Distal Growth Research Articles

Adult Tillaux-Chaput tubercle fracture of the ankle with rupture of the peroneus tertius muscle: a case report

BackgroundTillaux-Chaput tubercle fractures occur in adolescents, which are often associated with the separation of the distal tibial growth plate. These types of fractures are rare in adults and even rarer when accompanied by a rupture of the peroneus tertius muscle. Given the limited number of reported cases, there is limited clinical awareness, resulting in missed diagnoses and delayed treatment, ultimately affecting ankle function.Case presentationWe report a case of an adult patient who experienced a right ankle injury resulting in swelling and pain after a traffic accident. Initial examination failed to identify the rupture of the peroneus tertius muscle, but the patient was observed to have restricted dorsiflexion and eversion of the foot. Surgical exploration through an anterolateral incision confirmed the rupture and the muscle was then repaired. The patient received four weeks of cast immobilization and then engaged in progressive rehabilitation exercises.Discussion and conclusionThis report shares the diagnostic and therapeutic experiences of an adult with a Tillaux-Chaput tubercle fracture associated with peroneus tertius muscle rupture to improve clinical recognition of such injuries, thus preventing misdiagnosis and treatment delays.

Origin and factors for overgrowth in pediatric fractures of the femoral shaft after flexible intramedullary nail fixation.

Leg length discrepancy is a common complication following flexible intramedullary nail (FIN) fixation for femoral shaft fractures in adolescents. This retrospective study was designed to evaluate the possible cause of femoral overlengthening in children with femoral shaft fracture. We retrospectively included 138 patients diagnosed with femoral shaft fractures between June 2012 and December 2022 and reported the clinical/radiological outcomes after at least half a year of surgery. We have introduced a new parameter, distal physis growth proportion (DPGP), which can be used to predict the origin of femoral growth. The mean DPGP value of 138 samples was 50.9%, of which 24 (17.4%) were greater than 70% and 114 (82.6%) were less than 70%. In the group with nail-canal diameter ratio (NCD) values greater than 60%, the proportion of patients with DPGP values exceeding 70% was significantly higher compared to the group with NCD values less than 60%. However, there was no significant difference between gender, fracture side, fracture type, mode of reduction, associated craniocerebral injury or the distance from fracture site to distal articular surface of femur. In children with femoral shaft fractures treated with FIN fixation, the number of patients with DPGP lesser than 70% far exceeded the number of patients with DPGP greater than 70%, indicating the significant role of fracture end stimulation in femoral lengthening.

Functional analysis of a novel pathogenic variant in CREBBP associated with bone development.

CREBBP has been extensively studied in syndromic diseases associated with skeletal dysplasia. However, there is limited research on the molecular mechanisms through which CREBBP may impact bone development. We identified a novel pathogenic CREBBP variant (c.C3862T/p.R1288W, which is orthologous to mouse c.3789 C > T/p.R1289W) in a patient with non-syndromic polydactyly. We created a homozygous Crebbp p.R1289W mouse model and compared their skeletal phenotypes to wild-type (WT) animals. Bone marrow stem cells (BMSCs) were isolated and assessed for their proliferative capacity, proportion of apoptotic cells in culture, and differentiation to chondrocytes and osteocytes. We observed a significant decrease in body length in 8-week-old homozygous Crebbp p.R1289W mice. The relative length of cartilage of the digits of Crebbp p.R1289W mice was significantly increased compared to WT mice. BMSCs derived from Crebbp p.R1289W mice had significantly decreased cell proliferation and an elevated rate of apoptosis. Consistently, cell proliferative capacity was decreased and the proportion of apoptotic cells was increased in the distal femoral growth plate of Crebbp p.R1289W compared to WT mice. Chemical induction of BMSCs indicated that Crebbp p.R1289W may promote chondrocyte differentiation. The Crebbp p.R1289W variant plays a pathogenic role in skeletal development in mice. CREBBP has been extensively studied in syndromic diseases characterized by skeletal dysplasia. There is limited research regarding the molecular mechanism through which CREBBP may affect bone development. To our knowledge, we generated the first animal model of a novel Crebbp variant, which is predicted to be pathogenic for skeletal diseases. Certain pathogenic variants, such as Crebbp p.R1289W, can independently lead to variant-specific non-syndromic skeletal dysplasia.

