coast of Espírito Santo and verify that the analysis of X-rays of pectoral fin can be used for such. Thirty-seven Sotalia guianensis were used, determining the TL, examination of the degree of fusion of the vertebrae and X-ray of pectoral fins. At birth the TL is 103.3cm and in physically mature animals the TL is 187.5cm. The TL showed a significant correlation with the epiphyses of the distal radius and ulna and the degree of spinal fusion showed significant correlation with distal radius. It can be concluded that the X-ray analysis of the pectoral fins is a good way of assessing the physical maturation of these animals and can be used in routine procedures.(AU)

A mechanobiological model of epiphysis structures formation.

Developing bone consists of epiphysis, metaphysis and diaphysis. The secondary ossification centre (SOC) appears and grows within the epiphysis, involving two histological stages. Firstly, cartilage canals appear; they carry hypertrophy factors towards the central area of the epiphysis. Canal growth and expansion is modulated by stress on the epiphysis. Secondly, the diffusion of hypertrophy factors causes SOC growth. Hypertrophy is regulated by biological and mechanical factors present within the epiphysis. The finite element method has been used for solving a coupled system of differential equations for modelling these histological stages of epiphyseal development. Cartilage canal spatial-temporal growth patterns were obtained as well as the SOC formation pattern. This model qualitatively agreed with experimental results reported by other authors.

A mathematical model of epiphyseal development: hypothesis of growth pattern of the secondary ossification centre.

This paper introduces a 'hypothesis about the growth pattern of the secondary ossification centre (SOC)', whereby two phases are assumed. First, the formation of cartilage canals as an event essential for the development of the SOC. Second, once the canals are merged in the central zone of the epiphysis, molecular factors are released (primarily Runx2 and MMP9) spreading and causing hypertrophy of adjacent cells. In addition, there are two important molecular factors in the epiphysis: PTHrP and Ihh. The first one inhibits chondrocyte hypertrophy and the second helps the cell proliferation. Between these factors, there is negative feedback, which generates a highly localised and stable pattern over time. From a mathematical point of view, this pattern is similar to the patterns of Turing. The spread of Runx2 hypertrophies the cells from the centre to the periphery of the epiphysis until found with high levels of PTHrP to inhibit hypertrophy. This mechanism produces the epiphyseal bone-plate. Moreover, the hypertrophy is inhibited when the cells sense low shear stress and high pressure levels that maintain the articular cartilage structure. To test this hypothesis, we solve a system of coupled partial differential equations using the finite element method and we have obtained spatio-temporal patterns of the growth process of the SOC. The model is in qualitative agreement with experimental results previously reported by other authors. Thus, we conclude that this model can be used as a methodological basis to present a complete mathematical model of the whole epiphyseal development.

A mathematical model of epiphyseal development: hypothesis on the cartilage canals growth.

The role of cartilage canals is to transport nutrients and biological factors that cause the appearance of the secondary ossification centre (SOC). The SOC appears in the centre of the epiphysis of long bones. The canal development is a complex interaction between mechanical and biological factors that guide its expansion into the centre of the epiphysis. This article introduces the 'Hypothesis on the growth of cartilage canals'. Here, we have considered that the development of these canals is an essential event for the appearance of SOC. Moreover, it is also considered to be important for the transport of molecular factors (RUNX2 and MMP9) at the ends of such canals. Once the canals are merged in the centre of the epiphysis, these factors are released causing hypertrophy of adjacent cells. This RUNX2 and MMP9 release occurs due to the action of mechanical loads that supports the epiphysis. In order to test this hypothesis, we use a hybrid approach using the finite element method to simulate the mechanical stresses present in the epiphysis and the cellular automata to simulate the expansion of the canals and the hypertrophy factors pathway. By using this hybrid approach, we have obtained as a result the spatial-temporal patterns for the growth of cartilage canals and hypertrophy factors within the epiphysis. The model is in qualitative agreement with experimental results previously reported by other authors. Thus, we conclude that this model may be used as a methodological basis to present a complete mathematical model of the processes involved in epiphyseal development.

Aspectos histológicos da epífise de crescimento ósseo em resposta ao exercício físico extenuante em camundongos / Histologic aspects of bone growth epiphysis after strenuous physical exercise in mice

Procurou-se identificar se existe alteração histológica na epífise de crescimento ósseo de camundongos submetidos a exercício físico extenuante. Para tanto, foi realizada uma pesquisa experimental com uma amostra de 8 camundongos, que ficaram em condições ambientes em um biotério, alimentados com água e ração comum, ad libitum. A ninhada foi dividida em dois grupos, um grupo controle e um grupo experimental, sendo que, o grupo experimental foi submetido a um exercício físico extenuante, caracterizado pelo aumento do nível de ácido láctico sanguíneo, realizado por 40 minutos/dia, durante 20 dias ininterruptos. Ao final da intervenção, foram confeccionadas lâminas histológicas, com cortes longitudinais do fêmur dos camundongos e analisadas em um microscópio óptico. Os dados obtidos mostraram alteração na estrutura epifisária do grupo experimental com aparente diminuição da zona proliferativa do disco epifisário, articulação mais desenvolvida e aumento das espículas ósseas com diminuição das trabéculas, sugerindo uma maturação precoce da epífise de crescimento. Através da análise dos resultados, conclui-se que o exercício físico extenuante modifica a estrutura da epífise de crescimento ósseo em camundongos.

