Shear strength of the physis varies with anatomic location and is a function of modulus, inclination, and thickness

Slipped capital femoral epiphysis involves the gradual displacement of the femoral head relative to the neck. Many theories have arisen to explain this slip. Frequently cited etiological factors include increases in physeal thickness and inclination. Slipped epiphysis has been postulated to result from shear overload that causes separation through the hypertrophic cellular zone. We sought to answer the following questions: (a) Do significant regional differences in strength and stiffness exist within a given physis? (b) Are regional differences in resistance to shear related to thickness and inclination of the physis? (c) Does physeal compression cause mammillary interdigitation to begin sooner and increase the resistance to shear before, during, and after failure? (d) Does shear failure occur at displacements detectable by radiography? and (e) Does cleavage occur throughout the entire columnar zone, and do the chondrocyte columns remain intact on both sides of the cleavage plane? We prepared beam-shaped microstructural samples from different sites of the bovine proximal tibial physis. We determined thickness, inclination, ultimate stress and strain, modulus, and strain energy density at ultimate stress as a function of location. Using scanning electron microscopy, we also examined the entire failed surface of several samples. Forty-eight samples were tested by displacing the epiphysis end anteriorly, without axial (across the thickness) constraint; 41 were sheared while an average axial compressive stress of 0.3 MPa was applied to the physis. The posterior region had the greatest strength and stiffness, lowest physeal thickness, and steepest inclination. Compressing the plate did not increase the shear strength or tangent modulus. Ultimate strength varied inversely with thickness and increased when shearing up steeper inclinations; however, it was more strongly associated with the modulus, implying that additional factors control both strength and modulus. Scanning electron microscopy revealed that the plane of fracture differed widely between and within samples, involving all zones of the growth plate. On either side of the fracture, individual chondrocyte columns remained intact, although separated from neighboring columns.