We reviewed three infants with destructive osteomyelitis involving the proximal tibial epiphysis at a follow-up of eight to 22 years. All cases showed early radiographic destructive changes in the medial or lateral aspects of the epiphysis and metaphysis. Despite the ominous early appearance of the epiphysis, all cases showed spontaneous re-ossification of the epiphysis with restoration of the tibial condyle and preservation of joint congruity. The patients, however, developed a valgus or varus deformity which was treated satisfactorily with one to three proximal tibial osteotomies. The potential for regeneration of the epiphysis following infantile osteomyelitis of the proximal tibia suggests these cases should be treated expectantly with regard to joint congruity

We describe three cases of infantile tibia vara resulting from an atraumatic slip of the proximal tibial epiphysis upon the metaphysis. There appears to be an association between this condition and severe obesity. Radiologically, the condition is characterised by a dome-shaped metaphysis, an open growth plate and disruption of the continuity between the lateral borders of the epiphysis and metaphysis, with inferomedial translation of the proximal tibial epiphysis. All patients were treated by realignment of the proximal tibia by distraction osteogenesis with an external circulator fixator, and it is suggested that this is the optimal method for correction of this complex deformity. There are differences in the radiological features and management between conventional infantile Blount’s disease and this ‘slipped upper tibial epiphysis’ variant

We reviewed the clinical and radiological results of six patients who had sustained traumatic separation of the distal epiphysis of the humerus at birth. The correct diagnosis was made from plain radiographs and often supplemented with ultrasonography, MRI and arthrography. An orthopaedic surgeon saw two patients within two days of birth, and the other four were seen at between nine and 30 days. The two neonates underwent unsuccessful attempts at closed reduction. In the remaining patients, seen after the age of eight days, no attempt at reduction was made. All six displaced fractures were immobilised in a cast with the elbow at 90° of flexion and the forearm pronated. When seen at a mean of 58 months (16 to 120) after injury, the clinical and radiological results were excellent in five patients, with complete realignment of the injury. In one patient the forearm lay in slightly reduced valgus with the elbow in full extension. Traumatic separation of the distal epiphysis of the humerus may be missed on the maternity wards and not diagnosed until after discharge from hospital. However, even when no attempt is made to reduce the displaced epiphysis, a good clinical result can be expected

Three cases of a rare complication of Salter Type II fracture-separations of the distal tibial epiphysis are described. Interposition of the anterior tibial neurovascular bundle between the displaced epiphysis and the lower tibia prevented reduction and, in two patients, the blood supply to the foot was compromised. Open reduction and internal fixation resulted in a satisfactory outcome in each case

We have reviewed 12 cases of fracture-separation of the distal humeral epiphysis, three of which were initially misdiagnosed as fractures of the lateral condyle and one as an elbow dislocation. Cubitus varus deformity is as common after this fracture-separation as it is following supracondylar fracture, and is most common in children under two years of age. Closed reduction and simple immobilisation is adequate for the older child, but we recommend for those under two years of age that closed reduction should be followed by percutaneous pinning, so that the carrying angle can be assessed immediately after reduction. If the elbow is then in varus the wires should be removed, reduction repeated and treatment by straight lateral traction used to maintain a valgus carrying angle

Aims

We have previously reported cryoablation-assisted joint-sparing surgery for osteosarcoma with epiphyseal involvement. However, it is not clear whether this is a comparable alternative to conventional joint arthroplasty in terms of oncological and functional outcomes.

