Proximal Tibial Epiphyseal Plate Research Articles

Evaluation of distal femoral and proximal tibial epiphyseal plate in bone age estimation with 3.0T MRI: a comparison of current methods.

Dedouit et al, Kramer et al and Vieth et al defined different staging methods over different sequences in knee MRI for bone age determination. Our study aims to examine three different methods in which the maturation stages of the knee epiphyses are evaluated by MRI in the same population, to compare the methods and results and evaluate them for some age thresholds and to discuss their applicability in forensic age estimation. In this study, 597 knee images obtained using a 3.0T MR scanner were evaluated retrospectively. The T 1 weighted and proton density-weighted sequences were evaluated by two observers. Knee bone development was staged on the femur and tibia, and descriptive statistics were calculated for each stage according to age and sex. Descriptive statistics were presented according to the age and sex of the cases, and intra- and interobserver agreements were evaluated by the κ and κw statistics obtained by the Fleiss approach. Significant changes were found in stages depending on age. The intra- and interobserver agreement levels were very good (κ > 0.80) for each method. The methods of Dedouit, Kramer and Vieth can be used as an additional criteria for forensic age estimation for 14, 15, 18 and 21 year thresholds. Knee MRI stands out as an alternative modality for age estimation and it is necessary to prefer the method intended for the investigated age range with an individual-specific approach. Our study stands out as the first study in which current classification methods were applied and compared in the same population for age estimation with knee MRI.

The Protective Effects of Exclusive Enteral Nutrition Formulas on Growth Factor Expression and the Proximal Tibial Epiphyseal Growth Plate in a TNBS-Induced IBD Rat Model

This study aimed to evaluate the effectiveness of different types of nutritional formulas in a rat model of TNBS-induced IBD. IBD was induced with TNBS in 4-week-old rats that were then fed different exclusive enteral nutrition diets for 7 days. The length of the tibia and the number of chondrocytes in the proximal tibias were analyzed at 7 days after supplementation. Immunohistochemical analysis, ELISA and real-time PCR were performed to evaluate the levels of growth hormone receptor (GHR) and insulin-like growth factor-I receptor (IGF-IR), the growth factors IGF-I and insulin-like growth factor-binding protein-3 (IGFBP3) , bone morphogenetic protein (BMP)-2 and BMP-6 respectively. The results demonstrated that the tibia length of the peptide formula group was longer than that of the IBD-Modulen(®) formula and normal diet groups (P < 0.05). Furthermore, the number of chondrocytes of the proximal tibial was more pronounced in the peptide formula group compared to the other groups (P < 0.05). The peptide formula was also more effective in increasing the expression of GHR compared to the other groups (P < 0.05), while the expression of IGF-IR was not significantly different (P > 0.05). In addition, the IGF-I and IGFBP3 levels were more pronounced in the peptide formula supplement group (P < 0.05), and the expression of BMP-2 and BMP-6 mRNA in the proximal tibia growth plate from the peptide formula group was higher than that in the ordinary formula and normal diet groups (P < 0.05). EEN, and particularly a peptide formula, exerted protective effects on the proximal tibial epiphyseal growth plate in a TNBS-induced IBD model.

Ipsilateral distal femoral and proximal tibial epiphyseal growth plate injury: a case report

IntroductionBoth the isolated distal femoral epiphysiolysis and the isolated proximal tibial epiphysiolysis are the least common epiphyseal injuries. Even though they are uncommon, they have a high incidence rate of complications.Case presentationWe present a case with Gustilo-Anderson grade 3b open and Salter-Harris type 1 epiphysiolysis of the distal femur and proximal tibia caused by a farm machinery accident. The patient was a 10-year-old boy, treated by open reduction and internal fixation.ConclusionAlthough distal femoral and proximal tibial growth plate injuries are rarely seen benign fractures, their management requires meticulous care. Anatomic reduction is important, especially to minimize the risk of growth arrest and the development of degenerative arthritis. However, there is a high incidence of growth arrest and neurovascular injury with these type of fractures.

