Proximal Epiphysis Research Articles

The impact of neurological impairment and tone on hip joint development

Purpose: The purpose of this study was to define how different force environments by neuromuscular diagnosis (hypertonic versus hypotonic) impact the growth and morphology of the proximal femoral and acetabular regions relative to typically developing children. Methods: Children with cerebral palsy and spinal muscular atrophy were compared with typically developing children aged 6 months to 11 years. Routine pelvic radiographs were evaluated using measures of hip geometry for the proximal femur and acetabulum. The data were analyzed using general linear models to estimate the developmental patterns according to age and diagnosis. Results: One hundred eighty-four children met the inclusion criteria: 58 spastic cerebral palsy Gross Motor Function Classification System I–V (263 hips), 32 spinal muscular atrophy (79 hips)), and 94 typically developing (187 hips) were included with a mean age of 4.9 ± 3.1 years. Using spinal muscular atrophy as a reference, significant differences in proximal femoral development included long thin versus short neck ( p < 0.01) and round versus flat epiphysis ( p = 0.001). A thin neck-wide epiphysis was found in spinal muscular atrophy versus thick neck-small epiphysis for typically developing ( p < 0.05). The ratio of acetabular width to proximal femoral epiphysis width differed significantly for typically developing ( p = 0.001) compared with cerebral palsy and spinal muscular atrophy. There was a negative correlation between migration percentage and acetabular width to epiphysis width in children with cerebral palsy, but no correlation in children with spinal muscular atrophy. Conclusion: Hip geometry was impacted by the force environment experienced during growth. These findings emphasize the crucial roles of gross motor function, muscle tone, and strength differences in determining hip morphology. Level of Evidence: III, retrospective case control.

Brody's abscess of the humerus is the cause of sepsis in a patient with coronavirus infection (COVID-19)

Purpose: To conduct a clinical and morphological analysis of the case of death as a result of sepsis, the cause of which was Brody's abscess.Material and methods. An analysis of the fatal outcome of a 54–year-old patient who occurred in a hospital of a medical organization where he received medical care for a disease – a new coronavirus infection. The complex of clinical, laboratory and instrumental diagnostic methods could not explain the progressive deterioration of the severity of the patient's condition and the onset of death.Results. During the autopsy, an abscess of the proximal epiphysis of the left humerus was found with the spread of the inflammatory process to the soft tissues of the breast, the parietal pleura with the development of purulent fibrinous pleurisy, left-sided pneumonia, purulent fibrinous pericarditis, hematogenous purulent meningitis.Conclusion. The authors of the article have established a causal cause of death from Brody's abscess, which makes it possible to expand the diagnostic search in the case of sepsis with an unclear primary focus.

T2-weighted spoiled gradient echo MRI for forensic age estimation: a study on knee growth plates.

The timing of growth plate fusion is a key indicator for age estimation and is primarily used in forensic investigations. On the other hand, non-ionizing techniques such as MRI are being developed to provide safer and more ethical evaluations in forensic casework. This study aims to evaluate the closure process of growth plates in the distal femoral and proximal tibial epiphyses using Multiple Echo Recombined Gradient Echo (MERGE) MRI sequences and provide age estimation data based on staging methods for forensic purposes. We retrospectively analyzed 559 patients (294 males, 265 females, aged 8-25 years) diagnosed with trauma and knee pain at Tepecik Training and Research Hospital from 2016 to 2019. MRI scans were performed using a 1.5-T system with MERGE sequences and evaluated by two observers using a new staging system. Observer agreement was assessed using Cohen's κ test, yielding high agreement values (κ > 0.8). Positive correlations were found between age and ossification stages (p < 0.001). Minimum age thresholds for stages 5a and 5b of the distal femoral epiphysis were 16 and 18 years for females and 17 and 19 years for males, respectively. For the proximal tibial epiphysis, the minimum ages for stages 5a and 5b were 15 years for females and 17 years for males. The MERGE sequence provides a viable method for assessing skeletal maturity in living individuals with significant ethical advantages due to non-ionizing radiation. This study supports the potential application of the MERGE sequence in forensic age estimation, demonstrating high observer agreement and consistency. Future research should focus on comparing different sequences and populations to enhance the methodology's applicability.

