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26,365 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

After the determination of the shear strength and modes of failure of the capital femoral epiphyseal plates in twenty-five pairs of hips obtained post mortem from children five days to fifteen years and ten months old, with the plate intact on one side and with the perichondrial fibrocartilaginous complex removed on the other, the gross and microscopic morphology was studied. The shear strength of the human epiphyseal plate varied with age and was greatly dependent on the surrounding perichondrial complex in infancy and early childhood, but less so in adolescence. When this complex was excised, the strength of the epiphyseal plate was diminished, especially in specimens from younger children. The forces necessary to cause slipping were found to be within the physiological range of the force that would be generated in overweight children, suggesting that purely mechanical factors may play a major role in the etiology of slipped capital femoral epiphysis.
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PMID:Shear strength of the human femoral capital epiphyseal plate. 124 18

Growth during adolescence was analyzed in 40 children with slipped capital femoral epiphysis using the Infancy Childhood Puberty growth model. The advantage of this model is that reference values for height can be adjusted for the individual age at pubertal maturation. In both sexes an above average height was found before the onset of the pubertal growth spurt. However, the pubertal gain in height was less than normal, and at maturity the heights were only slightly above the reference mean values. Most of the children had their first hip symptoms during the period of increasing gain in height at the initial stage of the pubertal growth spurt. Both boys and girls were overweight before puberty and remained so during puberty and at maturity.
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PMID:Growth of children with physiolysis of the hip. 360 23

The authors have studied five cases of adolescents, four girls and one boy, affected of slipped capital femoral epiphysis, aged between twelve and fourteen years. They describe some clinical particularities and the analytical findings. The anthropometrical studies confirm that slipped capital femoral epiphysis is an entity observed in adolescents with overweight and obesity. The parameter showing fat, at the braquial and body level, are over two standard deviation of the local normal patterns.
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PMID:[Anthropometric characteristics of adolescents with primary epiphysiolysis]. 405 43

Slipped capital femoral epiphysis (SCFE) is a fairly common condition affecting older children and adolescents, and has the potential for long-term, crippling sequelae. Early recognition is the single most important controllable factor, but the diagnosis is often missed or delayed, resulting in progression of the slip. A SCFE should be suspected and promptly evaluated in any older child or adolescent presenting with a limp or complaints of hip, groin, thigh, or knee pain, especially if the patient is overweight. The diagnosis is usually made by anteroposterior and frog-leg lateral radiographs of the hips. Common errors at initial presentation include: not obtaining hip radiographs (due to either no hip pain or the lack of an impressive history and physical findings); misreading hip radiographs (the findings can be subtle); and lack of timely referral. Early involvement of and treatment by an orthopedic surgeon can greatly reduce the potential complications. We present three cases of SCFE that highlight common errors made at initial presentation, and a discussion that includes the differential diagnosis of an older child or adolescent with a painful limp.
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PMID:Missed slipped capital femoral epiphysis: illustrative cases and a review. 777 88

Slipped capital femoral epiphysis could be regarded as exceeding of a physiological process in puberty in which overweight of the patients seems to be the essential factor. Early clinical and radiological diagnosis are important to perform simple surgical procedures stopping further lysis and avoiding later osteoarthritis. Fixation of the femoral epiphysis with K.-wires are emphasized worldwide because of the lower complication rate. In case of severe slip osteotomies for realignment are more problematic. Long term follow-up studies have shown poor results mostly because of chondrolysis and femoral head necrosis in a high percentage. The demand on renunciation of realignment procedures in s.c.f.e. however, can't be supported. In our own patients, recently followed up, realignment osteotomies were without greater problems with no complications like chondrolysis or head necrosis. Stabile fixation of osteotomies allowed early mobilisation just after operation and may be one reason that chondrolysis didn't exist in our patient group. Considering our knowledge today therapeutic procedure of slipped capital femoral epiphysis is described.
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PMID:[Femoral head epiphyseolysis]. 896 37

Separation of the femoral capital epiphysis is associated with severe trauma in most species. This report describes 13 cats with slipped capital femoral epiphysis characterized by a distinctive lesion in the physeal cartilage. The lesion consists of irregular clusters of chondrocytes separated by abundant matrix on both the epiphyseal and metaphyseal side of the cleavage site. The affected population in this study is 85% male, 90% overweight, 23% Siamese, and 4.5-24 months old. The histopathology and demographics are similar to slipped capital femoral epiphysis in humans, which most often affects overweight adolescent boys.
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PMID:Physeal dysplasia with slipped capital femoral epiphysis in 13 cats. 1119 69