The aim of this study was to identify histological alterations in bone growth epiphysis of mice submitted to a tiring physical exercise. For so, it was carried out an experimental research with a sample of 8 mice that stayed in environment conditions, fed with water and common feed, ad libitum. The brood was divided in two groups, a control group and an experimental group, being the experimental group submitted to a tiring physical exercise, characterized by the increasing of blood lactate level, carried out by 40 minutes/day, during 20 days uninterrupted. At the end of the intervention, were confectioned histological slides corresponding to the bone growth epiphysis of the femur of the mice and analyzed in an light microscope. Data showed an alteration in the epiphysis structure in the experimental group, with apparent decrease of the proliferation zone of epiphysis disc, an articulation more evolution and an increase of bone specula’s with a decrease of trabeculaes, what suggests an early maturation, accelerating the substitution of cartilaginous woven by bone weave. Through the analysis of the results, it was concluded that the tiring physical exercise modifies the structure of bone growth epiphysis in mice.

Correction of bone angular deformities: experimental analysis of staples versus 8-plate.

BACKGROUND: Hemi-epiphysiodesis should always be considered as an effective treatment to correct axial limb deformity in children. The use of the 8-plate as opposed to conventional staples provides firm fixation to both sides of the physis, acting mainly upon the epiphyseal growth site of the implant insertion. The aim of our study is to compare the effectiveness of both devices for performing angular corrections. METHODS: Seventeen rabbits of 18 months of age were treated with an 8-plate in the distal femur and a staple in the contralateral femur. Eight weeks later, the level of deformity produced by each device was evaluated both radiographically and histologically. RESULTS: Axial deformity: the staples produced an average deviation of 48.1 degrees, and the 8-plate produced an average deviation of 49.1 degrees (P=0.44). Final longitudinal growth of the femurs: we recorded an average of 83.17 degrees for the staples and 85.7 degrees for the 8-plate. Histologic analysis: no significant difference was observed between both femurs of the same specimen; however, a slight difference was recorded when analyzing the results of different animals. CONCLUSIONS: Correction was achieved in less time when using conventional staples. The long-term effectiveness of both epiphysiodesis is similar. Longitudinal growth inhibition is lower when using 8-plate. CLINICAL RELEVANCE: Although both methods are effective in stopping the growth, the 8-plate has better grasp to the bone or epiphyseal cartilage avoiding extrusion in small children. The correction is faster using a staple and that is the reason why we prefer its usage in patients with little remnant growth.

Normal reference values of Southwick's anteroposterior angle in prepubertal and pubertal normal adolescents.

Measurement of the Southwick's anteroposterior (AP) angle (shaft epiphysis proximal femoral AP angle) is not only a useful tool for planning the surgical treatment of deformities caused by slipped capital femoral epiphysis, but seems to be also important for recognizing the risk of epiphysiolysis development in obese patients (increased AP angle) or to confirm the diagnosis of slipped capital femoral epiphysis (decreased AP angle). To establish normal reference values of the Southwick's AP angle, we studied 97 normal nonobese adolescents (42 females, 55 males), with ages ranging between 8 and 16 years. The mean (SD) AP angle was 151.2 (5.0), ranging from 140 to 164. The limits for the first (p25) and third (p75) quartiles were 148 and 155, respectively. No difference was observed in the AP angle in males when compared with females. The AP angle was evaluated according to sex, chronological age, bone age, weight, height, and pubertal stage of development. We observed an inverse correlation of the AP angle with chronological age (r=-0.57) and bone age (r=-0.52). A weak inverse correlation was also found with stature (r=-0.33). Only a tendency toward an inverse correlation with weight (r=-0.27) or body mass index (r=-0.26) was observed. No significant correlation with the pubertal stage was found. When chronological and bone ages were divided into intervals, a significant reduction of the AP angle was observed only in patients older than 14 years compared with those younger than 10 years of age. In this study, we propose that the AP angle should be considered to be normal if it varies between 148 and 155. We conclude that the normal AP angle does not depend on sex; however, it tends to decrease with stature, and chronological and bone ages. In the normal weight range also, the AP angle decreases, contrasting with our previous findings in obese adolescents, in which the AP angle increases with the severity of obesity.

