Alter's version of lefty bass player Mio Akiyama is almost perfect. They did a great job overall, and it is easy to see the care with which she was both sculpted and painted. Alter must have known fans of a character as popular as Mio would accept nothing but the best. In this case, as well as in the cases of most of Alter's figures, they delivered a must-have figure for any fan of “K-ON!” or even music in general.

Sculpt:
Mio Herself:
The quality of Mio’s sculpt is done very well. She doesn’t have any glaring seam lines or other flaws. There is a bit of a seam at the top of her head in the middle of her hair, but the hair seam is common, and seems to be one that is difficult to conceal. Other than that, Mio’s sculpt is extremely well done. Alter paid very close attention to detail when they sculpted her. The movements of her hair are captured very well, and her tie appears to be moving just like her hair is, creating a very consistent and believable feeling of movement. Her skirt appears to sway just a bit with her movement as well.
The small details were also included. Mio’s shoes appear to be polished or maybe brand new. The wrinkles in her jacket and skirt appear to be consistent with her pose as well. Even the little dimples in the backs of her knees are included. It was nice to see all the little things included. The care with which Mio was sculpted makes her well worth the price.

Mio’s Bass:
Mio’s bass is a very detailed representation of the actual instrument she plays. It compares well with pictures of the real Fender model. On the wood parts of the instrument are simulated grains that make it appear more like actual wood than plastic. Besides, it simply just looks cool in her hands. The only disappointing features of the bass itself are the clear, nylon-like strings. They are not metallic like they are on a real model. Though nylon strings are options on some guitars, they are generally not recommended on metal string guitars. Plus, the one Mio plays has metal strings. Still, the clear strings do not take much away from the figure itself, let alone the instrument. It still looks very detailed and does both Mio and Fender justice.

Paint:
The effort put into Mio’s paint job is very apparent. There are different shades of color on Mio’s skirt and shoes, which give her a bit more of a “real” feel. Even the small areas like the buckle on the strap of her bass are painted well. The buckle is painted silver, and the strap itself black, but the buckle’s paint is totally separate from the strap. Her instrument is painted very well, too. All of the details are painted perfectly, and the attractive paint makes her bass look almost real. The only tiny flaw that is visible is on the part of her hand that touches her pick. The white paint on the pick bleeds just a bit onto her left index finger, and a bit of the area of the pick under her thumb was missed. Without a very careful look, though, Mio’s paint job appears perfect. The tiny flaws are barely noticeable even after a good, hard look.

Pose:
Mio’s pose suits her well. When the original pictures were released, the pose appeared a little out of character for her, but after and in-person look, it is a lot more believable. The in-motion pose and makes Mio appear to be passionate about the song she is playing, and her face reflects that as well. She looks happy, and seems to be enjoying herself. After considering the poses Alter could have chosen for Mio, the one they picked is very good. The figure would not have such a lively feeling without an exciting pose.

Base:
Interesting bases are rare. Most figures' bases are simple, one color stands that aim for nothing more than practicality. Mio’s base is an exception. Across the middle of the circular base is a white silhouette of her lefty Fender bass with “K-ON!” written in blue letters on the bass’s body. Underneath the silhouette, there are two lines of text. The first line reads, in white capital letters, “Ho-Kago Tea Time,” and the second reads in blue “Mio Akiyama ★ Bass.” Alter added another interesting touch here, making Mio's base to resemble a music CD (thanks, Kilani). The dimensions of the base are also relatively close to the actual dimensions of a CD. The base is clear plastic, and compliments Mio very well without distracting a viewer from Mio herself. Her base is a bit on the large side, but it does not take up too much room, and it is overall a great addition to the figure’s appearance.

Packaging:
Mio came packed in a big blue and white window box. It showcases her well, and has some fun details on it, like the bass-shaped window on the top flap of the box. Musical notes that have a hand-written look are printed on its sides. These add a fun element to the figure before it is even removed from the box. It is apparent that Alter even put a lot of thought into Mio’s box. It is not surprising that such an outstanding figure comes in a well-designed package.

Enjoyment:
As with my first review, I would like to take a more personal approach to this section of the review.
After waiting for so long, I finally received my Mio today. I sent her to the wrong address originally, so I had to wait a bit longer for her than I would have otherwise. So, when she finally came into my current address, I was more than happy. I had seen all of the pictures online from users that had already received her, but I had not gotten to see her with my own eyes. When I took her out of her box for the first time, I could see right away that the money I had spent and the time I had waited had all been more than worth it. I am very happy with my Mio figure, and am proud to have her. She has made a great addition to my little collection; she is certainly a stand-out figure, and I enjoy her as much as one can enjoy a figure. :)

K-ON! Mio Akiyama: School Uniform ver. Figma Action Figure is one of the top choices that you can consider today. With a range of incredible features integrated in the reasonably priced packages, many people from all over the world who have bought this product seem contented enough and have provided lots of positive reviews. On the other hand, there are also customers who are not contented with this product and this review will tell you why.

