9780126386516

Preface

xvii

Acknowledgments

xix

PART I Basic Information

Developmental Bone Biology

Terminology

(2)

Overview

(1)

Theories of Embryogenesis-Preformationism and Epigenesis

(1)

Epiphysis

(1)

Endochondral Ossification

(1)

Intramembranous Ossification

(1)

Perichondrial Ossification Groove of Ranvier

(1)

Early Scientific Understandings of Bone Growth

(3)

Hales and Belchier

(1)

Nesbitt

(2)

Duhamel

(1)

Hunter

(1)

Howship

(1)

Flourens

(1)

Embryology of the Limbs

(5)

Timing and Staging of Human Limb Development

(1)

Outline of Embryonic Development of Long Bones

(4)

Bone Development at the Light Microscopic Level Following Delineation of the Cell Theory and Advances in Microscopy and Histochemistry

(3)

More Detailed Histologic Studies of Bone Formation

(3)

Histogenesis of Bone

(1)

Chondrocyte Shape and Orientation in Epiphyseal and Physeal Cartilage: Mineralization and Vascularization in the Endochondral Sequence (Dodds)

(1)

Cellular Components

(1)

Fate of the Hypertrophic Chondrocyte as Interpreted from Light Microscopic Studies

(2)

Chondrocyte Survival, Dedifferentiation, and Reemergence to a Bone Forming Cell Line

(1)

Direct Transformation of Cartilage Cells to Bone Cells

(1)

Death of Cartilage Cells

(1)

Variable Responses

(1)

Structural Development of the Epiphyseal Regions Including the Joints, the Metaphyses, and the Diaphyses

(32)

Epiphyses

(1)

Secondary Ossification Center Formation

(4)

Physis-Structure and Relation to Function

(14)

Perichondrial Ossification Groove of Ranvier

(1)

Periosteum and Its Relationship to the Epiphyses, Metaphyses, and Diaphyses

(2)

Cortical (Diaphyseal) Bone Formation-Woven Bone and Lamellar Bone

(3)

Development of Joints-General Description

(2)

Epiphyseal Blood Supply

(5)

Development of the Articular Cartilage

(2)

Axes along Which Bones are Patterned

(5)

Signaling Regions That Affect the Patterns of Bone Development

(1)

Models of Tissue Patterning

(2)

Positional Information Mechanisms

(2)

Prepattern Mechanisms

(1)

Determination Wave Mechanisms

(1)

Rearrangement Mechanisms

(1)

Cell Lineage Mechanisms

(1)

Gene and Molecular Controls of Limb Development

(24)

Apical Ectodermal Ridge

(1)

Progress Zone

(1)

Polarizing Region

(1)

Dorsal Nonridge Ectoderm

(16)

Overview of Gene Controls of Limb Development

(1)

Homeobox Genes

(3)

Specific Details Concerning Gene and Molecular Controls on Limb Development and the Hox Gene Network

(1)

Expression of Hoxa and Hoxd Genes during Normal Limb Development

(1)

Expression of Hoxc Genes in the Chick Limb Bud

(1)

Expression of Hoxb Genes

(1)

Signaling Molecules along Developing Limb Axes

(3)

Matrix Metalloproteinases (MMPs) and Tissue Inhibitors of Matrix Metalloproteinases (TIMPs)

(1)

Chemistry of the Extracellular Matrix

(11)

Collagen

(5)

Collagen Groups

(1)

Detailed Review of Specific Cartilage Collagens

(1)

Proteoglycans

(1)

Glycoproteins and Noncollagenous Proteins

(2)

Cell Surface Proteoglycans

(1)

Temporal and Spatial Changes in Specific Molecular Expression within the Endochondral Sequence

(1)

Mineralization

(3)

Epiphyseal Growth

(3)

Physeal Chondrocyte Metabolism

(1)

Studies of Cell Proliferation in Physeal Cartilage Using Tritiated Thymidine Autoradiography

(1)

Kinetics of Epiphyseal Growth

(1)

Amount of Growth at Each Epiphyseal Plate

(1)

Growth Slowdown and Growth Arrest Lines (Harris Lines)

(1)

Responses of Developing Bones and Epiphyses to Mechanical Stresses

(12)

Normal Responses to Mechanical Factors

(4)

Normal Relationship of Epiphyseal Plates to Compressive and Tensile Stresses

103

(2)

Mechanical Stresses and Their Differences and Effects on Skeletal Development

105

(2)

Responses of Physes to Abnormal Pressures-Pathogenesis of Creation and Correction of Deformity in Developing Bones

107

(2)

The Effects of Pressure on Epiphyseal Growth

109

(2)

Radiographic Characteristics in Development of Major Long Bone Epiphyses

111

(7)

General Information

111

(1)

