AP and LL projections. Standard norms are available for the thickness of the distal femoral epiphysis (Schlesinger et al. 1986). Enlargement of the epiphysis can be assessed by comparison with the companion metaphysis. Simple inspection is adequate in most cases.
1. Multiple small foci of ossification adjacent to the medial or lateral aspect of the affected epiphysis; coalescence with the epiphysis to form an irregular, lobulated bone mass; limb misalignment; precocious osteoarthritis (dysplasia epiphysealis hemimelica)
2. Epiphyseal enlargement, irregularities, and fragmentation; metaphyseal widening; periostitis; osteoporosis (infantile multisystem inflammatory disease)
3. Large epiphyses; metaphyseal irregularities; defective vertebral body ossification (spondylo-mega-epiphyseal-metaphyseal dysplasia)
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