FEATURES AND SPECIFICATIONS
Product Details Amazon Sales Rank: #173767 in Toys & Games Brand: Max Factory Model: 4545784061176 Dimensions: .57 pounds Features Imported from Japan Body size: Height: about 135mm Boy facing From 15 years old: Age (C) Kakifurai-Hobunsha / Sakura high Keion section

Product Description Depicting a loose high school life on the stage of Keioto section by "K-On! ", the base charge of a shy little" Akiyama Mio "the long-awaited figma. Of figma original joint parts determined to clear and smooth, it reproduces every scene in the play. It is not breaking a proportion by using the soft material to the point including as the blazer and skirt, to ensure the range of motion. We offer facial expression face and smile, three types of peep tearful face, the face shy sc

Abstract

Purpose

Ischio-pubic stress fracture is one of the potential complications after peri-acetabular osteotomy (PAO) in patients with hip dysplasia. The purpose of this study was to examine the prevalence of and risk factors for ischio-pubic fractures following PAO.

Methods

A total of 296 hips in 275 patients who underwent transposition osteotomy of the acetabulum between 2001 and 2012 were retrospectively reviewed. Patient characteristics and radiographic parameters were compared between patients with and without fracture.

Results

Fourteen ipsilateral hips (4.7 %) in 14 female patients had fracture of the inferior pubic ramus (11 hips) or the ischial ramus (three hips) on the same side as the surgery at an average of 4.6 weeks after PAO. Multivariate analysis indicated that younger age at operation (odds ratio of 1.43 per five years, p = 0.0169) and greater degree of correction (odds ratio of 1.98 per five degrees, p = 0.0005) were significantly associated with ischio-pubic fracture as independent risk factors. All fractures healed conservatively with partial weight-bearing.

Conclusions

Younger female patients and greater deformity corrections increased the risk of ischio-pubic stress fracture after PAO.

Keywords

Ischio-pubic fracture Peri-acetabular osteotomy Transpositional osteotomy of the acetabulum Hip dysplasia

Purpose

This study was conducted to assess the posterior inclination of the contralateral femoral epiphysis in patients with unilateral slipped capital femoral epiphysis (SCFE).

Methods

The posterior sloping angle (PSA) was measured using lateral radiographs in 67 patients with a unilateral SCFE and in 41 age-matched normal controls. A symptomatic epiphyseal slip was defined as the development of SCFE.

Results

The contralateral PSA in SCFE patients was more widely distributed and significantly larger compared to controls (15.0° vs. 9.0°, p < 0.0001). Forty-seven hips (70.1 %) had a PSA of greater than 12.8°, which was +2SD of the control hips. Of the 65 hips excluding the two cases with prophylactic pinning, 11 hips (16.9 %) eventually developed a contralateral SCFE during adolescence and their PSA at the initial visit was significantly larger compared to patients without a contralateral SCFE (18.0° vs. 14.3°, p < 0.005) with a cutoff value of 19°.

Conclusions

These findings suggested the possibility of bilateral hip involvement in SCFE patients. Hips with greater degrees of PSA (> 19°) are likely to become symptomatic.

Keywords: Slipped capital femoral epiphysis (SCFE), Posterior sloping angle (PSA), Subclinical posterior inclination, Contralateral slip, Bilateral involvement

Introduction

Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescence and is a potential cause of hip dysfunction and degenerative hip disease in adulthood [1–5]. SCFE usually occurs in one hip (unilateral SCFE) and some patients develop a contralateral slip (bilateral SCFE) [2, 3, 6, 7]. Bilateral SCFE usually presents in one of two ways—either initially bilaterally or unilaterally followed by bilateral involvement [8]. The prevalence of subsequent contralateral slips detected during adolescence has been reported to range from 7 % to 25 % [9]. However, the prevalence of bilateral hip deformities suggesting bilateral slips detected at long-term follow-up in adulthood is reportedly much greater, ranging from 41 % to 80 % [1, 2, 9–13]. This discrepancy of prevalence between adolescence and adulthood suggests the existence of subclinical changes in the contralateral hip in unilateral SCFE.

The idea of prophylactic pinning came from the fact that a certain number of unilateral SCFE patients developed a symptomatic slip in the contralateral hip. Some risk factors have been reported such as a younger age at the initial SCFE presentation [7, 8], endocrine disorders [14], and renal failure [15]. A larger posterior sloping angle (PSA) in the contralateral hip has also been reported to be a significant risk factor for subsequent slip, and cutoff values for prophylactic pinning ranging from 12° to 14.5° have been identified [16–19]. These studies focused on the difference between the symptomatic and asymptomatic hips; however, little is known regarding subclinical posterior inclination of the capital femoral epiphysis in the contralateral hip in unilateral SCFE patients to our knowledge. Therefore, the purpose of this study was to examine the prevalence and clinical course of contralateral posterior inclination of the capital femoral epiphysis until the epiphyseal closure.

