Physeal Angle Research Articles

Anterior Distal Femoral Hemiepiphysiodesis in Children With Fixed Knee Flexion Deformities: Does Screw Position Matter?

Anterior distal femoral hemiepiphysiodesis (ADFH) using 2 percutaneous screws is an effective technique for the treatment of fixed knee flexion deformities in children with neuromuscular disorders. The role of sagittal screw position on the outcome of the procedure is unknown. This is a retrospective case series of patients who underwent ADFH at a single pediatric hospital from 2013 to 2020. Radiographs were evaluated for sagittal screw position and the associated change in lateral distal femoral physeal angle over time. The position of the 2 screws was classified as either being both in the anterior third of the physis (AA), one screw in the anterior third and the other screw in the middle third (AM), or both screws in the middle third of the physis (MM). The study population included 68 knees in 36 patients. The mean physeal angle at the time of surgery was 93 degrees (SD 4.0 degrees), which increased to 102.4 degrees (SD 5.7 degrees) at 12 months, for a change of 9.4 degrees ( P <0.001). At 24 months, the mean physeal angle was 104.6 degrees (SD 6.3 degrees) for a further change of 2.9 degrees ( P <0.001). When stratified by screw position all screw configurations resulted in an increase in the physeal angle at 12 months. At the 24-month follow-up, the physeal angle in knees with AA screws continued to increase another 3.5 degrees ( P <0.05), there was a minimal change in knees with AM screws (1.47°, P >0.05) and knees with MM screws saw a reversal of physeal angle change (-7.1 degrees, P <0.05). ADFH using percutaneous screws results in an increase in the lateral distal femoral physeal angle. The rate of correction is largest in the first 12 months after the procedure. As such, this procedure should be considered in patients with less than 2 years of growth remaining. However, initial screw positioning influences the amount of change over time, and close postoperative surveillance until physeal closure is essential for all patients. Level IV-retrospective case series.

Coronal-plane leg alignment in adolescence and the effects of activity:A full leg length MRI study.

The aim of this study was to explore the association between developing coronal-plane leg alignment and activity levels during adolescence. We performed a cross-sectional cohort study with individuals from soccer club academies and an age-matched control population. Outcome measures were the hip knee angle (HKA), medial proximal tibial physeal angle (MPTPhyA), lateral distal femoral physeal angle (LDFPhyA) on full leg length magnetic reasonance imaginescans, and the physical activity questionnaire (PAQ) score. The cohort comprised 57 elite male soccer players, 34 male and 34 female controls aged 11-21 years. Mean HKA became more varus with age, with little change after 16 years or skeletal maturity. Skeletally mature elite male soccer players were significantly more varus than male controls with a HKA 2.28° less than male controls (p < 0.001). Skeletally mature male controls had a HKA 1.34°less than female controls (p < 0.001). A negative correlation existed between HKA and PAQ score (coefficient -0.24, p = 0.029). A positive correlation existed between HKA and MPTPhyA (coefficient 0.32, p = 0.008). In conclusion, high activity levels during adolescence are associated with the development of varus leg alignment. Mean HKA becomes more varus with age until skeletal maturity. The development of varus alignment may represent a physiological adaptation to load at the proximal tibial physis. Clinical Significance: A time period may exist for intervention before the development of varus leg alignment in young athletes, such as training load modification or proximal tibial morphology monitoring.

Treatment of Madelung Deformity With Vicker Ligament Release and Radial Physiolyses: A Case Series.

