Page 68 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Chapter 4
For this review, we present the results under five headings:
The physis in SCFE: reviews studies specifically dealing with SCFE
Endocrinology of growth and puberty: reviews the major endocrine effects on the physis throughout puberty
Obesity and SCFE
GH-IGF-1 axis and SCFE
Sex steroids in puberty and SCFE Leptin and SCFE
Thyroid hormones and SCFE
Glucocorticoids and SCFE
Vitamin D: reviews the effects of vitamin D at the growth plate
Chronic disease: reviews the effects of chronic disorders on the physis Diagnostic endocrine measurements in SCFE: reviews the studies that specifically investigated SCFE
The physis in SCFE
Histological changes in SCFE
Histological studies of tissue obtained from biopsies during surgery for SCFE show some characteristic features of the physis.
Changes in the longitudinal orientation of the cartilage cells of the physis, which are normally parallel to the axis of the bone, are seen in tissues taken from biopsies in SCFE. In SCFE, pathologic tangential forces damage the hypertrophic cartilage. As a result of the longitudinal orientation of these fibres, this zone is the least protected from these shearing forces [2]. However, it is not always clear as to whether the observed changes in cell orientation are found before or after the SCFE occurred. Obviously, the actual time of biopsies was taken after the slip occurred.
The resting zones of the epiphysis appeared to be relatively normal in SCFE [3-6], although some tissue samples showed clusters of numerous chondrocytes cells [5].
The proliferative and hypertrophic zones of the epiphysis in SCFE were widened compared with normal physis, and showed irregular columnar organization with gradual loss of longitudinal septa and diminished number of chondrocytes in each column [3-7]. Interestingly, Adamczyk et al. showed that apoptosis was increased throughout the physis in SCFE, in contrast with controls, where apoptosis was
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