Patients and methods

Patients

This multicentre retrospective study was approved by our institutional review board. From 1992 to 2010, 91 unilateral SCFE patients were treated at Kyushu University Hospital, Osaka City General Hospital, and Fukuoka Children’s Hospital. Twenty-one patients were excluded from this study because serial radiographs of the contralateral hips were not available. One patient with radiation-induced SCFE was also excluded due to the iatrogenic a etiology. Two patients with endocrine disorder were also excluded because their contralateral hips might have different courses from regular unilateral SCFE. The remaining 67 patients were included in this study. There were 45 boys and 22 girls with an average age of 11.3 years (range, 7.6–13.8 years). The average follow-up periods were three years (range, five months to seven years and nine months). All the patients were followed up until the epiphyseal closure. Clinical data were collected from the medical records including age at onset, sex, height, weight, body mass index (BMI), physeal stability [20], and past medical history. There were 49 stable cases and 18 unstable cases. The surgical procedure for the initial slip included in situ pinning in 51 cases, manual and gentle reduction and pinning in 12 cases, and proximal femoral osteotomy in five cases. Our treatment guideline for stable SCFE was as follows: in situ pinning for the case with PSA less than 40° and a corrective femoral osteotomy for the case with PSA 40° or more. As for the contralateral hip, careful observation was indicated regardless of PSA when the patient was asymptomatic.

A slip was defined when the patient had hip pain along with the posterior inclination of the femoral epiphysis in this study. When the patient showed the posterior inclination of epiphysis but was not symptomatic, he or she was not diagnosed to have a slip.

The age-matched normal control group included 41 hips in 41 cases presenting with inguinal pain where pathology was not found on exam. Their contralateral hips were used as control in this study. There were 28 boys and 13 girls with an average age of 10.9 years (range, 7.1–15.9 years), and there was no significant difference between the SCFE group and the control group regarding age and sex.

Radiographic measurement

The posterior sloping angle (PSA) was measured as described by Barrios et al. [16] on standard radiographs taken in the classic Lauenstein lateral view. The PSA is defined as the intersection of the neck–diaphyseal axis and a line perpendicular to the plane of the epiphysis (Fig. 1), and we defined the mean PSA of the control group +2SD as the upper limit of normal PSA in this study. We evaluated radiographs taken at the initial visit and at follow-up appointments. All measurements were performed by one observer (Y.K.) and were repeated in a blinded manner during the course of two sessions at least one month apart. Two observers (Y.K. and D.H.) independently made measurements of 30 randomly selected hips. The intraobserver and interobserver reliabilities were evaluated using the intraclass correlation coefficient. All radiographic assessments were performed two times on different occasions by two observers (Y.K. and D.H.) and intraobserver and interobserver reliabilities were evaluated with the use of kappa statistics. Intraobserver reliability of the measurements was 0.89. Interobserver reliability of the measurements was 0.82.

Statistical analysis

A statistical analysis was performed using JMP 9.0.2 (SAS Institute Inc., Cary, NC, USA). The Mann–Whitney U test was used to compare the demographic data and radiographic parameters between each group. The chi-square test was used to compare categorical data between each group. The Levene test was used to assess the equality of variances between the SCFE and control groups. A multivariate analysis using a logistic regression model was performed to evaluate the factors associated with a contralateral slip. For all statistical analyses, p values less than 0.05 were considered significant. A receiver operator coefficient (ROC) curve was created to predict the PSA value when prophylactic pinning should be considered. The number needed to treat (NNT) was calculated for this threshold PSA.

Results

Contralateral hip follow-up

Of the 67 unilateral SCFE patients, two patients underwent prophylactic pinning of the contralateral hip. These two cases were excluded from the statistics analysing the PSA value for a subsequent contralateral slip. Of the remaining 65 patients, 11 patients (16.9 %) developed a contralateral slip. These patients were defined as the SLIP(+) group. There were nine boys and two girls with an average age of 11.1 years at the initial visit (range, 9.0–13.0 years). Fifty-four patients (83.1 %) did not have a contralateral slip. These patients were defined as the SLIP(−) group. There were 34 boys and 20 girls with an average age of 11.1 years at the initial visit (range, 7.6–13.8 years). In the SLIP(+) group, the mean initial PSA of the contralateral hips was 18.0°, and it increased to 26.2° (range, 16–44°) at the contralateral slip onset. The mean time to the onset of a contralateral slip was 11.6 months (range, 2–31 months). On the other hand, in the SLIP(−) group, the mean initial PSA of the contralateral hips was 14.3°, and it increased to 16.6° (range, 9–26°) at the time of epiphyseal closure.

Comparison of PSA between the contralateral hips in SCFE patients and the control hips

The PSA of the contralateral hips in SCFE patients and the control hips were 15.0° ± 3.8° and 9.0° ± 1.9°, respectively, showing a significantly larger PSA in SCFE patients (p < 0.0001) (Fig. 2). When the deviation of value was compared between these groups, the PSA of the contralateral hips in SCFE patients was significantly more widely distributed (range, 7–22° vs. 6–12°, p < 0.0001) compared to control hips. When the normal range of the PSA was defined as the mean value ± 2SD, 12.8° was the upper limit of the normal PSA in this study. Of the 67 hips in unilateral SCFE patients, 47 hips (70.1 %) had a PSA greater than 12.8°.