To evaluate the surgical outcomes in a series of Madelung wrists treated with a Vicker ligament release at a young age. We hypothesize that early treatment of Madelung deformity with Vicker ligament release is safe and may minimize progression of deformity. A retrospective review was performed at a single large pediatric institution from 2013 to 2016 of patients with a diagnosis of Madelung deformity treated with Vicker ligament release and radial physiolysis. Exclusion criteria included patients who were skeletally mature, who underwent osteotomy procedures, or who had incomplete follow-up. Patient demographics were collected, concomitant surgeries were recorded, and outcomes including range of motion and pain were documented. Measurements of standard anteroposterior and lateral radiographs were calculated before and after surgery to monitor radiographic deformity and progression. Six girls with bilateral Madelung deformity who underwent bilateral Vicker ligament resection and radial physiolysis (12 total wrists) were included. The average age at presentation was 7.5 years (range, 7-9 years), with an average follow-up of 30 months. Reasons for presentation included sports injuries (2), ulnar-sided wrist pain (2), and mild deformity (2). Additional radial and ulnar epiphysiodeses were performed in 2 wrists each. There were no intraoperative complications. Although pain resolved within the first month after surgery for all patients, 2 patients had intermittent unilateral ulnar-sided wrist pain at final follow-up. All patients returned to their presurgery activities. There was no loss of range of motion, and 4 wrists with preoperative supination deficits improved by an average of 17°. Radiographic measurements demonstrated improvement in the radial physeal angle in 10 out of 12 wrists (83%). No patients displayed worsening deformity after surgery. Two patients underwent subsequent procedures. In patients with early Madelung deformity, Vicker ligament release with radial physiolysis is a safe treatment option that theoretically has the potential to minimize the progression of radiographic deformity. Therapeutic V.

Shear Stress in Epiphyseal Growth Plate is a Risk Factor for Slipped Capital Femoral Epiphysis

Slipping of the capital femoral epiphysis is an important orthopaedic problem of early adolescence. Many hypotheses about its etiology have been examined, yet the underlying mechanisms have not yet been fully elucidated. We examined elevated shear stress in the epiphyseal growth plate and elevated contact hip stress exerted on the femoral head as risk factors for slipping of the capital femoral epiphysis. Two groups of hips were compared: a group of 100 hips contralateral to the slipped ones and a group of 70 age- and gender-matched healthy hips. The characteristics of individual hips were incorporated by means of geometrical parameters determined from standard anteroposterior radiographs. Shear stress was calculated by using a mathematical model where the femoral neck was considered to function as an elastic rod. Contact hip stress was calculated by the HIPSTRESS method. Hips contralateral to the slipped ones had higher average shear stress (0.81 vs 0.51 MPa; P < 0.001) and more vertically inclined physeal angle (55.4 vs 63.2 degrees.; P < 0.001) in comparison to healthy hips. Shear stress in the contralateral hips to the slipped ones remained significantly higher even when normalized to the body weight (1400 vs 1060 Pa/N; P < 0.001). There was no significant difference in the average contact hip stress (1.86 vs 1.74 MPa; P = 0.145). Elevated shear stress, but not elevated contact stress, is a risk factor for slipping of the capital femoral epiphysis. III (prognostic study, case-control study).

The Relationship Between the Coracoid and Glenoid After Brachial Plexus Birth Palsy

The purpose of this study was to determine the changes in glenoid and coracoid anatomy after brachial plexus birth palsy. Fifty-seven children underwent bilateral shoulder magnetic resonance imaging. The uninvolved coracoid angle averaged 32.5 +/- 6.1 degrees (range 21.3-46.0) compared with 21.7 +/- 6.9 degrees (range 6.1-41.0) on the involved shoulder. The uninvolved coracoid physeal angle averaged 42.7 +/- 7.6 degrees (range 26.0-57.0) compared with 61.7 +/- 11.6 degrees (range 38.8-89.9) on the involved shoulder. The uninvolved glenoid physeal angle averaged 78.4 +/- 5.2 degrees (range 66.9-89.9) compared with 50.4 +/- 14.7 degrees (range 17.9-76.7) on the involved shoulder. The uninvolved interphyseal angle averaged 59.6 +/- 7.2 degrees (range 42.0-76.1) compared with 65.5 +/- 11.6 degrees (range 45.0-88.0) on the involved shoulder. The uninvolved coracoid scapular distance averaged 1.6 +/- 0.28 cm (range 1.0-2.5) compared with 1.2 +/- 0.37 cm (range 0.37-1.9) on the involved shoulder. These results highlight the contiguous relationship between the coracoid and glenoid physis during development and indicate that retroversion of both the glenoid and coracoid physis occurs after brachial plexus palsy.

Normal Radiographic Values for Cartilage Thickness and Physeal Angle in the Pediatric Hip

Normal Radiographic Values for Cartilage Thickness and Physeal Angle in the Pediatric Hip