Ischaemia resulting from increased joint pressure may play a role in the pathogenesis of necrosis of the femoral head epiphysis. We studied the effect of temporary vascular occlusion on this epiphysis in young rabbits. Occlusion for six hours resulted in necrosis of trabecular bone and of intertrabecular marrow and vascular tissue, later followed by revascularisation and repair, as has been demonstrated previously. In contrast, raised intra-articular pressure lasting for only two hours resulted in a more complex picture: trabecular osteocytes were dead, whereas the bone-forming marrow was shown by fluorochrome labelling to remain viable, and to form appositional repair bone throughout the epiphysis. We concluded that transient vascular occlusion may cause the death of trabeculae despite intact perfusion of the bone. This type of change may be important in the pathogenesis of Perthes' disease

Six mechanisms which may produce fracture-separation of the proximal humeral epiphysis are proposed. Four of them are illustrated by case reports. It is suggested that they may be differentiated by examination of the patient and study of the radiographs. In unstable fractures manipulation is indicated and, if performed with an understanding of the mechanism of injury, will produce a stable reduction

We report a case of neonatal separation of the distal humeral epiphysis in which non-invasive ultrasonic examination provided clear definition of the injury

A rare form of injury to the distal tibial growth plate is described. Only two patients with such an injury have been reported previously. The injury, rotational displacement of the distal tibial epiphysis with posterior displacement of the fibula but without fracture, can be reduced easily and appears to have no lasting ill-effects

We have reviewed the notes and radiographs of 57 patients with fractures of the proximal humeral epiphysis and examined 30 of them at 2 to 8 years after injury. Regardless of treatment the maximum shortening of the humerus was 2 cm and residual varus angulation was insignificant. Manipulation of a displaced, fresh fracture did not improve the final outcome with respect to humeral growth or function; and open reduction is very rarely indicated

In immature long bones, radical excision of malignant tumours of the metaphysis may necessitate sacrifice of the adjacent epiphysis. To preserve the adjacent joint while allowing a safe margin of excision, we used physeal distraction before removing the tumour. From July 1984 to August 1992, we operated on 20 patients by this method. After a mean follow-up of 54 months there was no local recurrence in the epiphyseal region. Three patients had developed pulmonary metastases

Aims

Obtaining solid implant fixation is crucial in revision total knee arthroplasty (rTKA) to avoid aseptic loosening, a major reason for re-revision. This study aims to validate a novel grading system that quantifies implant fixation across three anatomical zones (epiphysis, metaphysis, diaphysis).

Fracture separation of the capital femoral epiphysis occurring during attempted closed reduction of a traumatic dislocation of the hip is described in two adolescents. Although this complication is extremely rare, the prognosis of fracture separation with dislocation of the epiphysis is known to be poor. Avascular necrosis subsequently developed in both cases. The importance of gentle manipulative reduction under general anaesthesia with complete muscle relaxation is emphasised

Osteochondrosis juvenilis is caused by a dysfunction of endochondral ossification. Several epiphyses and apophyses can be affected, but osteochondrosis juvenilis of the medial malleolus has not been reported. We describe a 12-year-old boy with bilateral pes planovalgus who was affected by this condition. Conservative management was successful. The presentation, aetiology and treatment are described and the importance of including it in the differential diagnosis is discussed.

We present our experience of the modified Dunn procedure in combination with a Ganz surgical dislocation of the hip to treat patients with severe slipped capital femoral epiphysis (SCFE). The aim was to prospectively investigate whether this technique is safe and reproducible. We assessed the degree of reduction, functional outcome, rate of complications, radiological changes and range of movement in the hip. There were 28 patients with a mean follow-up of 38.6 months (24 to 84). The lateral slip angle was corrected by a mean of 50.9° (95% confidence interval 44.3 to 57.5). The mean modified Harris hip score at the final follow-up was 89.1 (sd 9.0) and the mean Non-Arthritic Hip score was 91.3 (sd 9.0). Two patients had proven pre-existing avascular necrosis and two developed the condition post-operatively. There were no cases of nonunion, implant failure, infection, deep-vein thrombosis or heterotopic ossification. The range of movement at final follow-up was nearly normal. This study adds to the evidence that the technique of surgical dislocation and anatomical reduction is safe and reliable in patients with SCFE.

Cite this article: Bone Joint J 2013;95-B:424–9.