Assessment of Epiphyseal Plate Allograft Viability and Function After Ex Vivo Storage in University of Wisconsin Solution

Compromised epiphyseal plate function can result in limb deformities. Microvascular transplantation of an epiphyseal plate allograft is a potentially effective approach to reestablish longitudinal limb growth. For this procedure to become clinically useful, the technique for temporary ex vivo storage of allografts must be reliable. The goal of this study was to determine a time frame for which proximal tibial epiphyseal plate allografts could be stored in University of Wisconsin Preservation Solution (UWPS) and remain functional in vivo after microvascular transplantation. Proximal tibial epiphyseal plate allografts from skeletally immature female New Zealand White rabbits (10 to 12 wk of age) were used. Allografts (isolated on the popliteal arteriovenous pedicle) were stored ex vivo in cold UWPS for periods of up to 21 days. Chondrocyte viability, phenotype, and extracellular matrix composition of growth plate cartilage was assessed. Microvascular transplantations of nonstored or prestored (3 d) allografts were performed and analysis of bromodeoxyuridine and calcein incorporation was done to determine chondrocyte proliferation and new bone growth, respectively. In vitro analysis showed that, compared with control tissue, epiphyseal plate chondrocyte viability (P>0.05), organization, and collagen extracellular matrix was preserved up to 4 days in cold UWPS. Microvascular transplantation of nonstored epiphyseal plate allografts was successful. Despite care being taken to ensure vascular patency during the microvascular procedure, transplantation of prestored allografts failed due to absent flow in the larger vessels and in the allograft based upon the visualization of organized thrombus within the vascular pedicle, and absent flow within the composite graft itself. However, growth plate viability and function was detected in a peripheral region of a single allograft where partial blood flow had been maintained during the transplantation period. Ex vivo storage in cold UWPS for 3 days maintains growth plate chondrocyte viability and function in vivo. However, future studies must be directed toward investigating the direct effect of ex vivo storage on the integrity and function of the vascular pedicles.

Nutrition-induced catch-up growth increases hypoxia inducible factor 1α RNA levels in the growth plate

Although catch-up growth is a well-known phenomenon, the local pathways at the epiphyseal growth plate that govern this process remain poorly understood. To study the mechanisms governing catch-up growth in the growth plate, we subjected prepubertal rats to 10 days of 40% food restriction, followed by a renewal of the regular food supply to induce catch-up growth. The animals were weighed daily, and their humeral length was measured at sacrifice. The proximal tibial epiphyseal growth plates (EGPs) were studied, and findings were compared with EGPs from animals fed ad libitum and animals under food restriction. The gene expression profile in the growth plates was examined using DNA microarrays, and the expression levels of selected genes were validated by real-time polymerase chain reaction. To localize gene expression in different growth plate zones, microdissection was used. Protein levels and localization were examined using immunohistochemistry. We showed that the expression level of 550 genes decreased during food restriction and increased during catch-up growth, starting already one day after refeeding. HIF-1α, as well as several of its downstream targets, was found among these genes. Immunohistochemistry showed a similar pattern for HIF-1α protein abundance. Additionally, HIF-1α mRNA and protein levels were higher in the proliferating than in the hypertrophic zone, and this distribution was unaffected by nutritional status. These findings indicate that nutrition has a profound effect on gene expression level during growth plate growth, and suggest an important role for HIF-1α in the growth plate and its response to nutritional manipulation.

Concomitant physeal fractures of the distal femur and proximal tibia

Concomitant physeal fractures of the distal femur and proximal tibia are very rare in children and adolescents. They are included in the classification of the "floating knee" injuries. Two cases with this combined injury are reported. They were closed injuries and in both patients the fracture of the proximal tibial epiphyseal plate was nondisplaced. In the first, a six-year-old girl, an early diagnosis was made radiographically. The intra-articular femoral fracture was operatively reduced and fixed. No growth abnormality was encountered 12 years later. The second patient, a 16-year-old boy, was conservatively treated for a displaced fracture-separation of the distal femoral epiphysis. Four weeks later there was physeal widening on both sides of the knee which indicated an associated fracture of the proximal tibial epiphyseal plate. One year after injury there was a varus deformity of the knee that was treated with a corrective osteotomy. Ten years later there is normal alignment of the leg.

Expression of CCAAT/enhancer-binding protein-beta (C/EBPbeta) and CHOP in the murine growth plate. Two possible key modulators of chondrocyte differentiation.