Comparison of the PSA between the SLIP(+) and SLIP(−) groups

The PSA of the contralateral hips in the SLIP(+) and SLIP(−) groups were 18.0° ± 3.6° and 14.3° ± 3.6°, respectively, showing a significantly greater PSA in the contralateral hips in the SLIP(+) group (p < 0.005) (Fig. 3, Table 1). Other factors including age, sex, BMI, stability in the initial hip, and PSA in the initial hip did not influence a contralateral slip (Table 1). A multivariate analysis also showed that the value of contralateral PSA was the only significant risk factor for a subsequent slip (p = 0.0040, Table 2) with an odds ratio (OR) of 1.69 per degree (95 % CI, 1.25–2.59). A ROC curve demonstrated that a PSA of 19°, which maximised sensitivity (true positives) while minimising 1 – specificity (false positives), was an optimal degree for prophylactic pinning (Fig. 4). When the cutoff value was 19°, sensitivity was 0.64 and 1 – specificity was 0.14. The NNT was 2.0, meaning that if a surgeon pinned all hips presenting with a unilateral SCFE with a contralateral PSA larger than 19°, 2.0 hips would need to be pinned to prevent 1 hip from progression to bilateral involvement. The area under the curve was 0.77 meaning moderate discrimination detection of a contralateral slip.

Discussion

We examined the PSA of contralateral hips in unilateral SCFE patients. Our results showed that the contralateral PSA in SCFE patients at the initial visit was significantly larger and more widely distributed than the PSA in control groups. Approximately 70 % of contralateral hips in SCFE patients had more than 12.8° of PSA, which was the upper limit of normal PSA defined in this study, suggesting subclinical bilateral involvement in many SCFE patients. The value of the initial PSA was a significant factor for a subsequent slip with a cutoff value of 19°.

There were several limitations to this study. First, the normal range of PSA is not clearly defined, thus we regarded the mean PSA of the control group +2SD as the PSA upper limit. Using this criterion, 70 % of unilateral SCFE patients had a PSA greater than the upper limit of normal in contralateral hips. Considering the reported prevalence of bilateral deformities detected in adulthood (40–80 %) [12], it might be compatible that posterior inclination more than this upper limit was regarded as subclinical posterior inclination. Second, we defined a slip as a symptomatic posterior inclination of the capital femoral epiphysis, thus an asymptomatic hip was not assumed as a slip regardless of the PSA. Although this definition is controversial, the hips in the SLIP(−) group had an epiphyseal closure without significant deterioration of PSA. This topic needs further clarification. Third, our study does not include re-examination at long-term follow-up. Therefore it is unclear whether this subclinical posterior inclination resulted in degenerative hip disease or not. Further follow-up and evaluation are needed.

In unilateral SCFE patients, the prevalence of a subsequent contralateral slip detected during adolescence has reportedly ranged from 7 % to 25 % [9]. In accordance, the rate of later slip development was 16.9 % in our study. However, a contralateral hip deformity possibly due to a slip (or posterior inclination of epiphysis) detected at long-term follow-up has been reported to be more prevalent. Hägglund et al. reported 61 % (159/260) had bilateral involvement after a mean of 33 years [1]. Jerre et al. also reported that the incidence of bilateral slipping was 63 % with use of the standard lateral view of Billing at an average 32 years follow-up time [2, 21]. Their criterion for a slip was based on radiographic findings: femoral heads with decreased anteversion, more than three standard deviations below its predicted position [22]. Additionally the risk of a contralateral slip in unilateral SCFE patients has been reported to be much higher than that of an initial slip [23]. These findings suggested the presence of subclinical changes in the contralateral hip from the initial visit. Our results showed a significant difference in the contralateral PSA between the SCFE and control groups, and 70 % of contralateral hips in the SCFE group had increased posterior inclination compared to the mean PSA + 2SD in the control group. These morphological changes might contribute to future impingement and degenerative joint disease [24–26].

Hurley et al. reported that some SCFE patients have bilateral slips that occur sequentially rather than concurrently [27], thus it is beneficial to determine factors contributing to a contralateral slip. Barrios et al. reported that the contralateral PSA was an important predictor for a subsequent slip [16]. Park et al. and Phillips et al. performed a further assessment of PSA [18, 19]. The former reported that the cutoff value for prophylactic pinning was a PSA of 13° in girls and the latter reported that it was a PSA of 14°. A younger age at the initial SCFE presentation [7, 8], endocrine disorders [14], and renal failure [15] also have been reported to be risk factors for bilateral SCFE. In our study, a contralateral PSA was the only significant risk factor for a contralateral slip (Tables 1 and ​and2)2) and a PSA of 19° was the threshold value for a contralateral slip (Fig. 4). Although 19° is higher than angles previously reported, this value is accompanied with higher specificity. Therefore, prophylactic pinning is worth performing for unilateral SCFE patients who have more than 19° of PSA with high possibility of a contralateral slip.

In conclusion, we found that approximately 70 % of contralateral hips in unilateral SCFE patients had subclinical posterior inclination of the capital femoral epiphysis, indicating the possibility of bilateral involvement. The contralateral PSA was a reliable predictor of a contralateral slip and a PSA of 19° was the cutoff value for developing SCFE.

References

1. Hägglund G, Hansson LI, Ordeberg G, Sandstrøm S. Bilaterality in slipped upper femoral epiphysis. J Bone Joint Surg Br. 1988;70(2):179–181.

2. Jerre R, Billing L, Hansson G, Karlsson J, Wallin J. Bilaterality in slipped capital femoral epiphysis: importance of a reliable radiographic method. J Pediatr Orthop B. 1996;5:80–84. doi: 10.1097/01202412-199605020-00005. 

3. Carney BT, Weinstein SL, Noble J. Long-term follow-up of slipped capital femoral epiphysis. J Bone Joint Surg Am. 1991;73(5):667–674.