An unusual Ogden type V tibial tubercle avulsion fracture: a case report and literature review

BackgroundOgden type V tibial tubercle avulsion fracture is an unusual type of physial injury. Thus, little is known about its mechanism of injury and treatment. The type of osteosynthesis is variable and depends on the experience of the surgeon. We commonly used cancellous screws fixation combined with tension band wiring for displaced fracture of the anterior tibial tuberosity.Case presentationThe present manuscript describes a case of a Han nationality 13-year-old boy who presented with severe pain of the left knee, which began after landing following a high jump. He had no significant past medical history apart from a high body mass index of 30.3. Radiographs revealed that he had an unusual Ogden type V tibial tubercle avulsion fracture. He was treated by open reduction and combined fixation with cannulated screws and tension-band wiring. After 3 months, the fracture healed without any complications or knee symptoms with full range of motion. He underwent reoperation for symptomatic hardware, which was removed at 5 months after initial surgery, and returned to his prior level of sporting activity at 1 year follow-up.ConclusionOur case suggests that excellent functional outcome could be achievable by open reduction with the combination of internal fixation and tension-band wiring for Ogden type V tibial tubercle avulsion fracture. This type of osteosynthesis could not only achieve anatomical reduction and stable fixation for such fractures, but also avoid further damage to the proximal tibial epiphysis, which prevents serious complications, such difference in leg length.

Hip joint degeneration - not only an issue of the elderly

Introduction: Legg-Calve-Perthes Disease (LCPD) is a condition characterized by ischemia of the proximal femoral epiphysis, leading to pain, limping, and potential hip joint deformities in children. Its etiology remains unclear, with theories implicating repetitive microtrauma, skeletal retardation, and vascular insufficiency. Diagnosis involves radiological assessment and classification systems to monitor disease progression, influencing treatment decisions and long-term outcomes. Material and methods: This study summarizes existing literature and clinical data on LCPD, focusing on etiological theories, diagnostic methods, treatment strategies, risk factors, and prognostic indicators. Information was gathered from medical databases, peer-reviewed journals, and case studies to compile a comprehensive overview of the disease. Aim of study: The aim was to gather current knowledge on LCPD, emphasizing diagnostic approaches, treatment modalities, and factors influencing clinical outcomes. Special attention was given to discussing the efficacy of various treatment options and identifying prognostic factors that impact the disease trajectory. Conclusion: Effective management of LCPD hinges on early diagnosis, appropriate treatment selection, and careful monitoring of disease progression. Prognosis is influenced by factors such as age at diagnosis, extent of femoral head involvement, and maintenance of hip joint congruence. Further research is needed to refine treatment protocols and improve long-term outcomes for affected children.

Effect of genetically engineered drugs in aseptic necrosis of the femoral head in rats

Bone tissue is a dynamic structure with a metabolic function. The maintenance of bone homeostasis is carried out due to the continuous process of its renewal, remodeling. At the same time, a number of pathological processes, such as ischemic catastrophe, can lead to a violation of the balance of maintaining the constancy of the bone structure. One of these diseases is aseptic necrosis of the femoral head. The presented study analyzes the dynamics of expression of genes involved in maintaining bone tissue homeostasis, changes in the histological picture during the development of aseptic necrosis of the femoral head in laboratory rats that did not receive genetically engineered drugs and against the background of the use of inhibitors of biological action IL-6, TNF-α. After induction of aseptic necrosis in the proximal epiphysis of the femur, the histological picture in animals of different groups was not the same. More preserved bone architectonics and a larger volume of bone plates were recorded in rats receiving genetically engineered drugs compared to animals without the introduction of biological agents. The latter also had the most vivid picture of osteodestruction with increased expression of proinflammatory cytokine genes. In animals, against the background of the use of drugs of inhibitors of the biological action of IL-6, TNF-α, from the second week after induction of aseptic necrosis of the mRNA, the profile of the spongiose bone of the proximal epiphysis of the femur tended to increase the expression of osteoreparation genes. At the same time, the greatest inhibition of osteoclastogenesis gene expression was obtained in rats after injection of a monoclonal antibody to the IL-6 receptor.