Our aim was to evaluate the expression of transcription factors CCAAT/enhancer-binding protein-beta (C/EBPbeta) and C/EBP-homologous protein (CHOP) in the growth plate. Proximal tibial epiphyseal growth plates from ten 15-day-old Wistar rats were used. Additionally, anti-proliferating cell nuclear antigen (PCNA), anti-5-bromo-2'-deoxyuridine (BrdU) immunostaining, terminal transferase dUTP nick end-labelling (TUNEL) and nucleolar organiser region-associated proteins (AgNOR) techniques were peformed. The histological morphology of the growth plate from C/EBPbeta knock-out mice was also analysed. The normal growth plate showed that C/EBPbeta and CHOP factors are expressed both in the germinative/ upper proliferative and in the lower proliferative zones. Furthermore, BdrU+ and PCNA+ cells were present exclusively in the germinative and proliferative zones, while TUNEL+ and AgNOR+ cells were seen in all three zones of the growth plate. Acellular areas, hypocellularity, the increase in cell death and anomalies in the architecture of the cell columns were observed in the growth plates of C/EBPbeta (-/-) knockout mice. We suggest that C/EBPbeta and CHOP transcription factors may be key modulators participating in the chondrocyte differentiation process in the growth plate.

Development and validation of new model for microvascular transplantation of epiphyseal plate allografts with minimal adjoining epiphyseal and metaphyseal bone.

A model for the free allograft microvascular transplantation of rabbit proximal tibial epiphyseal plate allografts was developed, validated, and tested in an in vivo animal model. Transplants contained the minimum amount of adjacent epiphyseal and metaphyseal bone compatible with preservation of the epiphyseal-plate vascular supply, as determined by corrosion casting. Perfusion to this graft was evaluated quantitatively using radioactive microspheres, and qualitatively using India-ink injection. Female New Zealand White rabbits at 12 weeks of age were utilized. Vascularized transplantation of epiphyseal plate allografts was performed either into a defect of matched size in the iliac crest or into a soft-tissue pocket without bone contact. Cyclosporine A immunosuppression (CSA) was administered daily for 6 weeks. Two control groups underwent identical surgical procedures, but had no postoperative immunosuppression. Epiphyseal plates both with and without bone contact, in rabbits immunosuppressed postoperatively with CSA, demonstrated longitudinal growth and preserved viability as determined by positive bromodeoxyuridine uptake. Control epiphyseal plates transferred without postoperative immunosuppression were uniformly nonviable. This new model has value as a basis for further studies into the clinical applicability of isolated epiphyseal-plate transplants.

Transplantation of Epiphyseal Plate Allografts Between Animals of Different Ages

The purpose of the experiment was to study growth of epiphyseal plate allografts after transplantation into subjects of a different age, thus preparing for future transplantation of epiphyseal plate or extremity allografts in children. Microvascular transplantation of proximal tibial epiphyseal plate allografts was performed in skeletally immature New Zealand White female rabbits. The growth of 9-week-old epiphyseal plate allografts was examined in both 9-week-old and 17-week-old recipients, as was the growth of 17-week-old epiphyseal plate allografts in 17-week-old recipients. Immunosuppression was with cyclosporine (Cyclosporine A). Successful transplants were confirmed with 99mTc-MDP isotope scanning, and growth was evaluated with weekly standardized radiographs until death. Growth rate was found to depend on the age of the donor epiphyseal plate and was independent of the age of the recipient. This has clinical implications for the procurement of donor tissue in potential transplantation of epiphyseal plate allografts in children.

Can quantitative 99mTc‐MDP bone scans be used to predict longitudinal growth of epiphyseal plate allografts after microvascular transplantation? An experimental study

Allograft and autograft microvascular proximal tibial epiphyseal plate transplants were performed in female New Zealand White (NZW) rabbits to quantify the growth rate and total growth potential of immunosuppressed and nonimmunosuppressed rabbits. The purpose of this experiment is to examine whether the 99mTc-MDP radionuclide uptake of the transplanted epiphyseal plate at 1 week postoperatively, done to assess anastomotic patency of the transplant, could also serve as a predictor of eventual longitudinal growth of the transplant or replant. All transplants and replants demonstrating positive 99mTc-MDP uptake in the proximal tibial epiphyseal plate at 1 week showed continued longitudinal growth. The precise amount of 99mTc-MDP uptake, however, did not correlate with the amount of growth at 3 and 5 weeks follow-up.

Biodegradation of Polydioxanone in Bone Tissue

Implants of polydioxanone (PDS), 1.3 mm in diameter, were operatively fixed in the juxta-epiphyseal area of the right proximal tibial metaphysis in six rabbits and were driven into a drill hole of equal bore through the right proximal tibial epiphyseal plate in ten rabbits. The PDS implants had biodegraded almost completely in cortical bone at 16 weeks without any significant sign of inflammation or foreign body reaction. The PDS implants did not cause any growth disturbance. Histologic studies, however, showed that seven of 10 rabbits demonstrated significant osseous bridge formation across the epiphyseal plate.