Microbiota-induced plastic T cells enhance immune control of antigen-sharing tumors.

Therapies that harness the immune system to target and eliminate tumor cells have revolutionized cancer care. Immune checkpoint blockade (ICB), which boosts the anti-tumor immune response by inhibiting negative regulators of T cell activation1-3, is remarkably successful in a subset of cancer patients, yet a significant proportion do not respond to treatment, emphasizing the need to understand factors influencing the therapeutic efficacy of ICB4-9. The gut microbiota, consisting of trillions of microorganisms residing in the gastrointestinal tract, has emerged as a critical determinant of immune function and response to cancer immunotherapy, with multiple studies demonstrating association of microbiota composition with clinical response10-16. However, a mechanistic understanding of how gut commensal bacteria influence the efficacy of ICB remains elusive. Here we utilized a gut commensal microorganism, segmented filamentous bacteria (SFB), which induces an antigen-specific Th17 cell effector program17, to investigate how colonization with it affects the efficacy of ICB in restraining distal growth of tumors sharing antigen with SFB. We find that anti-PD-1 treatment effectively inhibits the growth of implanted SFB antigen-expressing melanoma only if mice are colonized with SFB. Through T cell receptor clonal lineage tracing, fate mapping, and peptide-MHC tetramer staining, we identify tumor-associated SFB-specific Th1-like cells derived from the homeostatic Th17 cells induced by SFB colonization in the small intestine lamina propria. These gut-educated ex-Th17 cells produce high levels of the pro-inflammatory cytokines IFN-γ and TNF-α, and promote expansion and effector functions of CD8+ tumor-infiltrating cytotoxic lymphocytes, thereby controlling tumor growth. A better understanding of how distinct intestinal commensal microbes can promote T cell plasticity-dependent responses against antigen-sharing tumors may allow for the design of novel cancer immunotherapeutic strategies.

Posttraumatic growth disturbances of the distal radius in childhood

Fractures of the distal radius in childhood are frequent but rarely lead to relevant growth disturbances. The experiences of apediatric trauma center over 15years are exemplarily presented and discussed. Osteotomies of the distal radius were selected and the clinical and radiological findings were recorded and analyzed. Posttraumatic growth disturbances were corrected in 10 cases with amedian age of 13 ½ years. In six cases an iatrogenic cause was also possible. In two cases callus distraction with secondary palmar plate osteosynthesis was used for consolidation. In eight cases primary ad hoc corrections were carried out using palmar plate osteosynthesis (six with iliac crest and two with allogeneic grafts). In five cases the distal ulnar growth plate was also addressed. During follow-up breakage of one plate was registered. After an average of 31months postoperatively, 9 children had full range of motion (ROM) and in 1 case there was an extension deficit of 10o. It is important to evaluate the cause of the mostly partially inhibiting growth disturbances to draw preventive conclusions. From a clinical perspective the visible deformity is given priority and the pain and functional limitations are less relevant. The indications for corrective surgery must include the age of the patient, remaining growth potential, size and localization of the growth plate bridge, the deformity and the individual wishes of patients and parents. In most cases afull correction is possible with palmar plate osteosynthesis and an iliac crest graft. External fixation and callus distraction is an alternative in cases where the correction is more extensive. The distal ulnar growth plate should be controlled concerning further growth potential before hardware removal.

