Distal femoral epiphysis: normal standards for thickness and application to bone dysplasias

Flattening of the epiphysis of the long bones is seen in several bone dysplasias. It is the hallmark of multiple epiphyseal dysplasia and is an important sign in the diagnosis of spondyloepiphyseal dysplasias, diastrophic dysplasia, and pseudoachondroplastic dysplasia. The goal of this study was to determine norms for the height of the distal femoral epiphysis and to apply these standards to patients with bone dysplasias. Ratios of the distal femoral epiphysis height to both the distal femoral metaphysis width and the distal femoral epiphysis width were obtained from 640 radiographs of healthy children of different ages. Application of these standards to 41 patients with the bone dysplasias mentioned above proved useful in ascertaining decreased height of the distal femoral epiphysis. These standards are of particular value in subtle or early cases in which the thinning of the epiphysis may not be apparent upon simple observation. Obtaining three simple measurements from the anteroposterior knee radiographs allows determination of the presence or absence of flattening of the epiphysis.