Professional Documents
Culture Documents
of the
Upper
Humeral Gigantism
Epiphysis
in
Pituitary
BY GORDON C. ROBIN, MB., CH.B., F.R.F.P.S.,
JERUSALEM,
F.R.C.S.,
ISRAEL
AND
SHIMEON
S.
KEDAR,
M.D..
From
the
Department
of Orthopaedics,
Hadassah
University
Hospital,
.Jer,isale,,t
Separation
occurs
of adolescents.
the
humeral found
is
an
uncommon cases
in a
injury large
which
general
in
hospital
between
four
1929 nmle
The
one
injury
fenmie
occurs
in
in males;
reporte(l
patients
his
Smith
FIG. showing
of the right
shoulder.
Most
authors2348 ages
in
agree
that
this
type
of injury
with
is found
in adolescents
between
the
i)etween were
years, Of the
considered humeral however,
of
age that
group the
; he upper Gray,
age
related sixteen
of closure
years.
the epiphysis. there has been considerable discussion of the upper femoral epiphysis and of any
this
separation disease.
of the pituitary
relationship disease
between
,
we
have
no
reports
and
relationship between separation We, therefore, consider it worth of the upper humeral epiphysis in whom it is postulated of the epiphysis.
CASE REPORT of this hospital
twenty-three secondary
years to delayed
of
age, closure
that
the
bone
lesion
was
A. G. was
after house. an At the
admitted
age of sixteen
to attempt
tile
department
at associated
tile
age roof
of twenty-three of a three-story
unsuccessful
which
for and
he had
gonadotrophin.
jumped
from
Scondary
the
he had
treated
hypogonadism,
with
sexual
gigantism,
characteristics
by
the
VOL.
administration
44-A,
of methyl
1, JANUARY
1962
testosterone
NO.
189
190
G.
C.
ROBIN
AND
S.
S.
KEDAR
FIG.
A11t(roposterior
aCVtah)(llllITl
:111(1
of
and
FIG. Roentgenogram developed under hormone treatment of the but skull there suffer he was showing was
4 a normal little effect pituitary in arresting fossa. growth. no After two Since
years
the no
he had refused
onset
previous On
and
since
from
then
had
hormones.
a depressive
but
feet, eight
he had
made
exceptionally
inches-with
effeminate
narrow from chest, a fracture
features,
a female
smooth,
hairless
facial
of pubic upper
skin,
hair, humeral
with
was
a broad
found to be a fissure
JOINT
pelvis
fracture
and
suffering
separation
1 and
OF
2) and
AND
BONE
SURGERY
SEPARATION
OF
THE
UPPER
HUMERAL
EPIPITYSIS
191
FIG. 5 Fig.
the Ol)PIi
1K;.
of the normal acromion and 1 showing the
5: 1(oentgenogram
e1)i1)hVses (1: i)iagram
Ol)UIi
of the of Fig.
arm shiowillg the open epiphyseal line the coracoi(i poce significant features of the roentgenogram: open epiphysis; attaciied of the showed manipulatiomi spica. the The 3, the head of the epiphysis. showed upper humeral fracture diaphysis to the skull the of the humeral disappeared.
I is the
epiphysis; triangular
humerus,
open
epiphy-
4,
right
the
in the
(Fig. yet in
4), closed
and
of the
that
5). The
which
amid immobilization
in a plaster-of-Paris disability
satisfactorily
hip
had
also
DISCUSSION
Ill
discussing it is seen
injury years. does
this
not
type
occur
of fracture, eight
after
Blount fourteen
the age of
suggested years.
eighteen
that Bonnin
years.
the
In
usual
Smiths
age
series,
at said
which
that
and
this fifteen no It
which
was found disease. closure
described
the at the
average age
of twenty-three Furthermore,
with delaying at such
is significantly
previous is
reported.
w-as to disturbance,
associated by occur
considered
epiphyseal a relatively
beyond
age,
late For
epiphyses
Several the
signs iliac
of
skeletal until
years.
are
seen open
on (Fig.
the 3).
epiphyses
we
age
process
basis of
the epiphyses (Fig. 6). Harris, in discussing epiphysis, suggested that hormone
normal a
conditions
a deficiency there
hormone.
of
growth
to
of sex
apparent
sex
In
hormone
our patient
or of sex lesion
was within
excess in
However,
slipping
plate;
growth of the
whereas
hormone femoral
in the
in addition epiphysis,
so-called
to a deficiency pathological
of
.
lies
the
epiphyseal
separation
the
upper
humeral original
the epiphyseal
a
epiphysis, roentgenogram
classic triangular fragment;
the
lesion of the
fragment
is really injured
of that
From
the
that
there to the
was,
is present displaced
in fact,
this
suggests
lesion
juxta-epiphyseal
44.A,
fracture.
1, JANUARY 1962
It
is not
therefore
considered
that
the
hormonal
VOL.
NO.
192
abnormality has been acted suggested directly in hip
G.
C.
ROBIN
AND
S.
S.
KEDAR
on
the
epiphyseal It
plate is
in simply
causing postulated
the
as
epiphyseolysis.
skeletal maturity, secondary to the endocrinal lesion, seen in mid-adolescence to take place at a much later
SUMMARY
allowed age.
a fracture
normally
A
twenty-three
case
of
separation
of age
of
the
upper
The
humeral
patient
epiphysis
is significantly
in
a pituitary
older than
giant
any
years
is reported.
reported discussed.
with
a fracture
of this
type.
The
probable
endocrinological
REFERENCES 1. A1TKEN,
A. P. : End
18: 1036-1041,
Results
Oct.
of Fractures
1936.
of the Proximal
Humeral
Epiphysis.
J. Bone
and
Joint
W. P. : Fractures J. G. : A Complete
5. 6. 7.
8.
J. F. : Fracture-Separation of the Proximal Epiphysis of the Humerus. J. Bone Surg., 32-B: 35-37, Feb. 1950. BURROWS, H. J. : Slipped Upper Femoral Epiphysis. Characteristics of a Hundred Cases. J. Bone and Joint Surg., 39-B: 641-658, Nov. 1957. GRAY, HENRY: Anatomy. Descriptive and Applied. Edited by T. B. Johnson and J. Whillis. Ed. 27, p. 347. London, Longmans, Green and Co., 1938. HARRIS, W.R. : The Endocrine Basis for Slipping of the Upper Femoral Epiphysis. An Experimental Study. J. Bone and Joint Surg., 32-B: 5-11 Feb. 1950. SMITH, F.M. : Fracture-Separation of the Proximal ftumeral Epiphysis. A Study of Cases Seen and Joint
at the Presbyterian Hospital from 1929-1953. Am. J. Surg., 91 : 627-635, 1956.
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JOURNAL
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