Is longitudinal bone growth influenced by diurnal variation in the mitotic activity of chondrocytes of the growth plate?

The diurnal variations in the mitotic index, height, and rate of linear bone growth were determined and correlations between these parameters examined. Young, unweaned, female Wistar rats were housed under standardized conditions, labeled with a fluorochrome 60 h before sacrifice, and killed at intervals throughout a 24-h period, specifically 0600, 1200, 1800, and 2400. The proximal tibial epiphyseal growth plates were collected and processed, and the mitotic index, growth plate height, and the rate of linear bone growth were measured. The mitotic index measured at 0600 was significantly higher than that measured at 1800 and 2400. Growth plates of rats sacrificed at 1200 were taller than those of rats sacrificed at 1800, but there was no difference between heights of growth plates from rats sacrificed at other times. Daily growth rate for all rats averaged 283.9 microns/day and there were no statistically significant differences between daily growth rates measured at any time period. Our findings imply that in comparative, quantitative structural studies of animal groups, sacrifice should be carried out at identical times of the day, since, given a constant speed of vascular ingrowth and diurnal variation in width, relative diurnal accumulation and depletions of cells may take place. We also suggest that the daily growth rate and mitotic index be measured directly and not be considered a function of the height of the growth plate.

Tibiofibular Torsion from the Fetal Period Until Birth

The anatomic findings of Le Damany and Dupuis are still valuable as a reference. However, their measurement of tibial torsion does not correspond to clinical conditions. In fact, the torsion of the tibiofibular functional unit corresponds to the angle between the transverse axis of the proximal tibial epiphyseal plate and the axis through the middle of both malleoli. A comparative morphologic, radiologic, computerized axial tomographic and anatomic study performed on 50 fetuses with this definition has shown different results. Tibiofibular torsion was in the clear lateral position from the beginning of the fetal period, with a positive gradient at birth.

Tibiofibular Torsion from the Fetal Period Until Birth

The anatomic findings of Le Damany and Dupuis are still valuable as a reference. However, their measurement of tibial torsion does not correspond to clinical conditions. In fact, the torsion of the tibiofibular functional unit corresponds to the angle between the transverse axis of the proximal tibial epiphyseal plate and the axis through the middle of both malleoli. A comparative morphologic, radiologic, computerized axial tomographic and anatomic study performed on 50 fetuses with this definition has shown different results. Tibiofibular torsion was in the clear lateral position from the beginning of the fetal period, with a positive gradient at birth.

Discordance of serum and tissue somatomedin levels in growth hormone-stimulated growth in the rat.

Although the somatomedins are believed to mediate GH-induced somatic growth, circulating levels of insulin-like growth factor I (IGF-I) do not always correlate with growth rate. To evaluate a paracrine or autocrine effect that might explain this discordance, the concentrations of plasma and tissue IGF-I were compared with indices of growth in hypophysectomized rats treated with rat GH (rGH). The rats received a total of 250 micrograms rGH by either continuous pump infusion (P) or twice daily injections (I). After 4 days of treatment, the amounts of IGF-I present in acetic acid extracts of liver and kidney and in native serum were determined by RIA and related to proximal tibial epiphyseal plate width. Tibial epiphyseal plate width increased from 198 +/- 6 microns (mean +/- SE) in untreated controls to 339 +/- 13 microns in group P and 347 +/- 9 micron in group I; weight gain was 11.6 +/- 1.0 g in group P and 9.6 +/- 0.8 g in group I, while control animals lost 1.0 g. Serum concentrations of IGF-I were no different between control animals and those in the injection group (0.91 +/- 0.06 vs. 0.90 +/- 0.06 U/ml), whereas levels in the infusion group increased slightly (1.1 +/- 0.05 U/ml). In contrast, rGH administration caused tissue IGF-I to double in liver (control, 0.24 +/- 0.04 U/g; P, 0.51 +/- 0.03 U/g; I, 0.46 +/- 0.05 U/g) and nearly triple in kidney (control, 0.52 +/- 0.05 U/g; P, 1.51 +/- 0.09 U/g; I, 1.36 +/- 0.08 U/g). There was no detectable change in somatomedin-binding protein by gel exclusion chromatography. Since the rGH administered was sufficient to stimulate growth and increase tissue somatomedin levels without corresponding increases in circulating IGF-I, an autocrine or paracrine action of IGF-I appears to mediate GH's initial somatogenic actions in the young rat.