Proximal Humerus

111

(1)

Distal Humerus

112

(3)

Proximal Radius

115

(1)

Distal Radius

115

(1)

Proximal Ulna

115

(1)

Distal Ulna

115

(1)

Proximal Femur

115

(1)

Distal Femur

116

(1)

Proximal Tibia

116

(1)

Distal Tibia

116

(1)

Proximal Fibula

117

(1)

Distal Fibula

117

(1)

Relationship of Proximal and Distal Tibial and Fibular Physes

117

(1)

Time and Pattern of Physeal Closure

117

(1)

Distal Tibial Growth Plate Closure

117

(1)

Proximal Femoral, Proximal Tibial, Metatarsal, and Phalangeal Growth Plate Closure

117

(1)

Why Epiphyses Form and the Evolution of Epiphyses

118

(11)

References

119

(10)

Imaging Approaches for Epiphyseal Assessment

Dr. Diego Jaramillo

Introduction

129

(1)

Technical Considerations

129

(4)

Ultrasonography

129

(1)

Magnetic Resonance Imaging

130

(2)

Computed Tomography (CT)

132

(1)

Scintigraphy

132

(1)

Imaging Characteristics

133

(2)

Cartilage

133

(2)

Bone

135

(1)

Bone Marrow

135

(1)

Normal and Abnormal Growth and Ossification

135

(7)

Imaging of Abnormalities by Location: Disorders of the Lower Extremity

142

(5)

Disorders of the Hip

142

(3)

Disorders of the Knee

145

(2)

Disorders of the Distal Tibia and Fibula

147

(1)

Imaging of Disorders by Location: Disorders of the Upper Extremity

147

(6)

Shoulder

147

(1)

Elbow

148

(1)

Wrist

148

(1)

References

148

(5)

PART II Disorders of the Developing Hip and Knee

Developmental Dysplasia of the Hip

Terminology

153

(1)

Development of the Hip-Embryonic and Fetal Periods

154

(6)

General Aspects of Hip Development

154

(4)

Embryonic, Fetal, and Postnatal Development of the Femur

158

(1)

Embryonic, Fetal, and Postnatal Development of the Acetabulum

159

(1)

Primary Etiologies of Hip Maldevelopment

160

(1)

Etiology and Pathoanatomy of Developmental Dysplasia of the Hip

161

(31)

Early Clinical-Pathoanatomic Descriptions

161

(15)

Later Clinical-Pathoanatomic Descriptions

176

(3)

Most Recent Clinical-Pathoanatomic Descriptions with an Emphasis on Early Capsular Laxity

179

(8)

Multifactorial Causes of DDH Involving Late Stage Structural Modifications of the Hip, Mesenchymal Tissue Abnormalities, and Intrauterine Mechanical Stresses Due to Positioning

187

(3)

Experimental Reproduction of Hip Dislocation

190

(2)

Epidemiology and Its Relation to Pathophysiology

192

(3)

Sex Incidence

192

(1)

Incidence and Side of Hip Instability

193

(1)

Effects of Intrauterine Environment

193

(1)

Extrauterine Postnatal Environment

194

(1)

Genetic Considerations

194

(1)

Ethnic Considerations

194

(1)

Spontaneous Stabilization of Hips without Treatment

194

(1)

Summary of Pathoanatomic and Pathophysiologic Findings and Discussion of Pathogenetic Sequences

195

(3)

Overview

195

(1)

Capsular Laxity

195

(1)

Acetabular Dysplasia

196

(1)

Proximal Femoral Dysplasia

196

(1)

Adductor Muscle Tightness

196

(1)

Soft Tissue Deformation

196

(1)

Idiopathic and Teratologic Dysplasia

197

(1)

Worsening of Secondary Changes with Time

197

(1)

Natural History of Hip Dislocations, Subluxations, and Dysplasia

198

(1)

Natural History of Complete Dislocations

198

(1)

Natural History of Dysplasia and Subluxation

198

(1)

Osteoarthritis in Adult Life Following Childhood CDH

198

(1)

Brief History of Treatment Approaches in Developmental Dysplasia of the Hip

199

(14)

Gradual Development of Reasonably Effective Closed and Open Treatments

199

(4)

Progressively Earlier Diagnosis and Treatment of Congenital Dislocation

203

(2)

Assessments of Congenital Hip Dislocation Treated by Closed Reduction

205

(1)

Treatment by Open Reduction

206

(2)

Acetabular Corrective Procedures for Treatment of Hip Dysplasia

208

(4)

Proximal Femoral Osteotomies

212

(1)

Combined Acetabular and Proximal Femoral Osteotomies

213

(1)

Imaging Techniques Used to Assess Hip Position

213

(19)

Plain Radiographic Indices

214

(4)