4. Zilkens C, Bittersohl B, Jäger M, Miese F, Schultz J, Kircher J, Westhoff B, Krauspe R. Significance of clinical and radiographic findings in young adults after slipped capital femoral epiphysis. Int Orthop.2011;35(9):1295–1301. doi: 10.1007/s00264-010-1106-5. [PMC free article] [PubMed] [Cross Ref]

5. Seller K, Wild A, Westhoff B, Raab P, Krauspe R. Clinical outcome after transfixation of the epiphysis with Kirschner wires in unstable slipped capital femoral epiphysis. Int Orthop. 2006;30(5):342–347. doi: 10.1007/s00264-006-0110-2. [PMC free article] [PubMed] [Cross Ref]

6. Jensen HP, Steinke MS, Mikkelsen SS, Thomsen PB. Hip physiolysis. Bilaterality in 62 cases followed for 20 years. Acta Orthop Scand. 1990;61:419–420. doi: 10.3109/17453679008993553.

7. Loder RT, Aronson DD, Greenfield ML. The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan. J Bone Joint Surg Am. 1993;75(8):1141–1147.

8. Aronsson DD, Loder RT, Breur GJ, Weinstein SL. Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg. 2006;14(12):666–679.

9. Schultz WR, Weinstein JN, Weinstein SL, Smith BG. Prophylactic pinning of the contralateral hip in slipped capital femoral epiphysis: evaluation of long-term outcome for the contralateral hip with use of decision analysis. J Bone Joint Surg Am. 2002;84-A(8):1305–1314. 

10. Jerre T. Study in slipped upper femoral epiphysis: with special reference to late functional and roentogenological results and to value of closed reduction. Acta Orthop Scand Suppl. 1950;6:3–15.

11. Klein A, Joplin RJ, Reidy JA, Hanelin J. Management of the contralateral hip in slipped capital femoral epiphysis. J Bone Joint Surg Am. 1953;35-A(1):81–87.  Pediatr Orthop B.1996;5(3):158–161. doi: 10.1097/01202412-199605030-00004.

13. Billing L, Severin E. Slipping epiphysis of the hip. A roentgenological and clinical study based on a new roentgen technique. Acta Radiol Suppl. 1959;174:1–76. 

14. Loder RT, Wittenberg B, DeSilva G. Slipped capital femoral epiphysis associated with endocrine disorders. J Pediatr Orthop. 1995;15(3):349–356. doi: 10.1097/01241398-199505000-00018. 

15. Loder RT, Hensinger RN. Slipped capital femoral epiphysis associated with renal failure osteodystrophy.J Pediatr Orthop. 1997;17(2):205–211. doi: 10.1097/00004694-199703000-00013.

16. Barrios C, Blasco MA, Blasco MC, Gascó J. Posterior sloping angle of the capital femoral physis: a predictor of bilaterality in slipped capital femoral epiphysis. J Pediatr Orthop. 2005;25(4):445–449. doi: 10.1097/01.bpo.0000158811.29602.a5.

17. Zenios M, Ramachandran M, Axt M, Gibbons PJ, Peat J, Little D. Posterior sloping angle of the capital femoral physis: interobserver and intraobserver reliability testing and predictor of bilaterality. J Pediatr Orthop. 2007;27(7):801–804. doi: 10.1097/bpo.0b013e31814256af.

18. Park S, Hsu JE, Rendon N, Wolfgruber H, Wells L. The utility of posterior sloping angle in predicting contralateral slipped capital femoral epiphysis. J Pediatr Orthop. 2010;30(7):683–689. doi: 10.1097/BPO.0b013e3181efb888.

19. Phillips PM, Phadnis J, Willoughby R, Hunt L. Posterior sloping angle as a predictor of contralateral slip in slipped capital femoral epiphysis. J Bone Joint Surg Am. 2013;95(2):146–150.

20. Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am. 1993;75(8):1134–1140.

21. Jerre R, Billing L, Hansson G, Wallin J. The contralateral hip in patients primarily treated for unilateral slipped upper femoral epiphysis. Long-term follow-up of 61 hips. J Bone Joint Surg Br. 1994;76(4):563–567.

22. Hansson LI, Hägglund G, Ordeberg G. Slipped capital femoral epiphysis in southern Sweden 1910–1982. Acta Orthop Scand Suppl. 1987;226:1–67. doi: 10.3109/17453678709154165.

23. Castro FP, Jr, Bennett JT, Doulens K. Epidemiological perspective on prophylactic pinning in patients with unilateral slipped capital femoral epiphysis. J Pediatr Orthop. 2000;20(6):745–748. doi: 10.1097/01241398-200011000-00009.

24. Akiyama M, Nakashima Y, Kitano T, Nakamura T, Takamura K, Kohno Y, Yamamoto T, Motomura G, Ohishi M, Hamai S, Iwamoto Y. Remodelling of femoral head-neck junction in slipped capital femoral epiphysis: a multicentre study. Int Orthop.

25. Kandzierski G, Matuszewski L, Wójcik A. Shape of growth plate of proximal femur in children and its significance in the aetiology of slipped capital femoral epiphysis. Int Orthop. 2012;36(12):2513–2520. doi: 10.1007/s00264-012-1699-y.