A new transcriptome resource for Cellaria immersa (Phylum: Bryozoa) reveals candidate genes and proteins related to biomineralization

One of the most salient features of marine bryozoans is their well-calcified skeleton, and many species in this phylum are important reef-builders. To date, the molecular machinery responsible for skeletal formation in these key animals remains unknown. In this study we performed de novo transcriptome assembly from RNA from Cellaria immersa colonies collected in New Zealand, the first from the family Cellariidae. The assembly resulted in a set of 125,750 transcripts and was estimated to be 97.2% complete when compared to BUSCO core gene sets. A function was predicted for 61,442 (48.8%) of the translated proteins, using similarity searches against a range of databases using BLAST and InterProScan. Cellaria species form erect, heavily calcified arborescent colonies, which when abundant can create micro-forests or meadows on the ocean floor. RNA was extracted separately from younger distal and older proximal parts of the colonies, aiming to identify the key genes involved in biomineralization as the young zooids (at the distal growth margin) of the colony are more likely to be actively growing and calcifying compared to the old zooids of the proximal parts of the colony. Differential expression analysis was carried out to identify differential expression between the distal and proximal parts of the colonies. This showed that 506 (2.2%) of the transcripts were expressed more highly in the young zooids and 4,676 (20.4%) were expressed more highly in the old zooids. Over 50 protein families were identified as candidates involved in biomineralization in C. immersa based on the functional annotation, their expression pattern and literature. Transcripts encoding 24 such protein families were more highly expressed in the young zooids. This is the first such study on a heavily calcified species from the phylum Bryozoa, increasing the amount of ‘omics’ data available for C. immersa and the phylum. These data provide a resource for current and future studies of heavily calcified bryozoans, shedding a light on the biomineralization process in this phylum.

ESMAC Best Paper Award 2023: Increased knee flexion in participants with cerebral palsy results in altered stresses at the distal femoral growth plate compared to a typically developing cohort

IntroductionFemoral deformities are highly prevalent in children with cerebral palsy (CP) and can have a severe impact on patients’ gait abilities. While the mechanical stress regime within the distal femoral growth plate remains underexplored, understanding it is crucial given bone's adaptive response to mechanical stimuli. We quantified stresses at the distal femoral growth plate to deepen our understanding of the relationship between healthy and pathological gait patterns, internal loading, and femoral growth patterns. MethodsThis study included three-dimensional motion capture data and magnetic resonance images of 13 typically developing children and twelve participants with cerebral palsy. Employing a multi-scale mechanobiological approach, integrating musculoskeletal simulations and subject-specific finite element analysis, we investigated the orientation of the distal femoral growth plate and the stresses within it. Limbs of participants with CP were grouped depending on their knee flexion kinematics during stance phase as this potentially changes the stresses induced by knee and patellofemoral joint contact forces. ResultsDespite similar growth plate orientation across groups, significant differences were observed in the shape and distribution of growth values. Higher growth rates were noted in the anterior compartment in CP limbs with high knee flexion while CP limbs with normal knee flexion showed high similarity to the group of healthy participants. DiscussionResults indicate that the knee flexion angle during the stance phase is of high relevance for typical bone growth at the distal femur. The evaluated growth rates reveal plausible results, as long-term promoted growth in the anterior compartment leads to anterior bending of the femur which was confirmed for the group with high knee flexion through analyses of the femoral geometry. The framework for these multi-scale simulations has been made accessible on GitHub, empowering peers to conduct similar mechanobiological studies. Advancing our understanding of femoral bone development could ultimately support clinical decision-making.

Alcohol intake during pregnancy reduces offspring bone epiphyseal growth plate chondrocyte proliferation through transforming growth factor β-1 inhibition in the Sprague Dawley rat humerus.

