Jacob F. Katz

The Intra-articular Deformity in Osteochondrosis Deformans Tibiae

Observations made at the time of surgical exploration of the knee in five patients with osteochondrosis deformans tibiae have been described. In each child, a similar deformity was noted, namely, depression of the posteromedial aspect of the articular surface of the tibia. Whether this deformity is the result of pressure inhibition of enchondral ossification within the epiphysis itself, a secondary effect of growth retardation in the posteromedial growth plate, or a combination of both requires further investigation. The clinical findings of bowing, tibial torsion, sagging of the knee into varus, excessive prominence of the fibular head in the standing position, and a posteromedial rocking instability in slight fiexion are confirmatory clinical signs of intra-articular incongruity.

Growth Recovery Zones

Growth arrest lines and zones have been reinvestigated. Sequential studies after dietary deprivation reveal transformations of the physis with diminution in formation of the zone of cell columns, resorption of previously formed bone, and cessation of new bone formation. At 6 weeks post diet restriction, the physis is prominently narrowed with transversely oriented, thin bone plaque sealing it from the subjacent marrow. Initially, restoration of stock diet thickens the bony plaque, creating a growth arrest line. Later the zone of osteogenesis adds new bone as a dense metaphyseal band.

Spontaneous Correction of Angulational Deformity of the Proximal Femoral Epiphysis After Cervical and Trochanteric Fracture

This case report of a 5-year-old girl describes a severely comminuted fracture of the cervical and trochanteric areas of the left proximal femur which required open reduction and internal fixation for stable realignment. At 7 months follow-up, angulational deformity was recognized due to partial growth arrest leading to valgus tilt of the proximal femoral epiphysis. After persisting 1 year, gradual spontaneous improvement occurred leading to total realignment with a normally wide growth plate at 36 months following injury. It is hypothesized that the valgus deviation of the femoral head, by causing a medial shift of the weight bearing axis, led to relative unloading of the lateral margin of the growth plate. It is suggested that this mechanical element contributed to the spontaneous release of the epiphyseal tether.

Late modelling changes in Legg-Calvé-Perthes disease (LCPD) with continuing growth to maturity.

The changes occurring with hip bone growth in the typical case of LCPD consist of (1) lack of additional growth in height of the affected femoral capital epiphysis; (2) further increase in femoral capital epiphyseal width over that present at treatment termination, i.e., 4 mm to 7.2 mm; (3) diminution in length of the femoral neck of 11.5 mm over that of the unaffected hip; (4) an almost universal alteration of the plane of the proximal femoral growth plate from linearity to convexity and scattered instances of partial growth plate slowing affecting either the medial or lateral sectors; (5) change of neck-shaft angle from 132 degrees on the unaffected side to 128 degrees on the involved side; there were almost equal instances of partial depression either of the medial or lateral growth plate margins; when the growth of the medial portion was slowed or suppressed, the neck-shaft angle lessened and when the lateral side slowed, the neck-shaft angle increased; (6) diminution in the articular-trochanteric (A-T) difference on the affected side, i.e., 9.5 mm in comparison with 16.8 mm on the intact side; 2 major factors in this lessening of the A-T distance (or conversely, increase in trochanteric height) were slowing of growth of femoral neck while that of the greater trochanter continued normally and diminution in the neck-shaft angle; (7) alteration in the final result rating in Catterall IV group--one poor to fair: Catterall III group--one poor to fair and 2 fair to poor: Catterall II group--no change from good.

Tissue antibiotic levels with tourniquet use in orthopedic surgery.

Ten adult mongrel dogs were given 500 mg of cefazolin intravenously, before and after tourniquet cuff inflation. Muscle tissue antibiotic levels were comparable to the control side when the antibiotic was administered prior to tourniquet inflation. Muscle tissue antibiotic levels were markedly diminished compared to the control limb when the antibiotic was given after the tourniquet was inflated. The low level of antibiotic appeared slowly and peaked at 60 minutes as a reflection of minimal limb blood flow. It was questionable whether the small antibiotic concentration in the latter situation served adequate protective cover.