26. Westhoff B, Ruhe K, Weimann-Stahlschmidt K, Zilkens C, Willers R, Krauspe R. The gait function of slipped capital femoral epiphysis in patients after growth arrest and its correlation with the clinical outcome.Int Orthop. 2012;36(5):1031–1038. doi: 10.1007/s00264-011-1409-1. [PMC free article] [PubMed][Cross Ref]

27. Hurley JM, Betz RR, Loder RT, Davidson RS, Alburger PD, Steel HH. Slipped capital femoral epiphysis. The prevalence of late contralateral slip. J Bone Joint Surg Am. 1996;78(2):226–230.

Alter's version of lefty bass player Mio Akiyama is almost perfect. They did a great job overall, and it is easy to see the care with which she was both sculpted and painted. Alter must have known fans of a character as popular as Mio would accept nothing but the best. In this case, as well as in the cases of most of Alter's figures, they delivered a must-have figure for any fan of “K-ON!” or even music in general.

Sculpt:
Mio Herself:

The quality of Mio’s sculpt is done very well. She doesn’t have any glaring seam lines or other flaws. There is a bit of a seam at the top of her head in the middle of her hair, but the hair seam is common, and seems to be one that is difficult to conceal. Other than that, Mio’s sculpt is extremely well done. Alter paid very close attention to detail when they sculpted her. The movements of her hair are captured very well, and her tie appears to be moving just like her hair is, creating a very consistent and believable feeling of movement. Her skirt appears to sway just a bit with her movement as well.
The small details were also included. Mio’s shoes appear to be polished or maybe brand new. The wrinkles in her jacket and skirt appear to be consistent with her pose as well. Even the little dimples in the backs of her knees are included. It was nice to see all the little things included. The care with which Mio was sculpted makes her well worth the price.

Mio’s Bass:

Mio’s bass is a very detailed representation of the actual instrument she plays. It compares well with pictures of the real Fender model. On the wood parts of the instrument are simulated grains that make it appear more like actual wood than plastic. Besides, it simply just looks cool in her hands. The only disappointing features of the bass itself are the clear, nylon-like strings. They are not metallic like they are on a real model. Though nylon strings are options on some guitars, they are generally not recommended on metal string guitars. Plus, the one Mio plays has metal strings. Still, the clear strings do not take much away from the figure itself, let alone the instrument. It still looks very detailed and does both Mio and Fender justice.

Paint:

The effort put into Mio’s paint job is very apparent. There are different shades of color on Mio’s skirt and shoes, which give her a bit more of a “real” feel. Even the small areas like the buckle on the strap of her bass are painted well. The buckle is painted silver, and the strap itself black, but the buckle’s paint is totally separate from the strap. Her instrument is painted very well, too. All of the details are painted perfectly, and the attractive paint makes her bass look almost real. The only tiny flaw that is visible is on the part of her hand that touches her pick. The white paint on the pick bleeds just a bit onto her left index finger, and a bit of the area of the pick under her thumb was missed. Without a very careful look, though, Mio’s paint job appears perfect. The tiny flaws are barely noticeable even after a good, hard look.

Pose:

Mio’s pose suits her well. When the original pictures were released, the pose appeared a little out of character for her, but after and in-person look, it is a lot more believable. The in-motion pose and makes Mio appear to be passionate about the song she is playing, and her face reflects that as well. She looks happy, and seems to be enjoying herself. After considering the poses Alter could have chosen for Mio, the one they picked is very good. The figure would not have such a lively feeling without an exciting pose.

Base:

Interesting bases are rare. Most figures' bases are simple, one color stands that aim for nothing more than practicality. Mio’s base is an exception. Across the middle of the circular base is a white silhouette of her lefty Fender bass with “K-ON!” written in blue letters on the bass’s body. Underneath the silhouette, there are two lines of text. The first line reads, in white capital letters, “Ho-Kago Tea Time,” and the second reads in blue “Mio Akiyama ★ Bass.” Alter added another interesting touch here, making Mio's base to resemble a music CD (thanks, Kilani). The dimensions of the base are also relatively close to the actual dimensions of a CD. The base is clear plastic, and compliments Mio very well without distracting a viewer from Mio herself. Her base is a bit on the large side, but it does not take up too much room, and it is overall a great addition to the figure’s appearance.

Packaging:

Mio came packed in a big blue and white window box. It showcases her well, and has some fun details on it, like the bass-shaped window on the top flap of the box. Musical notes that have a hand-written look are printed on its sides. These add a fun element to the figure before it is even removed from the box. It is apparent that Alter even put a lot of thought into Mio’s box. It is not surprising that such an outstanding figure comes in a well-designed package.

Enjoyment:

As with my first review, I would like to take a more personal approach to this section of the review.
After waiting for so long, I finally received my Mio today. I sent her to the wrong address originally, so I had to wait a bit longer for her than I would have otherwise. So, when she finally came into my current address, I was more than happy. I had seen all of the pictures online from users that had already received her, but I had not gotten to see her with my own eyes. When I took her out of her box for the first time, I could see right away that the money I had spent and the time I had waited had all been more than worth it. I am very happy with my Mio figure, and am proud to have her. She has made a great addition to my little collection; she is certainly a stand-out figure, and I enjoy her as much as one can enjoy a figure. :)

Hair color is frequently used in Japanese animation as a mechanism to differentiate between characters, but did you know that specific hues have an associated symbolism?