Biochemical Events During Stapling of the Proximal Tibial Epiphyseal Plate in Pigs

Epiphyseal stapling is considered a safe, effective method of correcting angular deformities of the knee in growing children. A study of the underlying biochemical events would contribute to a better understanding of the control of longitudinal growth rate in epiphyseal growth plates and of the molecular pathology of exaggerated physiologic bowleg or knock-knee deformities. Blount stainless staples were applied to the medial side of the proximal tibia epiphyseal growth plate of domestic pigs. The resulting biochemical changes were investigated by incubation of the isolated growth plate cartilage under organ culture conditions. On the fourth to the eighth day after stapling, a significant decrease of [14C]glucose uptake and lactate formation and a significantly lower specific radioactivity of the isolated glycosaminoglycans were observed in relation to the controls. During the second to 12th week, the incorporation of [3H]thymidine and the specific radioactivity of the glycosaminoglycans following incubation with [14C]glucose showed statistically significant decreases. The glycosaminoglycan content of the cartilage was not altered, but the chondroitin sulfate/keratan sulfate ratio was lower in the stapled than in the nonstapled areas. In this period, glucose uptake and lactate production were found to be normalized.

Preliminary Observations on Epiphyseal Growth Rate in Congenital Pseudarthrosis of Tibia After Free Vascularized Fibular Graft

Observations were made on the growth rate of proximal and distal tibial epiphyseal growth plates in three children treated by free vascularized fibular grafts for congenital pseudarthrosis of the tibia. Postoperative measurements show that the distal tibial epiphysis can grow faster than the proximal epiphysis; the successful transfer of vascularized fibula may increase blood supply to the distal tibial epiphyseal plate, thus stimulating its growth.

The Interaction of Dietary Vitamin A and Vitamin D Related to Skeletal Development in the Turkey Poult

Large white male turkey poults were fed diets with different levels of vitamins A and D to study the interaction of these vitamins with regard to skeletal development. Poults fed a basal diet deficient in both vitamins A and D developed severe lameness, growth depression, mortality and lesions consistent with rickets. Birds fed a diet containing the required level of viatmin D (900 ICU/kg, NRC estimated requirement) and a high level of vitamin A (400,000 IU/kg) also developed severe lameness, growth depression and a rachiticlike condition, characterized by thicker than normal proximal tibial epiphyseal plates and lower than normal bone mineral content. When fed a diet containing the required level of vitamin A (4,000 IU/kg, NRC estimated requirement) and a high level of vitamin D (900,000 ICU/kg), poults developed hypervitaminosis D as evidenced by mild growth depression and renal tubular mineralization. When poults were fed a diet containing high levels of both vitamins A and D growth rate and bone mineral content were similar to control poults fed a diet containing the required levels of vitamins A and D. In addition, lameness and renal tubular mineralization were not apparent in the poults fed a diet containing high levels of both vitamins A and D. It was concluded that there is an antagonistic interaction between vitamins A and D.

Experimental study on the haematogenous origin of multinucleate osteoclasts in the rat.

When the resorption zones of the distal femoral and proximal tibial epiphyseal plates of rats are examined with the electron microscope, numerous macrophages can be seen surrounding degenerated chondrocytes. Macrophages are also found in the neighbourhood of the invading sinusoids and in close proximity to multinucleate osteoclasts. Cell fusion, however, could not be observed. Repeated transfusions of female leukocytes to isohistogenic growing male rats caused an increase in the number of nuclei containing a Barr body in the osteoclasts of the males. The result suggests that leukocytes--of which only the monocytes come in question--are the source of multinucleate osteoclasts in endochondral ossification.

Epiphyseal plate shear strength in rats treated with a diphosphonate.

AbstractRats treated with a small dose (0.5 mg P/kg/day) of dichloromethylene diphosphonic acid (C12MDP) exhibited a marked increase in the shear strength of the proximal tibial epiphyseal plate with no suppression of longitudinal growth. Our results suggest that mechanisms in addition to the absorption of diphosphonate onto hydroxyapatite crystals account for the increase in epiphyseal plate shear strength noted in our experiment. In this regard, this diphosphonate could be valuable in studies of the normal determinants of epiphyseal plate shear strength. In addition, since C12MDP increased epiphyseal plate strength without suppressing longitudinal growth, the compound may eventually prove to be useful in the treatment of epiphyseal displacements in humans.