Retrospective analysis of nonfatal skeletal injuries sustained in road incidents involving electric scooters

BACKGROUND: Although scooters were officially recognized as vehicles in the Russian Federation not so long ago, the incidence of scooter injuries has been growing for several years. AIM: To analyze epidemiological data and the nature of injuries in victims of nonfatal electric scooter incidents. MATERIALS AND METHODS: The study included 78 medical records of persons injured in road incidents involving electric scooters who were treated in the trauma department of the Regional Hospital No. 4 of Adler between 2020 and 2021. The nature of the injury by sex, age, seasonality, time of day, and characteristics of damage depending on the category of road users (driver and pedestrian) were analyzed retrospectively. RESULTS: Of the 78 road incidents involving electric scooters, 28 occurred in 2020 and 50 in 2021. The sex distribution was nearly the same, with ≥40 men and 38 women, and their median age was 36 (30–45.8) years. Most of the accidents (n=52) occurred in summer and autumn months. The exact time of injury was known in 35 cases (17‰ in the daytime, 18‰ in the evening. Depending on the circumstances, all accidents were divided into falls from electric scooters (n=73), collisions of moving scooters with pedestrians (n=3), and collisions of moving scooters with a moving car (n=2). Of the 73 patients who sustained fractures, 67 had a closed type. Intra-articular fractures were detected in 41 victims. Lowe-limb fractures (n=43) prevailed over fractures of other localizations. In addition, 18 cases of knee injuries and 14 cases of trauma to the proximal tibial epiphysis were recorded. CONCLUSION: The incidence of scooter injury is increasing. In the warm regions of the Russian Federation, such accidents have a year-round prevalence with predominance in the summer months owing to the large influx of vacationers. More often than other incidents, falls from electric scooters are noted, resulting in lower limb injuries, including with intra-articular fractures of the condyles of the tibia.

Ischaemic chondronecrosis as a novel causative factor in the aetiopathogenesis of infantile Blount’s disease

Infantile Blount’s disease primarily affects toddlers, leading to tibia vara with or without growth arrest. While the disease’s association with abnormal compressive forces on the proximal tibial physis is widely accepted, its precise aetiopathology remains elusive. This hypothesis suggests that ischaemic chondronecrosis serves as a previously unaddressed cause of Blount’s disease. Notably, it is also the foremost theory to offer a comprehensive explanation for the specificity of involvement of the posteromedial tibial epiphysis, addressing a crucial aspect that was overlooked in prior research. The theory of pressure-induced ischaemic chondronecrosis is supported by a compelling body of radiological and histological evidence. Experimental studies on femoral heads in animals highlight the susceptibility to ischaemic injury in the absence of an ossific nucleus. The proposed mechanism could explain the delayed ossification observed in the proximal medial tibial epiphysis in Blount’s disease. Comparisons with Perthes’ disease reveal striking parallels in radiographic and histological features, pointing toward a shared aetiology of vascular insult. Despite both conditions progressing through similar stages, the distinction lies in Perthes’ being characterised by osteochondral necrosis, while Blount’s results from chondronecrosis. The potential applications of this hypothesis extend to early detection and prevention, emphasising the avoidance of compression on the medial tibial epiphysis. The study suggests a reevaluation of brace therapy and exploration of the role of serial valgus casting, especially in the early stages of insult and limited to walking time, as a preventive measure against ischaemic chondronecrosis and its complications.In conclusion, this hypothesis sheds light on a novel mechanism of Blount’s disease. Further research is warranted to validate and refine this proposition, offering promising avenues for addressing a century-long enigma in its aetiology.