While not always 100% consistent, there is a connection between hair color and personality type in anime.

According to Carl Jung, there is a shared collection of mental associations that are within the collective unconscious of humanity. Along with repetition, and eventual simplification, these ideas come together to become the stereotypes described:

Black:

Mysterious, refined, traditional, cerebral, capable, powerful, independent, sad, cruel, macabre

As opposed to their bright-colored friends, black hair can define a character as being more traditional. Black is a neutral color that is associated with positive personal traits. These characters tend to be deep thinkers that can see the “big picture”, and seldom need advice.

Pictured Above (From top left to bottom): Hei Darker Than Black, Kagome Higurashi Inuyasha, Rokuro “Rock” Okajima Black Lagoon, Ranma Saotome Ranma 1/2, Mio Akiyama K-On!, Yoite King of Nabari, Black★Rock Shooter (self-titled), Brandon Heat Gungrave.
Grey/Silver:

Calm, balanced, demure, sophisticated, sublime, logical, composed, disguised, obscene, irreverent

Grey-haired characters have a mix of moral black & white—much like their hair. They are “do-it-your-selfers” with problem solving methods beyond the status quo. Characters may also have grey hair to emphasize a modest, self-less nature. Also, while not always evil, may have a hidden power.

Pictured Above (From top left to bottom): Yu Narukami Persona 4 The Animation, Moka Akashiya Rosario + Vampire, Kakashi HatakeNaruto, Fuko Ibuki Clannad, Violetta Code Geass: Lelouch of the Rebellion, Shi Ryuuki The Story of Saiunkoku, Shizuka Queen’s Blade,Kilik Air Gear.

Brown/Auburn:

Approachable, comfortable, temperate, charming, practical, consistent, sincere, enduring, predictable, boring

The staple color of any stock character or “normal” person, brown is also a common color for the main protagonist. When characters have darker or lighter brown hair, they often absorb the traits of yellow or black. This color can be deceiving, as a character with this hair color may be far from normal.

Pictured Above (From top left to bottom): Italy Hetalia, Chihiro Spirited Away, Kyon The Melancholy of Haruhi Suzumiya, Tohru Honda Fruits Basket, Haruhi Fujioka Ouran High School Host Club, Hideki Motosuwa Chobits, Sakura Kinomoto Cardcaptor Sakura,Keima Katsuragi The World God Only Knows.

Red:

Passionate, seductive, feisty, enthusiastic, adventurous, dynamic, primal, hot-headed, aggressive, opinionated

For red-headed characters, the western “hot-head” stereotype is true. Tsundere alert: their emotions are explosive! Strangely, male protagonists with red hair are often calm, humble, and disciplined fighters.

Pictured Above (From top left to bottom): Ayano Kannagi Kaze no Stigma, Grell Sutcliff Black Butler, Natsumi Hinata Sergeant Frog,Renji Abarai Bleach, Spirit Soul Eater, Lisara Restall So, I Can’t Play H!, Lavi D.Gray-man, Yoko Littner Tengen Toppa Gurren Lagann.
Orange:

Courageous, loyal, spirited, optimistic, unpredictable, brazen, testy, selfish, annoying, attention-seeking

Orange-haired characters have a personality combination between red and yellow. They can be very interesting in that they have the courage and fire of a ginger, but with less rage and more optimism. The down-side is that they can be attention whores, which can be annoying.

Pictured Above (From top left to bottom): Asuka Langley Neon Genesis Evangelion, Ichigo Kurosaki Bleach, Nana “Hachi” Komatsu Nana,Tasuki Fushigi Yûgi: The Mysterious Play, Kazuma Kuwabara YuYu Hakusho, Eris Cat Planet Cuties, Hiroto “Cherry” Sakurai Gantz,Nami One Piece.
Yellow/Blonde:

Confident, happy, romantic, artful, whimsical, Naïve, ditzy, impish, manipulative, callous, stubborn

Although not absolute, blondes loosely fall into three camps:

1.) Dumb blonde: They may also lack maturity, and have selfish attitudes.

2.) Troublemaker: Unwittingly attracts chaos. They have street-smarts, charm, and plenty of tricks.

3.) Prince: This protagonist is rare, and demonstrates the western “prince charming” archetype. This hero/heroine is chivalrous, humble, and pure.

Blonde may be an assigned to indicate a character has foreign ancestry. Usually European/American.

Pictured Above (From top left to bottom): Naruto Uzumaki Naruto, Pacifica Casull Scrapped Princess, Vash the Stampede Trigun,Astraea Heaven’s Lost Property: Forte, Saber Fate/Stay Night, Shizuo Heiwajima Durarara!!, Misa Amane Death Note, Soubi AgatsumaLoveless.

Green:

Easy-going, trustworthy, docile, enlightened, tolerant, rejuvenating, of raw energy, roguish, imprudent, poisonous, jealous

A cross between warm and cool colors, green imparts a unique energy to a character. Like mother nature, green is capable of an evolving, healing atmosphere as well as bringing destruction and decay. These characters tend to side with the protagonists, even with bad first-impressions.