Arthrography in Assessing Hip Position and Anatomy

218

(3)

Ultrasonography in the Diagnosis of Newborn Developmental Dysplasia of the Hip

221

(9)

Long-Term Studies of Sonographic Indices in Normal and Abnormal Hip Development

230

(1)

CT Scan to Assess Hip Structure

230

(1)

MR Imaging to Assess Position and Vascularity of the Femoral Head Postreduction

231

(1)

Assessments of Hip Growth and Development Following Closed and Open Treatments

232

(2)

Growth and Development of the Hip Following Closed Reduction in Early Infancy

232

(1)

Acetabular Development Following Hip Reduction by Closed, Open, or Varus Osteotomy Treatments

232

(1)

Acetabular Development after Removal of the Limbus in Infancy

233

(1)

Acetabular Growth Following Acetabular Surgery

234

(1)

Growth Disturbance Lines in Proximal Femur: O'Brien

234

(1)

Proximal Femoral Growth Following Femoral Osteotomy

234

(1)

Treatment Based on the State of the Underlying Pathoanatomy, Including Secondary Changes

234

(5)

General Overview

234

(1)

Diagnosis Made in the Newborn Period

235

(1)

Diagnosis Made at 3 Months of Age

236

(1)

Diagnosis Made at 6 Months of Age

237

(1)

Diagnosis Made at 12 Months of Age

238

(1)

Diagnosis Made at 18 Months of Age

238

(1)

Diagnosis Made between 18 Months and 4.5 Years of Age

238

(1)

Imperfect Hip Structure after 5 Years of Age

239

(1)

Preadolescent-Adolescent Hip Dysplasia

239

(1)

Avascular Necrosis as a Complication of Treatment of Developmental Dysplasia of the Hip

239

(33)

Blood Supply of the Proximal Femur

239

(6)

Epiphyseal Blood Supply: Cartilage Canals

245

(1)

Recognition of the Problem of Avascular Necrosis as a Complication of Treatment for Developmental Dysplasia of the Hip

246

(1)

Efforts to Understand and Treat the Causes of Avascular Necrosis

247

(4)

Classification of Patterns of Avascular Necrosis Following Treatment of Developmental Dysplasia of the Hip

251

(2)

Avascular Necrosis Associated with Immobilization Devices Other Than a Hip Spica

253

(1)

More Recent Reports of the Incidence of AVN in Developmental Dysplasia of the Hip

254

(4)

Long-Term Results Following AVN in Childhood CDH-DDH

258

(1)

MR Imaging to Detect Hip Ischemia Due to Extreme Immobilization Positioning

258

(4)

References

262

(10)

Legg-Calve-Perthes Disease

Definition

272

(1)

Original Recognition of Disorder

272

(4)

General Review

272

(1)

Legg

273

(1)

Calve

273

(2)

Perthes

275

(1)

Waldenstrom

275

(1)

Sourdat

276

(1)

Clinical Profile

276

(5)

General Features

276

(1)

Epidemiologic Features of Legg-Calve-Perthes Disease

277

(4)

Early Pathologic Reports of Cell and Tissue Changes in Legg-Calve-Parthes Disease

281

(4)

Zemansky, 1928

281

(1)

Schwarz, 1914

282

(1)

Phemister, 1920

282

(1)

Axhausen, 1923

282

(1)

Heitzmann, 1923

283

(1)

Riedel, 1923

283

(1)

Walter, 1925

283

(1)

Konjetzny, 1926, 1934

283

(1)

Delchef, 1926

284

(1)

Rockemer, 1927

284

(1)

Lippmann, 1929

284

(1)

Nagassaka, 1930

284

(1)

Summary of Histopathologic Changes after Two Decades of Study (Zemansky)

285

(1)

Subsequent Pathologic Reports with Better Defined Clinical and Radiographic Correlations

285

(12)

Ferguson and Howorth, 1934

285

(1)

Gall and Bennett, 1942

286

(1)

Haythorn, 1949

287

(1)

Jonsater, 1953

287

(2)

Ponseti, 1956

289

(1)

Mizuno, Hirrayama, Kotani, and Simazu, 1966

289

(1)

Dolman and Bell, 1973

290

(1)

Larsen and Reiman, 1973

290

(1)

McKibbin and Ralis, 1974; McKibbin, 1975

290

(2)

Jensen and Lauritzen, 1976

292

(1)

Inoue, Freeman, Vernon-Roberts, and Mizuno, 1976

292

(1)

Inoue, Ono, Takaoka, Yoshioka, and Hosoya, 1980

292

(1)

Catterall et al., 1982a,b

293

(2)

Ponseti et al., 1983

295

(2)

Early Correlation of Radiographic with Histopathologic and Clinical Features of Legg-Perthes from the Incipient Stage to the Residual Stage