Evaluation of anatomical and radiological measurements of the proximal phalanx of the horse

When performing osteosynthesis by screw fixation, it is important to carry out operational planning (choosing the screw of the optimal length and diameter). Choosing the optimal osteosynthesis tactics and the correct screw size allows you to stimulate regeneration and prevent possible complications. The X-ray examination method is included in the mandatory criterion of preoperative examination, which allows you to determine the size of the deformation and bone parameters. The present study is based on the hypothesis that the lifetime X-ray measurement of the bone of the proximal phalanx of a horse (longitudinal and transverse dimensions of the proximal and distal epiphysis and diaphysis, bone length), allows us to justify the size and technique of fixing the screw in the treatment of fractures. Morphometric studies included macroscopic dissection; morphometry of bone preparations; Xray measurement of the putus bone; documentation of the data obtained, photographing. A morphometric study was performed on 20 bone preparations (10 thoracic and 10 pelvic) and 40 X-ray images (20 in lateromedial and 20 in dorso-palmar/plantar projections) of the proximal phalanx of the horse. As a result of the work performed, it was found that the variability of parameters (longitudinal and transverse size of the proximal epiphysis, longitudinal and transverse size of the distal epiphysis; the longitudinal and transverse size of the diaphysis, bone length) of the fetal bone of the thoracic and pelvic limbs in horses for average values has no significant deviations (up to 1%), while the differences between the minimum and maximum values range from 20.0% to 66.6% for values obtained by anatomical method; from 12.2% and 33.3% for the Xray method.

Transrectal ultrasonographic assessment of the fetal proximal phalanx: A new tool to assess fetal age and bone development in horses

Fetal age in Quarter Horses can be predicted within 2 weeks from 100- to 200- days of gestation using femur length, biparietal diameter (cranium diameter) and eye approximated volume. However, as pregnancy advances, the femur and cranium become too large to be imaged in their entirety using ultrasound and the corresponding biometric parameters can no longer be measured. In this longitudinal study, the proximal phalanx (P1) was evaluated as a novel biometric parameter for late gestation to predict fetal age and bone maturation. Transrectal ultrasound was performed in ten pregnant mares with known ovulation dates, every two weeks from 240- days of gestation until parturition. P1 was imaged in 69 % of the examinations. Inability to image P1 was due to obstructive positioning such as carpal or fetlock flexion, or posterior presentation of the fetus. Advancing fetal age did not affect visibility of P1. P1 length correlated significantly with days of gestation and a correlation equation was established: y = 0.3837x -69.55 where y is the predicted value of P1 length and x is the day of gestation (with day 0 being the day of ovulation). When P1 length was equal to or larger than the width of the ultrasound image (52.5 mm), 90 % of mares (9/10) were above 300- days of gestation. Ossification of the proximal and distal epiphysis of P1 typically appeared between 277- and 303 -days of gestation (mean: 288 days). The proximal epiphysis did not close before parturition whereas the distal one closed between 306- and 333-days of gestation (mean: 320 days). P1 epiphyseal appearance and closure occurred chronologically reflecting bone maturation. Radiographic findings at birth and prenatal ultrasound findings were in agreement, apart from timing of P1 distal epiphyseal closure. In conclusion, P1 length can be used as a new fetal biometric parameter to assess fetal age and growth after 240- days of gestation. The knowledge of P1 bone maturation process in utero as a marker for fetal bone development, may also be valuable in clinical decision-making when considering inducing parturition in the mare.

Closed reduction and intramedullary nails for acute completely displaced femoral diaphysis fracture in children aged 2-6.