Intrauterine alcohol exposure delays bone maturation and intensifies osteoporosis and fracture risk. As most studies emphasize the neurological aspects of intrauterine alcohol exposure, there is a lack of research on the implications pertaining to osseous tissue. Previous studies investigated these effects in fetuses, with limited studies on postnatal life. Postnatal studies are crucial since peak bone growth occurs during adolescence. This study aimed at assessing the effects of prenatal alcohol exposure on the humerus proximal and distal growth plate chondrocytes in 3-week-old rats. Sprague Dawley rats (n=9) were assigned to either the ethanol group (n=3), saline (n=3), and untreated (n=3) group and time-mated. Once pregnant, as confirmed by the presence of a copulation plug, the former 2 groups were treated with 0.015 ml/g of 25.2% ethanol and 0.9% saline. The untreated group received no treatment. The left humeri belonging to 6 pups per group were used. Serial sections were cut with a microtome at 5 μm thickness. These sections were stained with haematoxylin and eosin for assessment of normal morphology or immunolabeled with anti-Ki-67 and transforming growth factor β-1 (TGFβ-1) antibody. Prenatal alcohol exposure adversely effected the growth plate sizes and the number of cells in the proliferative zone. Fewer TGFβ-1 immunopositive and proliferative chondrocytes were found using the anti-Ki-67 antibody. This may explain the growth retardation in offspring exposed to gestational alcohol, showing that gestational alcohol exposure inhibits cell proliferation, aiding the diminished stature.

Shikonin and chitosan-silver nanoparticles synergize against triple-negative breast cancer through RIPK3-triggered necroptotic immunogenic cell death

Necroptotic immunogenic cell death (ICD) can activate the human immune system to treat the metastasis and recurrence of triple-negative breast cancer (TNBC). However, developing the necroptotic inducer and precisely delivering it to the tumor site is the key issue. Herein, we reported that the combination of shikonin (SHK) and chitosan silver nanoparticles (Chi-Ag NPs) effectively induced ICD by triggering necroptosis in 4T1 cells. Moreover, to address the lack of selectivity of drugs for in vivo application, we developed an MUC1 aptamer-targeted nanocomplex (MUC1@Chi-Ag@CPB@SHK, abbreviated as MUC1@ACS) for co-delivering SHK and Chi-Ag NPs. The accumulation of MUC1@ACS NPs at the tumor site showed a 6.02-fold increase compared to the free drug. Subsequently, upon reaching the tumor site, the acid-responsive release of SHK and Chi-Ag NPs from MUC1@ACS NPs cooperatively induced necroptosis in tumor cells by upregulating the expression of RIPK3, p-RIPK3, and tetrameric MLKL, thereby effectively triggering ICD. The sequential maturation of dendritic cells (DCs) subsequently enhanced the infiltration of CD8+ and CD4+ T cells in tumors, while inhibiting regulatory T cells (Treg cells), resulting in the effective treatment of primary and distal tumor growth and the inhibition of TNBC metastasis. This work highlights the importance of nanoparticles in mediating drug interactions during necroptotic ICD.

Enhanced catalytic activity of Fe3O4-carbon dots complex in the Fenton reaction for enhanced immunotherapeutic and oxygenation effects

Tumor metastasis and recurrence are closely related to immune escape and hypoxia. Chemodynamic therapy (CDT), photodynamic therapy (PDT), and photothermal therapy (PTT) can induce immunogenic cell death (ICD), and their combination with immune checkpoint agents is a promising therapeutic strategy. Iron based nanomaterials have received more and more attention, but their low Fenton reaction efficiency has hindered their clinical application. In this study, Fe3O4-carbon dots complex (Fe3O4-CDs) was synthesized, which was modified with ferrocenedicarboxylic acid by amide bond, and crosslinked into Fe3O4-CDs@Fc nano complex. The CDs catalyzed the Fenton reaction activity of Fe3O4 by helping to improve the electron transfer efficiency, extended the reaction pH condition to 7.4. The Fe3O4-CDs@Fc exhibit exceptional optical activity, achieving a thermal conversion efficiency of 56.43 % under 808 nm light and a photosensitive single-line state oxygen quantum yield of 33 % under 660 nm light. Fe3O4-CDs@Fc improved intracellular oxygen level and inhibited hypoxia-inducing factor (HIF-1α) by in-situ oxygen production based on Fenton reaction. The multimodal combination of Fe3O4-CDs@Fc (CDT/PDT/PTT) strongly induced immune cell death (ICD). The expression of immune-related protein and HIF-1α was investigated by immunofluorescence method. In vivo, Fe3O4-CDs@Fc combined with immune checkpoint blocker (antibody PD-L1, αPD-L1) effectively ablated primary tumors and inhibited distal tumor growth. Fe3O4-CDs@Fc is a promising immune-antitumor drug.