Slipped capital femoral epiphysis (SCFE) is a condition seen during the preadolescent growth spurt, often in obese children and in children with endocrine disorders. Given that endocrine factors also play a role in bone density, a link between low bone mineral density (BMD) and SCFE was proposed. Dual energy X-ray absorptiometry (DXA) scanning of the spine and hips was performed on 12 children with SCFE and on 5 overweight children without this hip disorder. All scans were performed by the same technician using a Hologic Delphi W densitometer and were interpreted by a pediatric orthopedic surgeon certified in clinical densitometry. Z-scores were obtained using a pediatric database. Mean and standard deviation of the Z-scores were calculated, and paired t tests were used to assess differences between these subjects and the expected norm. The SCFE patients' Z-scores at each of the skeletal sites assessed (spine, femoral neck, and total hip) were greater than the mean by an average of 1 standard deviation. The control subjects' BMD was also greater than the mean. The P values were less then 0.05. These results suggest that children with SCFE do not have low BMD, but show bone density significantly greater then expected for age and sex. Although BMD is endocrinologically driven and endocrinologic abnormalities are implicated in SCFE, there appears to be no correlation between low BMD and SCFE.
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PMID:Evaluation of bone density in children with slipped capital femoral epiphysis. 1643 94

Hip pain is a frequent cause for limping in children. Etiology work out is oriented by the age of the child, the existence of a traumatic or infectious background, the child's morphology and ethnic origin, and most of the diagnoses will require only a standard X-ray and an ultrasound to be confirmed. In this way, the three main causes to be considered in children of less than 10 years of age are septic arthritis, transient synovitis and Perthes disease. Septic arthritis will require an urgent treatment, whereas Perthes disease will need a long care and follow up in order to watch for a poor outcome that will necessitate a surgical treatment to restore containment of the femoral head. In the adolescent, especially in case of overweight, the first etiology to be considered is slipped femoral capital epiphysis, a condition that requires an early and adequate surgical treatment (in situ screw fixation), in order to avoid further displacement and femoral head deformity of poor prognosis.
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PMID:[The limping child with a painful hip]. 1658 44

The following finite element study was conducted to determine whether increased body weight, femoral retroversion, and varus hip loading could sufficiently raise physeal shear strains and stresses above the yield point and predispose an adolescent hip to a slip. A computer tomography scan of a 13-year-old child with slipped capital femoral epiphysis was used to generate a solid model of the proximal femur and physis. The model was parameterized using 3-dimensional software to generate three difference angles of femoral neck version-neutral, 15 degrees retroversion, and 15 degrees anteversion. Loads of 2.7 times body weight in a 46- and 86-kg child were applied to the proximal femur to model stance on one leg. In addition, the loading vector was reoriented at various degrees of varus to study the effect of varus loading on physis shear. The results demonstrated that physis stress, strain, and displacement increased with greater body weight, retroversion, and varus displacement of the loading vector. Physis shear strain in hips with a combination of varus loading and femoral neck retroversion exceeded the reported ultimate strain values for cartilaginous soft tissues. The finite element models suggest that in an overweight child, the combination of retroversion and varus hip load may be sufficient to increase physeal strains above the yield point and result in a slip.
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PMID:Proximal femoral physis shear in slipped capital femoral epiphysis--a finite element study. 1667 May 37

Posterior lumbar apophyseal ring fractures are rare in adolescents. We report 4 such cases in Chinese adolescents. Two of the patients had a slipped capital femoral epiphysis; 3 of them were overweight/obese. All presented with low back pain and radicular pain. Apophyseal fractures of the upper lumbar spine usually involve the lower end plate, whereas those of the lumbar sacral spine usually involve the upper end plate. The radiological features and pathophysiology are discussed. Two of the patients were treated with laminotomy and diskectomy after conservative treatment failed. All patients had complete resolution of their neurological deficits at a mean follow-up of 2 years. Despite its benign nature, long-term follow-up is necessary to define the natural course and prognosis of the disease. A high index of suspicion is needed to diagnose these fractures in adolescents.
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PMID:Posterior lumbar apophyseal ring fractures in adolescents: a report of four cases. 1939 1


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