title: Symphysis pubis width and unaffected hip joint width in patients with slipped upper femoral epiphysis: widening compared with normal values.
abstract: BACKGROUND
  The exact pathomechanism of slipped upper femoral epiphysis (SUFE) remains elusive. This paper suggests a generalised abnormality of the development or maturation of cartilage as a possible cause.
  
  
  OBJECTIVE
  It is proposed that SUFE is part of a generalised abnormality of the cartilage formation or maturation resulting in abnormal measurements of cartilaginous joint structures.
  
  
  METHODS
  Radiographs of SUFE patients were assessed for the width of the unaffected hip joint and the symphysis pubis. Comparison with previously published normal values was made.
  
  
  RESULTS
  Fifty-one patients were assessed, 35 male, 16 female. The average age was 12 years and 11 months combined for both sexes, 13 years 8 months for boys, 11 years 4 months for girls. Width of the symphysis pubis was assessed on 46 datasets, and comparison with normal values was performed using the Wilcoxon paired rank test. Statistical significance was set as p < 0.05. The average expected width was 5.8 mm (5.4-6.2 mm), the average measured width was 7.3 mm (3.5-12 mm), median value 7.0 mm, and the difference is statistically significant. Cartilage thickness of the uninvolved hip joint could be assessed in 46 cases, and comparison using the Wilcoxon paired rank test resulted in a statistically significant difference (significance set as p < 0.05). The average expected width was 4.9 mm (3.6-6.5 mm), the average measured width was 5.5 mm (4-8 mm), and median 5.3 mm.
  
  
  CONCLUSIONS
  The results indicate that SUFE patients display a generalised increased width of joint cartilage for their age. This could be due to increased cartilage formation or decreased maturation or a combination of the two, and could explain the increased mechanical vulnerability of these children to normal or abnormal stresses, despite histologically normal organisation of the physis as shown in previous studies.
authors.affiliation: Department of Radiology, RJAH Orthopaedic Hospital, Oswestry, Shropshire, SY 107 AG, UK. Bernhard.Tins@rjah.nhs.uk
authors.forename: Bernhard
authors.initials: B
authors.lastname: Tins
authors.forename: Victor
authors.initials: V
authors.lastname: Cassar-Pullicino
authors.forename: Mike
authors.initials: M
authors.lastname: Haddaway
mesh_terms: D000293:Adolescent; D002648:Child; D004839:Epiphyses, Slipped / Q000000981:diagnostic imaging*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging*; D006617:Hip Dislocation; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011631:Pubic Symphysis / Q000000981:diagnostic imaging*; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
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