50 YEARS AGO IN CORR: The Effect of Juxta-epiphyseal Pyogenic Infection on Epiphyseal Growth

Abstract

CORR 1957;10:131-139 This month's issue of Clinical Orthopaedics and Related Research includes an article by Ashraf et al1 exploring molecular mechanisms by which mid-shaft fractures stimulate epiphyseal over-growth. In 1957, childhood osteomyelitis was far more commonly seen than today, and one of its consequences was epiphyseal overgrowth. Siffert, in the article we highlight, commented, “Occasionally temporary stimulation of growth occurs, due probably either to hyperemia of the local inflammation or thrombosis of the medullary vessels. Wilson and McKeever noted that growth stimulation was related more commonly to diaphyseal than to juxta-epiphyseal foci of infection.” While RNA had been chemically known since the late 1860s, its role in protein production was largely unknown until François Jacob and Jacque Monod postulated the existence of “messenger RNA” in 1960 (a concept for which they were awarded the 1965 Nobel Prize in Medicine). The paper of Ashraf et al1 in this month's CORR suggests, “The data support increased mitotic activity in the physis after a midshaft fracture and not increased vascularity.” While the study of Ashraf et al1 focuses not on infection but on fractures, the mechanisms for epiphyseal stimulation are likely the same, and if so their work challenges previous ideas.Fig 1: (Left) Roentgenogram of the forearm of a 2-year-old child with Staphylococcus aureus infection of the upper end of the ulna and secondary involvement with periosteal reaction along the entire shaft of the bone. There is an angulated pathologic fracture of the ulna shaft and of the involucrum. (Right) Roentgenogram of the forearm in the same child taken 6 months later, demonstrating healing of the fracture with residual angular deformity at the fracture site. A secondary curve of the lower ulna, due to compensatory epiphyseal growth has occurred in order to maintain the normal integrity and alignment of the wrist joint. As remodeling of the fracture angulation occurs, associated straightening of the lower compensatory angulation will also take place. (Reprinted with permission from Siffert RS. The effect of juxta-epiphyseal pyogenic infection on epiphyseal growth. Clin Orthop Relat Res. 1957;10:131-139.)Richard A. Brand, MD Editor-in-Chief, Clinical Orthopaedics and Related Research