The management of femoral fractures in children aged two to six years is still controversial. The purpose of this study was to assess the results of closed reduction and elastic stable intramedullary nail (ESIN) fixation in completely displaced fractures of the femoral diaphysis in children in this age group. A retrospective review of all children with acute completely displaced fractures of the femoral diaphysis in children aged 2-6 years treated from 2013 to 2020 was performed. A total of 34 patients were treated who met the inclusion criteria: Group 1: 21 fractures (transverse and short oblique); Group 2: 13 fractures (long oblique and spiral) that underwent closed reduction and elastic stable intramedullary nail (ESIN) fixation. No differences existed between the 2 groups with respect to age, extremity, sex, time to treatment, mechanism of injury, or fracture displacement. Demographic characteristics and radiographs were reviewed, and the following parameters were documented: surgery time, time to union, return to activities, range of motion of knee joints, and complications. Major complications were defined as those with presumptive long-term side effects or those requiring a reoperation. No major complications were observed in the two groups. All included fractures were treated by a single senior paediatric surgeon. The mean follow-up period was 28.4 months (range 24-45 months). The level of significance was set at p < 0.05. Thirty-four children with acute completely displaced fractures of the femoral diaphysis were included: Group 1: 21 fractures; Group 2: 13 fractures. The patients included 15 girls (44.1%) and 19 boys (55.9%), with an average age of 4.4 years (range 2.8 to 6.5 years). The mean follow-up period was 28.4 months (range 24.2-45.0 months). The demographic characteristics did not differ between the two groups of patients. Overall, successful closed reduction and elastic stable intramedullary nail (ESIN) fixation could be achieved in all 34 patients. The mean surgical time was 40.4 and 43.0 min in Group 1 and Group 2, respectively (p = 0.857). Fluoroscopy time was not significantly different between the two groups (37.0 vs. 36.1 s, respectively; p = 0.247). Cosmetic results were described as good and satisfactory by all patients. There were no refractures and no incidences of nonunion or growth arrest in the proximal epiphysis. Only two patients suffered from a superficial infection, which was resolved after the pins were shortened and oral antibiotics were administered. Closed reduction and elastic stable intramedullary nail (ESIN) fixation can be successfully used to treat completely displaced fractures of the femoral diaphysis in children aged two to six years. This technique is efficient and minimally invasive, and the results are satisfactory.

Anatomical and topographic substantiation of various accesses to the proximal epiphysis of the tibia

One of the most frequently performed accesses in the practice of an orthopedic veterinarian is access to the proximal epiphysis of the tibia. Access to the proximal epiphysis of the tibia is necessary in many cases of treatment of pathologies of the musculoskeletal system in cats and dogs and can be used in such surgical pathologies. The aim of the study was to consider options for surgical access to the proximal epiphysis of the tibia to perform osteosynthesis of fractures according to the Salter–Harris type, and osteotomy leveling the slope of the tibial plateau (TPLO) with anatomical and topographic justification. The study was conducted in the Network of veterinary centers "Kotonai" and the Department of Animal Anatomy of the St. Petersburg State University of Veterinary Medicine. The object of the study was dogs of small and medium breeds in the number of twelve individuals. The average age of the patients ranged from 6 months to 12 years. The study involved 5 intact females and 7 intact males. The average weight at the time of the study ranged from 2.5 to 21.0 kg. In the process of collecting the life history of all patients, the presence of chronic diseases, allergies and infectious diseases is excluded. The initial examination of the animal included: collection of anamneses of life and illness, general clinical examination, thermometry, neuroorthopedic examination, auscultation of the heart and lungs, X-ray examination under sedation. General clinical examination, thermometry and auscultation of the heart and lungs did not reveal pathological changes in all cases. According to the results of the study, it was found that there were no severe postoperative complications requiring repeated treatment in the studied patients. With the observance of clear anatomical and topographic landmarks in the formation of accesses, a good understanding of the anatomy of the medial and cranial surfaces of the tibia, visualization in the wound during surgical interventions (osteosynthesis of SalterHarris fractures, TPLO osteotomy) in the area of the proximal epiphysis of the tibia is convenient and safe.

Intercalary Resection of the Tibia for Primary Bone Tumors: Are Vascularized Fibula Autografts With or Without Allografts a Durable Reconstruction?

Intercalary Resection of the Tibia for Primary Bone Tumors: Are Vascularized Fibula Autografts With or Without Allografts a Durable Reconstruction?

Comparison of exposure of the radius afforded by the craniomedial and craniolateral open surgical approaches in dog cadavers.