297

(1)

Pathoanatomic Changes and Their Relation to the Clinical, Radiologic, and Other Imaging Findings

297

(24)

Overview of Plain Radiographic Changes in Legg-Perthes Disease

297

(3)

Pathologic Changes and Their Demonstration by Varying Imaging Modalities Including Ultrasonography, Scintigraphy, Magnetic Resonance Imaging, and Computerized Axial Tomography

300

(4)

Subsequent Pathologic Changes Presenting as a Realtive Decrease in Size of the Involved Secondary Ossification Center

304

(1)

Nutrition of the Proximal Femoral Epiphysis and Its Bearing on Legg-Calve-Perthes Disease

304

(1)

Gage Sign-Catterall Sign: Lateral-Proximal Neck Convexity-Lateral Epiphyseal Lysis

304

(1)

Subchondral Fracture and Crescent Sign

304

(1)

Increased Radiodensity of the Secondary Ossification Center

305

(1)

Alternating Areas of Radiodensity and Radiolucency

306

(1)

Responses of the Cartilage Model of the Femoral Head

307

(4)

Assessment of Cartilage Model of Proximal Femur Using Arthrography

311

(1)

Responses of the Physis

312

(1)

Sagging Rope Sign

313

(1)

Responses of the Femoral Neck (Metaphysis)

313

(3)

Femoral Neck Anteversion

316

(1)

Responses of the Greater Trochanter

316

(1)

Responses of the Acetabulum

316

(2)

Remodeling in the Residual Phase of the Disease between the Termination of Healing and Skeletal Maturity

318

(1)

Imperfect Healing of Legg-Calve-Perthes with Persistence of an Osteochondritis Dissecans Lesion at Skeletal Maturity

319

(1)

Hinge Abduction: Imperfect Healing with a Flattened Femoral Head and a Superolateral Prominence Impeding Smooth Abduction

319

(1)

Femoral Shortening as a Sequel to Legg-Perthes Disease

319

(2)

Lower Extremity Length Discrepancies with Legg-Perthes Disease

321

(2)

Maximum Total Femoral and Tibial Discrepancy during Growth Years

321

(1)

Femoral and Tibial Discrepancy at Skeletal Maturity

321

(1)

Maximum Femoral Discrepancy

321

(1)

Maximum Tibial Discrepancy

321

(1)

Developmental Patterns of Discrepancies in Legg-Perthes Disease

321

(2)

Prognostic Indicators during the Active Disease Process

323

(6)

General Considerations

323

(1)

Age of Occurrence of the Disease

323

(1)

Plain Radiographic Classifications

324

(5)

Comparison of Classification Schemes

329

(1)

More Recent Clarifications of Poor Prognostic Signs

329

(1)

Classifications Defining Results Based on Appearances at Skeletal Maturity at the End of Repair

329

(7)

General Considerations

329

(1)

Sundt Classification

330

(1)

Quantitative Indices of Femoral Head-Acetabular Repair

330

(3)

Stulberg Classification

333

(2)

Butel, Borgi, and Oberlin Grading System

335

(1)

Additional Long-Term Studies of Adult Responses to a Childhood Perthes Disorder

335

(1)

Treatment Approaches to Legg-Perthes Disease

336

(40)

Early Major Reviews of Treatment Approaches

336

(3)

Range of Approaches to the Disorder

339

(21)

Other Factors Concerning Results

360

(2)

Late-Stage Surgical Intervention to Treat the Sequelae of Legg-Perthes Disease

362

(2)

Summary of Treatment Approaches

364

(4)

References

368

(8)

Coxa Vara in Developmental and Acquired Abnormalities of the Femur

Slipped Capital Femoral Epiphysis, Proximal Femoral Focal Deficiency, Infantile Coxa Vara, Coxa Vara with Congenital Short Femur, Coxa Vara with Skeletal Dysplasias

Coxa Vara-General Overview

376

(2)

Terminology

376

(1)

Causes of Coxa Vara

376

(2)

Clinical Presentation of Coxa Vara

378

(1)

Imaging Assessments in Coxa Vara

378

(1)

Slipped Capital Femoral Epiphysis

378

(58)

Terminology

378

(1)

Evolving Clinical Awareness and Description of the Disorder

379

(2)

Etiology of Slipped Capital Femoral Epiphysis

381

(2)

Pathoanatomy

383

(6)

Interpretation of the Studies on Pathogenesis and Pathoanatomy

389

(3)

Medical Disorders Predisposing to Slipped Capital Femoral Epiphysis

392

(4)

Types of Classification for the SCFE Entity

396

(2)

Epidemiologic Characteristics of Slipped Capital Femoral Epiphysis: Age, Sex, Weight, Symptom Time, Bilaterality, and Associated Disorders