Effects of glucosamine on the tibial epiphyseal disk of ovariectomized rats: morphologic and morphometric analysis.

OBJECTIVE: The aim of this study was to analyze the effect of glucosamine sulfate on the tibial epiphyseal disk of the ovariectomized rats. METHODS: After ovariectomy (OVx), 28 female rats were randomly divided into 4 experimental groups with 7 animals each, treated as follows: OVx 21 - vehicle (NaCl 0.9%) 0.5 mL/day) for 21 days; OVx GS21 - 230 mg/kg/day glucosamine sulphate for 21 days; OVx 45 - treated with NaCl 0.9% as above for 45 days; and OVx - GS45230 mg/kg/day glucosamine sulphate for 45 days. Seven intact animals in the proestrous phase were used as controls (CG). Upon treatment completion, the animals were sacrificed and the left knee joint was dissected and prepared for histological analysis. RESULTS: The percentage of remaining cartilage in new bone of the CG; that found in THE OVx GS45 group was significantly less than that of the OVx 21, OVx GS21, and OVx 45 groups. The percentage of trabecular bone in proestrous animals was the highest. The OVx GS45 group showed higher values compared with the other ovariectomized groups. These results were paralleled by the findings regarding the cells of the proliferative zone, since the CG had the highest values, and the values of the OVx GS45 group were greater than those of the OVx 21, OVx GS21, and OVx 45 groups. CONCLUSION: Our studies suggested that glucosamine may stimulate tibial cartilage and bone growth after ovariectomy in rats.

Effects of glucosamine on the tibial epiphyseal disk of ovariectomized rats: morphologic and morphometric analysis

OBJECTIVE: The aim of this study was to analyze the effect of glucosamine sulfate on the tibial epiphyseal disk of the ovariectomized rats. METHODS: After ovariectomy (OVx), 28 female rats were randomly divided into 4 experimental groups with 7 animals each, treated as follows: OVx 21 - vehicle (NaCl 0.9 percent) 0.5 mL/day) for 21 days; OVx GS21 - 230 mg/kg/day glucosamine sulphate for 21 days; OVx 45 - treated with NaCl 0.9 percent as above for 45 days; and OVx - GS45230 mg/kg/day glucosamine sulphate for 45 days. Seven intact animals in the proestrous phase were used as controls (CG). Upon treatment completion, the animals were sacrificed and the left knee joint was dissected and prepared for histological analysis. RESULTS: The percentage of remaining cartilage in new bone of the CG; that found in THE OVx GS45 group was significantly less than that of the OVx 21, OVx GS21, and OVx 45 groups. The percentage of trabecular bone in proestrous animals was the highest. The OVx GS45 group showed higher values compared with the other ovariectomized groups. These results were paralleled by the findings regarding the cells of the proliferative zone, since the CG had the highest values, and the values of the OVx GS45 group were greater than those of the OVx 21, OVx GS21, and OVx 45 groups. CONCLUSION: Our studies suggested that glucosamine may stimulate tibial cartilage and bone growth after ovariectomy in rats.

OBJETIVO: O alvo deste estudo foi analisar o efeito do sulfato de glicosamina no disco epifisário da tíbia em ratas ooforectomizadas. MÉTODOS: Após a ooforectomia (OVx), 28 ratas foram aleatoriamente divididas em 4 grupos experimentais de 7 animais cada, tratados da seguinte maneira: OVx 21 - veículo (0,5ml de NaCl 0.9 por cento ip uma vez ao dia) por 21 dias; OVx GS21 230 - mg/kg peso corporal por dia de sulfato de glicosamina, 21 dias; OVx 45 - tratados com NaCl 0.9 por cento igual ao grupo OVx 21, por 45 dias; e OVx GS45 - 230 mg/kg peso corporal por dia com sulfato de glicosamina, 45 dias. Sete animais intactos, na fase de proestro, foram usados como controle (CG). Ao completar o tratamento, os animais foram sacrificados e a articulação do joelho esquerdo foi dissecada e preparada para análise histológica. RESULTADOS: A porcentagem de cartilagem remanescente no novo osso do CG foi a menor. Os achados no grupo OVx GS45 foi significantemente menor do que no grupo OVx 21, OVx GS21 e OVx 45. A porcentagem de osso trabecular nos animais em pró-estro foi a maior. O grupo OVx GS45 mostrou valores maiores em relação aos outros grupos ooforectomizados. Esses resultados foram correspondentes aos achados em relação às células da zona proliferativa, desde que o CG teve os maiores valores e os valores do grupo OVx GS45 foram superiores aos dos grupos OVx 21, OVx GS21 e OVx 45. CONCLUSÃO: Nossos estudos sugerem que a glicosamina pode estimular o crescimento da cartilagem e do osso tibial após a ooforectomia em ratas.

Association between growth stunting with dental development and skeletal maturation stage.