Management of antebrachial fractures in dogs typically involves open reduction and bone plate stabilisation of the radius performed using either a craniomedial approach (CMA) or craniolateral approach (CLA). The aim of this cadaveric study was to compare radial exposure afforded via the craniomedial and craniolateral approaches, without and with releasing the abductor digiti I longus (ADIL) muscle. The CMA and CLA were performed on alternate paired cadaver forelimbs with the subsequent release (CMA) or elevation (CLA) of the ADIL muscle (n = 12). The percent area of exposure was calculated in defined longitudinal radial segments (LRSs) and hemi-circumferential radial segments (HRSs) using digitally uploaded images. A non-parametric rank sum test was used for statistical analysis (p < 0.05). While both the CMA and CLA provided sufficient exposure for radial cranial plate placement in the mid-to-distal diaphyseal region (50-80% LRSs), the CMA afforded greater exposure to the distal metaphysis (80-90% LRS). The CLA was advantageous in exposing the proximal diaphysis (20-50% LRSs) and distal epiphysis (90-100% LRS). Exposure of the distal diaphyseal, metaphyseal, and epiphyseal regions (80-100% LRSs) was impeded by the ADIL muscle. A tenotomy of the tendon of insertion of the ADIL muscle increased exposure afforded by the CMA in the distal metaphyseal and epiphyseal regions. The exposure afforded by the CLA in the distal diaphyseal and metaphyseal regions was significantly improved by elevating the origin of the ADIL muscle. The results of this study provide useful clinical information when surgeons are deciding which approach to use for cranial radial plating.

Effects of Weight Bearing on Marrow Adipose Tissue and Trabecular Bone after Anterior Cruciate Ligament Reconstruction in the Rat Proximal Tibial Epiphysis.

The effects of mechanical unloading after anterior cruciate ligament (ACL) reconstruction on bone and marrow adipose tissue (MAT) are unclear. We investigated weight bearing effects on bone and MAT after ACL reconstruction. Rats underwent unilateral knee ACL transection and reconstruction, followed by hindlimb unloading (non-weight bearing), no intervention (low-weight bearing, the hindlimb standing time ratio (STR; operated/contralateral) during treadmill locomotion ranging from 0.55 to 0.91), or sustained morphine administration (moderate-weight bearing, STR ranging from 0.80 to 0.95). Untreated rats were used as controls. At 7 or 14 days after surgery, changes in trabecular bone and MAT in the proximal tibial were assessed histologically. Histological assessments at 7 or 14 days after surgery showed that ACL reconstruction without post-operative intervention did not significantly change trabecular bone and MAT areas. Hindlimb unloading after ACL reconstruction induced MAT accumulation with adipocyte hyperplasia and hypertrophy within 14 days, but did not significantly affect trabecular bone area. Increased weight bearing through morphine administration did not affect trabecular bone and MAT parameters. Our results suggest that early weight bearing after ACL reconstruction is important in reducing MAT accumulation, and that reduction in weight bearing alone is not sufficient to induce bone loss early after ACL reconstruction.

The Effects of Corticosteroid Administration and Treadmill Exercise on Marrow Adipose Tissue and Trabecular Bone after Anterior Cruciate Ligament Reconstruction in Rats.

We aimed to investigate the effects of short-term corticosteroid administration after anterior cruciate ligament (ACL) reconstruction on marrow adipose tissue (MAT) and trabecular bone mass, as well as to examine whether treadmill exercise can mitigate MAT increase and trabecular bone deterioration caused by corticosteroid. ACL-reconstructed rats were divided into groups: no intervention, daily treadmill exercise (60 min/day), administration of the steroidal drug dexamethasone (250 μg/kg on days 0-5, 7, and 9 post-operatively), or dexamethasone administration combined with treadmill exercise. Untreated rats were served as controls. At day 10 or 30 post-operatively, histological assessments were performed in the proximal tibial epiphysis. MAT accumulation and trabecular bone loss were observed after ACL reconstruction. Dexamethasone promoted MAT accumulation at day 10 post-operatively but did not affect the trabecular bone loss. The MAT accumulation caused by dexamethasone reversed within 21 days after discontinuation. Treadmill exercise did not influence the changes in the MAT and trabecular bone areas. Short-term corticosteroid administration after ACL reconstruction promoted MAT accumulation while not affecting trabecular bone area. The MAT accumulation resulting from corticosteroid administration was reversible after discontinuation. Treadmill exercise could not mitigate the accumulation of MAT caused by corticosteroid administration and did not affect trabecular bone area.

