Page 88 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Chapter 5
physes of controls (i.e children with normal physes) with special emphasis on their histomorphology. We registered signs of abnormality in architecture, cellular composition and vascularity in affected physes. Hormone receptors, which are known to play an important role in puberty, were stained to detect their presence or absence in the chondrocytes in the biopsies of the physes in SCFE and controls. We assessed whether slipped physes were associated with altered hormone receptor expression, showed altered vascularity or signs of increased apoptosis. The correlation with gender, age and BMI was also analyzed.
Materials and Methods
Case control design
We recruited cases and controls on the basis of hospital admission after approval of the local medical ethical committee and with informed consent of the parents/ carers. Twenty biopsies of 18 patients with SCFE (2 bilateral) were taken during percutaneous epiphysiodesis. We began by performing a screw epiphysiodesis and, after securing the femoral head, the biopsy was taken using fluoroscopy through the same percutaneous incision next to the screw. All biopsies were collected with a Jamshidi needle across the physis. (8ga.X 6in, Bone Marrow Biopsy Needle, ARGON). Nine patients (11 physes) served as controls. We used specimens taken from growth plates from the foot in patients with either an amputation (Syme, below knee for tibia aplasia, 6th toe), or obtained during a percutaneous epiphysiodesis procedure for leg length difference of the proximal tibia and/or distal femur.
Clinical parameters were defined by body mass indices (BMI in kg/cm2), defined normal when <25 and obese when ≥25 respectively, by age defined as young <11 versus adolescents ≥11 years old and by sex.
The hormone receptors, that were studied immunohistochemically were, Insulin like Growth Factor Receptor (IGHR), Growth Hormone Receptor (GHR), Estrogen Receptor α and β (ERαβ), Thyroid Receptor α and β ( TRαβ), Androgen Receptor (AR) and Leptin Receptor (LR). Caspase expression served as marker for apoptosis. S100 expression was utilized for representativeness of the physes. Expression of CD34 was used as identification for endothelial cells as proxy for signs of inflammation chronicity.
86