Guided Growth to Treat Anterolateral Tibial Bowing Associated with Congenital Pseudarthrosis of the Tibia.

Anterolateral tibial bowing associated with congenital tibial pseudarthrosis occurs often in patients with neurofibromatosis type 1 and results from the inability of the fractured bone to unite, leading to persistent nonunion, abnormal bone growth, and further bowing of the tibia. Current surgical and nonsurgical approaches demonstrate persistent nonunion or refracture, often resulting in amputation. This report describes the management of 3 patients with anterolateral tibial bowing and NF1 who underwent distal tibia-guided growth. The patients had an average age of 1.6 years at initial operation, with a total of 3 to 4 surgeries over an average of 2.1 years. The latest follow-up on all patients is included, at a mean of 5.1 years after the initial operation. All 3 patients experienced substantial functional improvement and improved alignment of the mechanical axis of the tibia. One patient has experienced refracture. Our study indicates that guided growth can serve as an additional surgical option to improve ALTB and potentially reduce the risk of fracture and pseudarthrosis by restoring normal mechanical alignment. Level-IV, Case Series.

Mitochondria-Targeting Type-I Photodrug: Harnessing Caspase-3 Activity for Pyroptotic Oncotherapy.

Precise control of cellular signaling events during programmed cell death is crucial yet challenging for cancer therapy. The modulation of signal transduction in cancer cells holds promise but is limited by the lack of efficient, biocompatible, and spatiotemporally controllable approaches. Here we report a photodynamic strategy that modulates both apoptotic and pyroptotic cell death by altering caspase-3 protein activity and the associated signaling crosstalk. This strategy employs a mitochondria-targeting, near-infrared activatable probe (termed M-TOP) that functions via a type-I photochemical mechanism. M-TOP is less dependent on oxygen and more effective in treating drug-resistant cancer cells, even under hypoxic conditions. Our study shows that higher doses of M-TOP induce pyroptotic cell death via the caspase-3/gasdermin-E pathway, whereas lower doses lead to apoptosis. This photodynamic method is effective across diverse gasdermin-E-expressing cancer cells. Moreover, the M-TOP mediated shift from apoptotic to pyroptotic modulation can evoke a controlled inflammatory response, leading to a robust yet balanced immune reaction. This effectively inhibits both distal tumor growth and postsurgical tumor recurrence. This work demonstrates the feasibility of modulating intracellular signaling through the rational design of photodynamic anticancer drugs.

SEM morphological study on Holotype of Spinicaudatan Shipingia luchangensis (Chen, 1974) comb. nov. From Upper Triassic of Huili, Sichuan, Southwest China

ABSTRACT A re-examination of the holotype of the Rhaetian (Late Triassic) clam shrimp Loxomegaglypta luchangensis has revealed that the large-sized reticulations are located in the upper part, and the small-sized reticulations in the lower part of each growth band in the middle part of the carapace. The distal growth bands are ornamented with small-sized reticulations. These features indicate that the species should be assigned to Shipingia. This discovery indicates that Shipingia has ranged to Rhaetian (Upper Triassic).