The aim of this study was to determine the influence of growth stunting on the maturation stage of the medium phalanx of the third finger (MP3) and the dental development of the left mandibular canine in 280 high school children (140 stunted and 140 normal controls; equally distributed by sex) between 9.5 and 16.5 years of age, from a representative Peruvian school. Periapical radiographs of the MP3 from the left hand were used to determine the skeletal maturity stage, according to an adaptation of the Hägg and Taranger method. Panoramic radiographs were used to determine the dental maturity stage of the lower left canine, according to Demirjian method. Stunting was determined by relating height and age, according to the World Health Organization recommendations. There was no statistically significant difference in the skeletal maturation stage (P = .134) and the dental development stage (P = .497) according to nutritional status, even when considering different age groups (P > .183). A high correlation (r = 0.85) was found between both maturity indicators regardless of the nutritional status (growth stunted, r = 0.855 and normal controls, r = 0.863) or sex (boys, r = 0.809 and girls, r = 0.892). When skeletal level was considered, correlations values were similar between advanced (r = 0.903) and average (r = 0.895) maturers but lower (r = 0.751) for delayed maturers. Growth stunting was not associated with dental development and skeletal maturity stages in Peruvian school children.

Structural stages in the development of the long bones and epiphyses: a study in the New Zealand white rabbit.

BACKGROUND: Histologic delineation of the events involved in the development of long bones and the developmental age at which these events occur is needed to elucidate the genetic and molecular mechanisms associated with these events. This report describes the sequence of histologic events involved in the formation of long bones and their epiphyses in the New Zealand White rabbit. METHODS: Prenatal studies were performed on twelve, fourteen, fifteen, sixteen, eighteen, twenty-one, twenty-four, and twenty-seven-day-old rabbit embryos, and postnatal studies were performed on newborn rabbits and on three-to-four-day-old; one, two, four, and six-week-old; and two, three, four, six, and eight-month-old rabbits. Histologic specimens from embryos were embedded in plastic and stained with toluidine blue or safranin O-fast green, and specimens from postnatal rabbits were embedded in paraffin and stained with hematoxylin and eosin or safranin O-fast green. RESULTS: Studies of twelve-day-old embryos demonstrated upper and lower limb buds filled with undifferentiated mesenchymal cells, and studies of fourteen-day-old embryos showed mesenchymal condensation and beginning cartilage formation outlining major long bones. Long-bone and epiphyseal development progressed through sixteen structural stages, and the developmental age at which these stages occurred was determined. These stages included limb-bud formation with uniform distribution of mesenchymal cells and formation of an apical ectodermal ridge (stage 1); mesenchymal condensation (stage 2); cartilage differentiation (stage 3); formation of a primary center of ossification (stage 4a); epiphyseal cartilage vascularization with formation of cartilage canals (stage 7); vascular invasion of the developing secondary ossification center (stage 9); bone formation and marrow cavitation in the secondary ossification center with formation of hematopoietic marrow (stage 10); fullest relative extent of secondary-ossification-center development in epiphyseal cartilage (stage 14); thinning of the physis (stage 15); and resorption of the physis with establishment of continuity between epiphyseal and metaphyseal circulations (stage 16).

Criterios de manejo de las lesiones fisarias en el Hospital Angeles del Pedregal / Criteria for treatment of physeal injuries in Hospital Angeles del Pedregal

Este es un estudio prospectivo, realizado en el periodo comprendido del 1º de enero de 1997 al 28 de febrero de 1998, en el servicio de urgencias de nuestro hospital. Fueron capturados los datos de todos los pacientes que ingresaron con una lesión fisaria de las extremidades; en total fueron 20 pacientes, 15 hombres y cinco mujeres. Se utilizó la clasificación de Salter y Harris, encontrando a dos pacientes en el tipo I, once pacientes en el tipo II, cinco en el tipo III y dos en el tipo IV. A todos los pacientes de los tipos I, II y III se les manejó con manipulación cerrada e inmovilización; a los dos pacientes con lesión tipo IV fueron ingresados para cirugía, realizando reducción abierta y fijación con clavillos de Kirschner. En la evaluación a los seis meses, se encontraron sin dolor 18 pacientes (90 pacientes) y el resto, sólo con dolor leve. Dieciocho pacientes tuvieron movilidad articular completa; un caso de lesión tipo II distal de radio tuvo limitación de 10 grados en la flexión de muñeca y otro paciente con lesión de la fisis de la epitróclea tuvo 10 grados de limitación en la extensión de codo. No hubo casos de acortamiento ni angulación. Es de importancia recalcar, que aunque la frecuencia de lesiones fisarias es baja en nuestro medio, se debe de efectuar una correcta evaluación y tratamiento para evitar complicaciones. El seguimiento del paciente se debe llevar a cabo hasta la fase final del crecimiento