398

(6)

Diagnostic Imaging Studies

404

(1)

Therapy

404

(32)

Coxa Vara Due to Other Acquired Causes

436

(1)

Developmental Abnormalities of the Femur

436

(7)

Terminology

436

(1)

Proximal Femoral Focal Deficiency

436

(6)

Congenital Short Femur

442

(1)

Distal Femoral Developmental Abnormalities

442

(1)

Infantile Coxa Vara

443

(19)

Terminology

443

(1)

Clinical and Radiographic Presentation of Infantile Coxa Vara

443

(1)

Pathoanatomy of Infantile Coxa Vara

444

(2)

Evolution of Radiographic Change

446

(1)

Pathomechanics of Deformity in Infantile Coxa Vara

447

(1)

Clinical-Radiographic Correlations

448

(1)

Management of Infantile Coxa Vara

449

(6)

References

455

(7)

Developmental Disorders of the Knee

Distal Femur, Proximal Tibia, and Proximal Fibula

Normal Developmental Variability

462

(3)

Physiologic Genu Varum and Genu Valgum in Childhood

462

(1)

Normal Radiographic Developmental Variants of the Distal Femoral and Proximal Tibial Epiphyses

462

(3)

Osteochondritis Dissecans of Distal Femur

465

(14)

Disease Profile

465

(1)

Original Descriptions by Paget, Teale, and Koenig

466

(1)

Three Stages of the Disorder

467

(1)

Age of Occurrence

468

(1)

Regions of Involvement of Distal Femur

468

(1)

Etiology

468

(2)

Pathogenesis and Pathoanatomic Findings

470

(4)

Current Understanding of the Disease Entity

474

(1)

Radiographic and Other Imaging Findings

475

(2)

Age at Occurrence, Treatment, and Relation to Healing

477

(1)

Summary of Treatment Approaches in Childhood OD

478

(1)

Infantile Tibia Vara (Blount's Disease)

479

(14)

Terminology

479

(1)

Clinical and Radiographic Profile of Infantile Tibia Vara

480

(1)

Clinical-Radiographic Grading Scheme of Langenskiold, Types I-VI

481

(1)

Pathogenesis of Varus Deformity

481

(3)

Pathoanatomy

484

(2)

Imaging Assessments in Relation to Tibia Vara

486

(1)

General Management Considerations

487

(1)

Recurrent Deformity Following Osteotomy

488

(2)

Spontaneous Correction

490

(1)

Surgical Approaches to Tibia Vara

490

(1)

Adult Sequelae of Childhood Tibia Vara

491

(2)

Adolescent Tibia Vara

493

(4)

Terminology

493

(1)

Clinical Profile

493

(2)

Variable Opinions on Whether Late-Onset Tibia Vara is Superimposed on a Preexisting Varus Deformity

495

(1)

Physeal Height and the Question of Distal Femoral Varus Tilt

495

(1)

Association of Femoral Varus with Tibia Vara in Late-Onset Blount's Disease

496

(1)

Radiographic Assessments

496

(1)

Pathoanatomy of Adolescent Tibia Vara

496

(1)

Treatment

497

(1)

Osgood-Schlatter Disease (Tibial Tubercle Chronic Traumatic Apophysitis)

497

(10)

Terminology and Outline

497

(1)

Pathophysiology

497

(1)

Tibial Tuberosity Development

498

(3)

Pathoanatomic Changes in Osgood-Schlatter Disease

501

(3)

Clinical and Radiologic Features of Osgood-Schlatter Disease

504

(1)

Clinical Symptoms and Management

504

(3)

Congenital Dislocation of the Knee

507

(3)

Definition and Clinical Profile

507

(1)

Classification

507

(1)

Pathoanatomy

508

(1)

Diagnostic Considerations

509

(1)

Treatment Approaches

509

(1)

Valgus Angulation Following Proximal Tibial Metaphyseal Fractures in Childhood

510

(1)

Description and Clinical Profile

510

(1)

Etiological Considerations Underlying Valgus Deformation

510

(1)

Guidelines for Treatment

511

(1)

Disorders of the Proximal Fibular Epiphysis

511

(8)

Congenital Proximal Tibial-Fibular Synostosis

511

(1)

Proximal Fibular Elongation

511

(1)

Hypoplasia of Fibula

511

(1)

Hereditary Multiple Exostosis

512

(1)

Proximal Fibular Overgrowth Secondary to Damage to the Proximal Tibial Physis

512

(1)

References

512

(7)

PART III Deformities Due to Disorders Primarily Affecting the Epiphyses and Metaphyses

Epiphyseal Growth Plate Fracture-Separations

Introduction: Pre-radiographic Era, Pathoanatomic Approaches, and Pathophysiologic Approaches

