Yonsei Med J.  2011 Sep;52(5):809-817. 10.3349/ymj.2011.52.5.809.

Effects of Multiple Drilling on the Ischemic Capital Femoral Epiphysis of Immature Piglets

• Gong SY
• Kim HW
• Park HW
• Lee SY
• Lee KS

• KMID: 1108075
• DOI: http://doi.org/10.3349/ymj.2011.52.5.809

Abstract

PURPOSE
This study investigated the effects of multiple drilling on the immature capital femoral epiphysis following ischemic injury in a piglet model.
MATERIALS AND METHODS
Ischemic necrosis of capital femoral epiphysis was induced bilaterally in 12 piglets using a cervical ligation method. Three weeks later, medial, central, and lateral 3 drill holes were made on the left femoral head using 0.062" K-wire. At 3, 6, 9, and 12 weeks following the multiple drilling, femoral heads were harvested from each three piglets. On histologic examination, percent of revascularization, percent of osteoblast surface, capital femoral epiphyseal quotient and proximal femoral growth plate height were evaluated. Untreated right femoral heads served as control.
RESULTS
While percent of revascularization of left capital femoral epiphysis with multiple drilling was significantly higher than untreated control side (p<0.001), percent of osteoblast surface, capital femoral epiphyseal quotient and proximal femoral growth plate height showed no significant difference.
CONCLUSION
This study indicates that multiple drilling could promote revascularization of ischemic capital femoral epiphysis, and multiple drilling does not appear to produce bony physeal bars at short-term, if using small diameter drill. However, multiple drilling alone does not seem to prevent femoral head deformity or to promote new bone formation.

Keyword

LCP disease; multiple drilling; revascularization; head collapse

MeSH Terms

Animals
Bone Remodeling
Disease Models, Animal
Epiphyses/*blood supply/pathology/*surgery
Female
Femur Head/*blood supply/pathology/*surgery
Humans
Ischemia/pathology/*surgery
Legg-Calve-Perthes Disease/pathology/surgery
Swine

Figure

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  Fig. 1 An experimental model of ischemic necrosis of the capital femoral epiphysis using a cervical ligation. After a longitudinal skin incision over the left hip joint under sterile condition, a partial capsulotomy was performed and the ligamentum teres was transected. Two ethibond sutures were placed around the neck and hand-tied using slip-proof ligation technique as tightly as possible to disrupt the ascending cervical vessels supplying the capital femoral epiphysis (A). To evaluate the position of cervical ligation, stainless steel wire was used in pilot study and the postoperative radiograph showed proper position of cervical ligation wires (B).

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  Fig. 2 Three weeks following ischemic insult, drilling was performed using 0.062" K-wire and a motorized drill under fluoroscopic control. Medial, central, and lateral three drill holes were made from medial side of cervical neck through the proximal femoral growth plate to the capital femoral epiphysis.

• 

  Fig. 3 Capital femoral epiphyseal quotient was defined as height of osseous capital epiphysis divided by maximum transverse diameter.

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  Fig. 4 After staining with hematoxylin and eosin, the thickness of the growth plates was measured. The growth plate was divided into three regions on coronal sections (medial, middle, and lateral thirds, and dot lines show borders of each region) and the thicknesses were measured along the direction of enchondral ossification (axis of arrows) at each region and averaged.

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  Fig. 5 Photomicrographs of normal femoral head of immature piglet. (A) Polycut section view (H&E, ×4). (B) Higher magnification of the growth cartilage surrounding the secondary ossification center shows normal columnar pattern (H&E, ×10). (C) Higher magnification of the growth plate cartilage of the metaphyseal physis shows normal cellular zones including reserve, proliferative and hypertrophic zones. Vascular invasion of terminal hypertrophic chondrocytes and primary spongiosa formation in the metaphysis, indicative of enchondral ossification, are evident (H&E, ×10).

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  Fig. 6 Photomicrographs of the femoral head of immature piglet at two weeks following induction of ischemia. (A) Polycut section view (H&E, ×4). (B) The growth cartilage surrounding the secondary ossification center shows empty lacunae at growth plate cartilage, which indicates establishment of ischemic insult to the capital femoral epiphysis (H&E, ×10). (C) The growth plate of the metaphyseal physis also shows disarray of normal pattern of columnization and necrosis after the ischemic damage (H&E, ×10).

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  Fig. 7 Photomicrographs of the femoral head of immature piglet at fifteen weeks following induction of ischemia. (A) Polycut section view (H&E, ×1). (B) The growth cartilage surrounding the secondary ossification center shows complete regeneration of normal columnar pattern and enchondral ossification (H&E, ×10). (C) In the central area of the secondary ossification center, necrotic bony trabeculae remnants intermixed with fibrovascular scar tissue are noted, and there is no evidence of new bone formation at all (H&E, ×10).

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  Fig. 8 Photomicrographs of the femoral head of immature piglet at three weeks following multiple drilling. (A) Polycut section view (H&E, ×1). (B and C) The centro-medial and centro-lateral junctions of the proximal femoral growth plate are disrupted by drilling. From cervical metaphysis to the secondary ossification center through transphyseal hole, abundant fibrovascular invasion is observed (H&E, ×4).

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  Fig. 9 Photomicrographs (H&E, ×1) and antero-posterior radiographs of the femoral head of immature piglet at twelve weeks following drilling. Although multiple drilling provided increased revascularization on the ischemic capital femoral epiphysis, there was no significant difference in head collapse or proximal femoral growth plate height between untreated control group (A and C) and multiple drilling group (B and D).

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