Antenatal Endotoxin Induces Dysanapsis in Experimental Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia (BPD), the chronic lung disease of prematurity, is characterized by impaired lung development with sustained functional abnormalities due to alterations of airways and the distal lung. Although clinical studies have shown striking associations between antenatal stress and BPD, little is known about the underlying pathogenetic mechanisms. Whether dysanapsis, the concept of discordant growth of the airways and parenchyma, contributes to late respiratory disease as a result of antenatal stress is unknown. We hypothesized that antenatal endotoxin (ETX) impairs juvenile lung function as a result of altered central airway and distal lung structure, suggesting the presence of dysanapsis in this preclinical BPD model. Fetal rats were exposed to intraamniotic ETX (10 μg) or saline solution (control) 2 days before term. We performed extensive structural and functional evaluation of the proximal airways and distal lung in 2-week-old rats. Distal lung structure was quantified by stereology. Conducting airway diameters were measured using micro-computed tomography. Lung function was assessed during invasive ventilation to quantify baseline mechanics, response to methacholine challenge, and spirometry. ETX-exposed pups exhibited distal lung simplification, decreased alveolar surface area, and decreased parenchyma-airway attachments. ETX-exposed pups exhibited decreased tracheal and second- and third-generation airway diameters. ETX increased respiratory system resistance and decreased lung compliance at baseline. Only Newtonian resistance, specific to large airways, exhibited increased methacholine reactivity in ETX-exposed pups compared with controls. ETX-exposed pups had a decreased ratio of FEV in 0.1 second to FVC and a normal FEV in 0.1 second, paralleling the clinical definition of dysanapsis. Antenatal ETX causes abnormalities of the central airways and distal lung growth, suggesting that dysanapsis contributes to abnormal lung function in juvenile rats.

Photo-Driven InSitu Solidification of Whole Cells through Inhibition of Trogocytosis for Immunotherapy.

Achieving antitumor immunotherapy based on hybridization of multiple types of inactivated cells has attracted a lot of attention. However, the hybridized cells of disordered structure could result in the shedding of antigens and their transfer to immune cells, which suppresses tumor immunity through trogocytosis. Here, we report a strategy for in situ solidification of tumor whole cell by biomineralization for sustained stimulation of antitumor immunity. The near-infrared light was used to accelerate the breaking of Au=P bonds in auranofin, and the exposed Au atoms biomineralize at the secondary structure (β-corner) of the protein to form Au nanocrystals with insitu protein coronas in tumor cells. Au nanocrystals are anchored to the tumor cells through protein coronas, which fixes the morphology and antigens of whole tumor cells, rendering them physiologically inactive. Interestingly, this solidified tumor cell prevents immune cells from undergoing trogocytosis, which inhibits proximal and distal tumor growth. Thus, this study presents the strategy of solidified cells and its potential application in tumor immunotherapy.

Visualization of drug release in a chemo-immunotherapy nanoplatform via ratiometric 19F magnetic resonance imaging.

Visualization of drug release in vivo is crucial for improving therapeutic efficacy and preventing inappropriate medication dosing, yet, challenging. Herein, we report a pH-activated chemo-immunotherapy nanoplatform with visualization of drug release in vivo by ratiometric 19F magnetic resonance imaging (19F MRI). This nanoplatform consists of ultra-small histamine-modified perfluoro-15-crown-5-ether (PFCE) nanodroplets loaded with doxorubicin (Dox), which are packaged in trifluoromethyl-containing metal-organic assemblies via coordination-driven self-assembly. The chemical shifts of two types of 19F atoms in the nanoplatform are significantly different in 19F nuclear magnetic resonance (NMR) spectra, which facilitates the implementation of ratiometric 19F MRI without any signal crosstalk. In an acidic tumor microenvironment, this nanoplatform gradually degrades, which results in a sustained drug release with a real-time change in the ratiometric 19F MRI signal. Therefore, a linear correlation between the Dox release profile and ratiometric 19F MRI signal is established to visualize Dox release. Moreover, the pH-triggered disassembly of the nanoplatform leads to cell pyroptosis, which evokes immunogenic cell death (ICD), resulting in the regression of the primary tumor and inhibition of distal tumor growth. This study provides the proof-of-concept application of ratiometric 19F MRI to visualize drug release in vivo.