519

(1)

Clinical and Experimental Investigations of Growth Plate Fracture-Separations in the Preradiographic Era

519

(12)

Early Clinical Descriptions

519

(1)

Important Studies Establishing the Validity of the Entity of Epiphyseal Growth Plate Fracture-Separations

520

(2)

Relatively Slow Acceptance by Many of the Existence of Epiphyseal Fractures

522

(1)

Pathoanatomic Studies of Epiphyseal Growth Plate Fracture-Separations

523

(5)

Understanding of Growth Plate Fracture-Separations at the End of the Pre-radiographic Era

528

(3)

Clinical Approaches to Growth Plate Fracture-Separations in the Radiographic Era

531

(6)

Pathoanatomic Classifications

531

(4)

Mechanistic Considerations

535

(2)

Negative Sequelae of a Growth Plate Fracture-Separation

537

(1)

Pathophysiologic Approaches to Growth Plate Fracture-Separations

537

(19)

Pathophysiologic Classification-Shapiro

537

(2)

Experimental Approaches to Growth Plate Structure, Blood Supply, and Function

539

(9)

Pathogenesis of Growth Deformity

548

(1)

MR Imaging in Assessment of Growth Plate Fracture-Separations

549

(7)

General Clinical Profile of Growth Plate Fracture-Separations

556

(4)

Overview

556

(1)

Distribution of Physeal and Nonphyseal Fractures in Childhood

557

(1)

Incidence of Epiphyseal Growth Plate Fracture-Separations in Males and Females

558

(1)

Incidence of Epiphyseal Growth Plate Fracture-Separations at Specific Epiphyses

558

(1)

Age at Occurrence of Physeal Fractures

558

(1)

Distribution of Specific Salter-Harris Types per Long Bone Region

559

(1)

Epiphyseal Fracture-Separations with Difficult Births

559

(1)

Clinical Features of Acute Epiphyseal Fracture-Separations

560

(32)

General Principles of Management

560

(1)

Proximal Humerus

561

(1)

Distal Humerus

562

(8)

Proximal Radius

570

(1)

Distal Radius

570

(4)

Distal Ulna

574

(1)

Metacarpals and Phalanges

574

(1)

Triradiate Acetabular Cartilage

574

(1)

Proximal Femur

575

(1)

Distal Femur

576

(6)

Proximal Tibia

582

(3)

Distal Tibia

585

(6)

Proximal and Distal Fibula

591

(1)

Growth Patterns Following Distal Tibial and Fibular Growth Plate Fracture-Separations Using Roentgen Stereophotogrammetry

591

(1)

Ligament Damage Following Distal Femoral and Proximal Tibial Physeal Fractures

592

(1)

Traumatic Damage to Growth Plates by Pathologic, Chronic Repetitive, and Indirect Effects

592

(4)

Pathologic Epiphyseal Growth Plate Fracture-Separations

592

(2)

Premature Physeal Closure Following Seemingly Unrelated Fractures of the Ipsilateral Diaphysis and Metaphysis

594

(1)

Physeal Separation Due to the Stress Injury Caused by Chronic Repetitive Activity

595

(1)

Genu Recurvatum after Skeletal Traction Involving Inadvertent Placement of the Proximal Tibial K-Wire through the Tibial Tubercle-Physeal Area

596

(1)

Management of Negative Sequelae of Growth Plate Fracture-Separations

596

(10)

General Considerations

596

(1)

Management of Early Bone Bridge Formation

596

(1)

Management of Late Sequelae of Bone Bridges: Bone Bridge Excision, Physical Interposition Materials, and Transphyseal Chondrodiatasis

597

(1)

References

597

(9)

Lower Extremity Length Discrepancies

Terminology

606

(1)

Clinically Significant Length Discrepancies

606

(4)

General Guidelines Concerning Extent of Clinically Significant Length Discrepancies

606

(1)

Percentage of Individuals with Equal Limb Lengths

606

(2)

Clinical Effects of Lower Extremity Length Discrepancies

608

(2)

Limb Length Determination

610

(1)

Clinical Measurements

610

(1)

Segments to Be Considered in Assessing Lower Extremity Length Discrepancies

611

(1)

Radiographic and Other Imaging Documentation of Lower Extremity Length Discrepancies

611

(1)

Causes of Lower Extremity Length Discrepancies

611

(1)

Developmental Patterns in Lower Extremity Length Discrepancies

612

(3)

Patient Population

612

(3)

Classification of Developmental Patterns in Lower Extremity Length Discrepancies

615

(1)

Lower Extremity Length Discrepancies in Specific Disease Entities: Pathoanatomy, Pathophysiology, Developmental Patterns, and Ranges of Discrepancies