Pictured Above (From top left to bottom): Roronoa Zoro One Piece, Eureka Eureka Seven, Cilan Pokémon: Best Wishes!, C.C. Code Geass: Lelouch of the Rebellion, Rin RIN: Daughters of Mnemosyne, Quiche Tokyo Mew Mew, Lum Urusei Yatsura, Nicol Amarfi Gundam Seed.
Blue:

Wise, impartial, talented, mature, intuitive, introverted, concerned with science, justice, reason

Cool like water. While not always noticed, their influence is clearly felt (also like the element of wind). Blue-haired characters have many hidden talents, and a keen awareness of the emotions of themselves and others. Unlike black-haired characters, they are not averse to seeking advice. With their smarts and even-handedness, they often play the role of teachers, tacticians, and confidants. The darker the hair, the more responsible–but they may be an elitist jerk. Supernatural abilities are common to blue hair.

Pictured Above (From top left to bottom): Blue Rose Tiger & Bunny, The Count Gankutsuou: the Count of Monte Cristo, Mercury Sailor Moon, Johji Koizumi Paradise Kiss, “Big Bro” Kamina Tengen Toppa Gurren Lagann, Kuroha Diana Shiraroti Eden of the East, Lord Darcia III Wolf’s Rain, Rei Ayanami Neon Genesis Evangelion.
Purple:

Powerful, privileged, noble, elegant, intriguing, restless, fickle, conflicted, pompous, egotistical

Purple-haired characters rarely have to assert power through force; they are entitled to it. Full of hubris or out of touch with other characters, their goals may revolve around prestige and the acquiring of material possessions. Protagonists with purple hair must face the challenge of balancing the red and blue oni within themselves.

Pictured Above (From top left to bottom): Sinbad Magi: The Labyrinth of Magic, Kagami Hiiragi Lucky Star, Dark Mousy D.N. Angel, Unchou Kan-u Ikkitousen, Faye Valentine Cowboy Bebop, Chrono Chrono Crusade, Misato Katsuragi Neon Genesis Evangelion, Tieria ErdeGundam 00.

Pink:

Benevolent, feminine, youthful, innocent, cheerful, cute, orderly, accomplished, gullible, frustrated

Characters with pink hair may at first seem saccharine, but their natural charisma combined with their desire for order can bring about a positive change in others. Pink haired characters can have a great destiny. Whatever their sexual orientation, male characters with pink hair can be perverse. Perhaps this is to accentuate/overcompensate for the feminine connotations of pink. Characters with bright pink hair may share some personality traits with red-heads.

Pictured Above (From top left to bottom): Natsu Dragneel Fairy Tail, Utena Tenjou Revolutionary Girl Utena, Shuichi ShigenoGravitation, Lacus Clyne Gundam Seed, Milfeulle Sakuraba Galaxy Angel, Szayel Aporro Bleach, Kurumi Steel Angel Kurumi, Renzou Shima Blue Exorcist.

White:

Pure, ethereal, magical, serene, lucid, mature, humble, indifferent, narcissistic, immoral

A strange, inhuman essence surrounds white-haired characters. Their purity can be unnatural and over-sanitized. These characters are usually strong-willed, skillful, and dignified. If a woman, it is common that she is either magical or of the spiritual realm. If the character is a guy, he usually has a broken moral compass, and is an anti-hero–on a good day. If he is a bishonen, odds are he is bisexual/homosexual. Egotism is common, and if inflicted with an injury (however minor–especially to the face) these characters will go berserk.

The combination of white hair and tan skin can indicate middle-eastern/foreign ancestry. In this case, the above description does not apply.



Pictured Above (From top left to bottom): Ginko Mushishi, Teletha Testerossa Full Metal Panic!, Griffith Berserk, Shiro Deadman Wonderland, Suigantou Rozen Maiden, Creed Diskenth Black Cat, Shizuma Hanazono Strawberry Panic, Accelerator A Certain Magical Index.

Mio is a member of the light music club. She originally intended to join the literary club, but is forced into the light music club by her childhood friend and the club's drummer, Ritsu Tainaka. Mio is the shyest member of the club and is easily embarrassed, but even so, she is the most mature of the bunch. She was emotionally damaged for a short while after falling down on stage during a performance and landing in such a position that her blue and white striped panties were visible to everyone in the audience. This incident was also the catalyst for her popularity, and the forming of her own fan club in the school.

Mio's bass is a left handed Sunburst Fender Jazz with Tortoiseshell pickguard.

Mio claims that she chose the bass because she wanted to avoid the spotlight which naturally fell on the guitarist. Despite this, she ended up sharing singing duties with Yui, and wrote several of Houkago Tea Time's songs.

Amongst the students of the all-female Sakura High School, Mio is extremely popular, and has her own fan club.

Mio Akiyama is voiced by Yōko Hikasa in the original Japanese dub, and Cristina Vee in the English dub.

K-ON! After School Live!

Mio playing her bass.

Mio appears as a playable character in K-ON! After School Live! Mio's gameplay centers around playing 'bass guitar' tracks. Mio also appears in the main menu or, as it's known, the club-room, along with all the other characters, at random and can active special events if in the room at the same-time as other members.

Both 'Heart Goes Boom' and 'Hello Little Girl' appear in the games setlist from Mio's Character Image album, entitled 'K-ON! Character Image Song Series Vol. 2: Mio Akiyama'.