Correcting for asymmetry of the proximal tibial epiphysis is warranted to determine postoperative alignment deviations in kinematic alignment from planned alignment of the tibial component on the native tibia

BackgroundIn total knee arthroplasty, unrestricted kinematic alignment aims to restore pre-arthritic lower limb alignment and joint lines. Joint line orientations of the contralateral healthy proximal tibia might be used to evaluate accuracy of tibial component alignment post-operatively if asymmetry is minimal. Our objective was to evaluate left-to-right asymmetry of the proximal tibial epiphysis in posterior tibial slope and varus-valgus orientation as related to unrestricted kinematic alignment principles. MethodsHigh resolution CT images (0.5 mm slice thickness) were acquired from bilateral lower limbs of 11 skeletally mature subjects with no skeletal abnormalities. Images were segmented to generate 3D tibia models. Asymmetry was quantified by differences in orientations required to shape-match the proximal epiphysis of the mirror 3D tibia model to the proximal epiphysis of the contralateral 3D tibia model. FindingsSystematic and random differences (i.e. mean ± standard deviation) in tibial slope and varus-valgus orientation were − 0.8° ± 1.2° and − 0.2° ± 0.8°, respectively. Ninety five percent confidence intervals on the means included 0° indicating that systematic differences were minimal. InterpretationSince random differences due to asymmetry are substantial in relation to random surgical deviations from pre-arthritic joint lines previously reported, post-operative computer tomograms of the contralateral healthy tibia should not be used to directly assess accuracy of tibial component alignment on a group level without correcting for differences in tibial slope and varus-valgus orientation due to asymmetry.

Bone age assessment based on different MRI modalities of the proximal humerus epiphysis: the comparisons of T1WI, T2WI, and PDWI

Bone age assessment based on different MRI modalities of the proximal humerus epiphysis: the comparisons of T1WI, T2WI, and PDWI

Legg-Calvé-Perthes Disease: Diagnosis, Decision Making, and Outcome.

Legg-Calvé-Perthes disease (LCPD), or idiopathic avascular necrosis of the proximal capital femoral epiphysis in children, has a variable presentation and can result in significant femoral head deformity that can lead to long-term functional deficits. Plain radiographic imaging is crucial in diagnosing LCPD and guiding treatment. Although the etiology of LCPD remains unknown, the evolution of the disease has been well characterized to include the phases of ischemia, revascularization, and reossification. The mechanical weakening during these phases of healing place the femoral head at high risk of deformity. Treatment of LCPD, therefore, focuses on minimizing deformity through operative and nonoperative strategies to reduce the risk of premature osteoarthritis. Advanced imaging using perfusion MRI may refine surgical decision making in the future, and biological treatments to improve femoral head healing are on the horizon.

Positive outcome reporting in orthopaedic literature.

Perthes' disease (PD) is a relatively rare syndrome of idiopathic osteonecrosis of the proximal femoral epiphysis. Treatment for Perthes' disease is controversial due to the many options available, with no clear superiority of one treatment over another. Despite having few evidence-based approaches, many patients with Perthes' disease are managed surgically. Positive outcome reporting, defined as reporting a study variable producing statistically significant positive (beneficial) results, is a phenomenon that can be considered a proxy for the strength of science. This study aims to conduct a systematic literature review with the hypothesis that positive outcome reporting is frequent in studies on the treatment of Perthes' disease. We conducted a systematic review of all available abstracts associated with manuscripts in English or with English translation between January 2000 and December 2021, dealing with the treatment of Perthes' disease. Data collection included various study characteristics, surgical versus non-surgical management, treatment modality, mean follow-up time, analysis methods, and clinical recommendations. Our study included 130 manuscripts. Overall, 110 (85%) reported positive (beneficial) results, three (2%) reported negative results, and 17 (13%) reported no significant difference. Despite only 10/130 studies (8%) having a testable hypothesis, 71 (55%) recommended the use of their studied treatment methods for the patients, five (4%) made recommendations against the use of the studied treatment modality, and 54 (42%) did not make any recommendations. The overall rate for positive outcomes among included manuscripts regarding different treatment methods for Perthes' disease (85%) is higher than the 74% positive outcome rate found among studies for other surgically treated disorders and significantly higher than most scientific literature. Despite the lack of testable hypotheses, most manuscripts recommended their studied treatment method as a successful option for managing patients solely based on the reporting of retrospective data.