615

(38)

Congenital Limb Deficiencies

615

(10)

Skeletal Dysplasias with Asymmetric Involvement

625

(2)

Destroyed Physes

627

(1)

Abnormal Growth Following Use of Neonatal Umbilical or Femoral Catheters

627

(1)

Poliomyelitis

627

(2)

Hemiparetic Cerebral Palsy

629

(1)

Septic Arthritis of the Hip

630

(1)

Tuberculosis

631

(1)

Premature Epiphyseal Fusion at the Knee Complicating Prolonged Lower Extremity Immobilization

632

(1)

Osteomyelitis

633

(1)

Meningococcemia

634

(1)

Physeal Damage Following Irradiation for Childhood Tumors

635

(1)

Fractured Femoral Diaphysis

636

(3)

Fractured Tibial Diaphysis

639

(1)

Hemihypertrophy and Hemiatrophy (Anisomelia)

639

(9)

Neurofibromatosis

648

(1)

Juvenile Rheumatoid Arthritis

649

(1)

Thalassemia

650

(1)

Hemophilia

651

(1)

Synovial Hemangioma of the Knee Joint

651

(1)

Legg-Calve-Perthes Disease

651

(1)

Slipped Capital Femoral Epiphysis

652

(1)

Limb Length Discrepancies Due to External Causes

652

(1)

Infantile Cortical Hyperostosis-Caffey's Disease

652

(1)

Projection of Limb Length Discrepancies by the Time Skeletal Maturity is Reached

653

(8)

Percentages of Growth at Each End of Major Long Bones

653

(1)

Systems for Projecting Limb Length Discrepancy at Skeletal Maturation

653

(6)

Discussion of Methods

659

(2)

Use of the Developmental Pattern Classification in Projecting Limb Length Discrepancies

661

(2)

Type I

661

(1)

Type II

662

(1)

Type III

662

(1)

Type IV

662

(1)

Type V

662

(1)

Management of Lower Extremity Length Discrepancies

663

(43)

General Considerations

663

(1)

Procedures to Shorten the Longer Limb

663

(29)

Procedures to Lengthen the Shorter Limb

692

(14)

Direct Operation on Epiphyses to Enhance Growth Potential by Removing Focal Transphyseal Tethers

706

(27)

Bone Bridge Resection

706

(1)

Varieties of Interpositional Materials

706

(1)

Treatment of Premature Physeal Closure by Means of Growth Plate Transplantation

706

(9)

Comparative Studies in Experimental Animal Models of Differing Focal Physeal Implants

715

(1)

Transplantation of Entire Physes and Epiphyses

715

(4)

Implantation of Chondrocyte Suspensions

719

(1)

Treatment of Premature Physeal Closure by Means of Physeal Distraction

719

(1)

References

720

(13)

Skeletal Dysplasias

Terminology

733

(1)

Classification Approaches

733

(5)

Prevalence of Skeletal Dysplasias

738

(1)

Diagnosis of Skeletal Dysplasias

738

(6)

Overview

738

(2)

Prenatal Assessment

740

(1)

Clinical Examination

740

(3)

Radiographic Examinations

743

(1)

Laboratory Studies

743

(1)

Chromosome Abnormality Sites in Skeletal Dysplasias

744

(1)

Genetic and Molecular Abnormalities in Skeletal Dysplasias

744

(11)

Mutation Families

744

(8)

Molecular Function Defects

752

(2)

Phase of the Developmental Cycle in Which Abnormality Has Its Negative Effect

754

(1)

Lethal Perinatal Skeletal Dysplasias

755

(6)

Diagnostic Profile

755

(1)

Thanatophoric Dysplasia

756

(2)

Homozygous Achondroplasia

758

(1)

Osteogenesis Imperfecta

759

(1)

Achondrogenesis

759

(1)

Hypochondrogenesis

759

(1)

Atelosteogenesis

759

(1)

Chondrodysplasia Punctata, Rhizomelic Form

759

(1)

Campomelic Dysplasia

760

(1)

Hypophosphatasia

760

(1)

Short Rib Syndromes

760

(1)

Asphyxiating Thoracic Dystrophy (Jeune)

761

(1)

Microstructural-Morphologic Abnormalities of the Epiphyses and Metaphyses in Skeletal Dysplasias

761

(8)

General Considerations

761

(1)

Structure of Developing Epiphyses and Adjacent Metaphyses Including the Periphyseal Tissues of the Groove of Ranvier

761

(1)

Histopathologic Classification of Skeletal Dysplasias

762

(7)

Interpretation of the Pathogenesis of Skeletal Dysplasias in Relation to the Structural Approach

769

(1)

Histopathologic Changes in Specific Chondrodysplasias

769

(9)

Lethal Chondrodysplasias

769

(4)

Histopathologic Changes in Nonlethal Chondrodysplasias

773

(5)

Orthopedic Deformities in Skeletal Dysplasias-Regional Abnormalities and Their Relation to Clinically Significant Deformity

778

(16)

Overview

778

(1)

Cervical Spine Abnormalities

779

(3)

Thoracolumbar Spine Abnormalities: Scoliosis, Kyphosis, and Kyphoscoliosis

782

(1)

Lumbar Spinal Stenosis and Lumbar Lordosis

783

(2)

Abnormalities of the Skull

785

(1)

Abnormalities of the Clavicles

785

(1)

Abnormalities of the Extremities

785

(2)

Abnormalities of the Hip Region

787

(3)

Knee Abnormalities

790

(3)

Ankle Abnormalities

793

(1)

Foot Abnormalities

794

(1)

Abnormalities of the Upper Extremities

794

(1)

Limb Lengthening

794

(1)

Review of Specific Skeletal Dysplasias: Pathobiology, Clinical and Radiographic Characteristics, and Orthopedic Management

794

(66)

Achondroplasia

794

(7)

Hypochondroplasia

801

(1)

Multiple Epiphyseal Dysplasia

801

(2)

Dysplasia Epiphysealis Hemimelica

803

(1)

Metatropic Dysplasia

804

(1)

Kniest Dysplasia

804

(1)

Chondrodysplasia Punctata

804

(1)

Spondyloepimetaphyseal Dysplasia

804

(1)

Diastrophic Dysplasia

805

(2)

Spondyloepiphyseal Dysplasia

807

(1)

Dyggve-Melchior-Claussen Dysplasia and Smith-McCort Dysplasia

808

(1)

Pseudo-achondroplasia

808

(1)

Mucopolysaccharidoses

808

(4)

Metaphyseal Dysplasia

812

(1)

Spondylometaphyseal Dysplasia

812

(1)

Cleidocranial Dysostosis (Dysplasia)

813

(1)

Hereditary Arthro-opthalmopathy (Stickler) Syndrome

813

(1)

Dyschondrosteosis

813

(1)

Other Mesomelic Dysplasias

813

(1)

Acromesomelic Dysplasia

813

(2)

Acromelic Syndromes (Acrodysplasias)

815

(1)

Larsen's Syndrome

816

(1)

Ollier's Disease

816

(5)

Maffucci Syndrome

821

(1)

Hereditary Multiple Exostoses

821

(15)

Metachondromatosis

836

(1)

Osteopetrosis

837

(9)

Pycnodysostosis

846

(1)

Osteogenesis Imperfecta

847

(13)

Trichorhinophalangeal Dysplasia

860

(1)

Anesthetic Implications in the Skeletal Dysplasias

860

(12)

Occipital and Cervical Structural Abnormalities

861

(1)

Airway Abnormalities

861

(1)

Pulmonary Abnormalities

861

(1)

Neurologic Abnormalities

861

(1)

Abnormalities of Thermal Regulation

861

(1)

Cardiac Abnormalities

861

(1)

References

861

(11)

Epiphyseal and Metaphyseal Involvement with Metabolic, Inflammatory, Neoplastic, Infectious, and Hematologic Disorders

Rickets

872

(17)

Terminology

872

(1)

Pathogenesis of Rickets

872

(1)

Experimental Models of Rickets

872

(2)

Pathology of Human Nutritional Vitamin D Deficiency Rickets

874

(2)

Classification of Types of Rickets

876

(13)

Inflammatory Disorders

889

(5)

Juvenile Rheumatoid Arthritis

889

(5)

Pigmented Villonodular Synovitis

894

(1)

Neoplastic Disorders of Epiphyses

894

(3)

Primary Involvement of Epiphyseal Regions

894

(1)

Secondary Involvement of Epiphyseal Regions from Primary Metaphyseal Foci of Benign and Malignant Disorders

895

(2)

Osteomyelitis and Septic Arthritis

897

(12)

Primary Subacute-Chronic Epiphyseal Osteomyelitis

897

(1)

Epiphyseal Osteomyelitis Secondary to Transphyseal Spread from Subacute or Chronic Metaphyseal Foci

897

(1)

Acute Neonatal-Infantile Osteomyelitis and Its Damaging Effects on Epiphyses

898

(7)

Summary of Effects of Epiphyseal and Metaphyseal Infection on Epiphyseal Growth

905

(1)

Tuberculosis

906

(3)

Hematologic Disorders

909

(26)

Hemophilia

909

(15)

Von Willebrand Disease

924

(1)

Hemoglobinopathies: Sickle Cell Anemia and Thalassemia

925

(2)

References

927

(8)

Index

935

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Pediatric Orthopedic Deformities

012638651X

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