Prevention of ankle joint deformities in children on the side of fibular graft intake for microsurgical transposition

BACKGROUND: Reconstructive operations of the musculoskeletal system in children may require the removal of a massive autograft for microsurgical bone grafting. The traditional donor site is the diaphyseal part of the fibula. In the late postoperative period, these patients may develop complications such as a valgus deformity of the ankle joint on the side of the donor fibular defect.
 AIM: To analyze the effectiveness of surgical methods for the prevention of hallux valgus of the ankle joint after free transplantation of a fragment of the fibula to replace limb-bone defects in children.
 MATERIALS AND METHODS: The treatment results of 11 patients aged 11–16 years (6 girls and 5 boys), in whom an autograft from the fibular diaphysis was used to replace defects in long tubular bones were analyzed. Two patients had a femoral defect as a result of previously transferred hematogenous osteomyelitis. A congenital false joint of the femur was found in 2 patients, bones of the lower leg in 6, and the ulna in 1. The distal fragment of the resected fibula was stabilized by an autograft from the iliac bone, in eight and three cases at the level of the diaphysis and metaphysis of the specified fragment, respectively. The size of the resected fragment in % of the total length of the fibula and the level of distal osteotomy were considered. The presence and magnitude of the proximal displacement of the fragment and the position of the ankle joint gap were evaluated at least 5 years after surgery.
 RESULTS: In this study, ≥5 years after the intervention, proximal displacement of the distal fragment of the fibula was absent in only one patient. In the remaining 10, the displacement value did not exceed 3.5 mm. Valgus deformity in the ankle joint of 5° from the initial position developed in two patients. Its progression was prevented by temporary hemiepiphysis of the distal epiphysis of the tibia using a 4.0-mm diameter spongiose screw, whereas in up to 16 months, the valgus deformity progression stopped and decreased to initial values.
 CONCLUSIONS: Fibular resection in the optimal variant should preserve the distal part of the bone as much as possible, and the stability of the ankle joint increases with synostosis of the shin bones in the distal diaphyseal section without bringing the bones closer together. When a clinically significant valgus deformity appears (5° from the initial position) with the preservation of the function of the distal growth zone of the tibia, the use of temporary transphyseal hemiepiphysiodesis of the tibia for correction is optimal.

Physeal Fractures of the Distal Ulna: Incidence and Risk Factors for Premature Growth Arrest.

The aim of this study is to assess the rate of distal ulnar growth arrest following physeal fracture and to identify specific risk factors for premature physeal closure. A retrospective review of patients with a distal ulnar physeal fracture was performed at a single United States children's hospital. Patients without 6-month follow-up were excluded. Patient demographics, injury characteristics, treatment, and outcomes were abstracted. Fractures were classified by the Salter-Harris (SH) system. All follow-up radiographs were reviewed for changes in ulnar variance or signs of premature physeal arrest. Fifty-six children with distal ulnar physeal fracture at a mean age of 10.7±3.3 years were included with a mean follow-up of 1.9 years. The most common fracture pattern was a SH II (52.7%), versus SH I (29.1%), SH III (9.1%), and SH IV (9.1%). Of displaced fractures (41.1%), the mean translation was 40.2±38.3% the and mean angulation was 24.8±20.9 degrees. Eleven fractures (19.6%) demonstrated radiographic signs of growth disturbance, including 3 patients (5.4%) with growth disturbance but continued longitudinal growth and 8 patients (14.3%) with complete growth arrest. The average ulnar variance was -3.4mm. Three patients underwent subsequent surgical reconstruction including ulnar lengthening with an external fixator, distal ulna completion epiphysiodesis with distal radius epiphysiodesis, and ulnar corrective osteotomy. Patients with displaced fractures and SH III/IV fractures were more likely to develop a growth disturbance (34.8% vs. 3.2%, P =0.003; 50.0% vs. 11.1%, P =0.012, respectively). Children with less than 2 years of skeletal growth remaining at the time of injury had a higher risk of growth disturbance (46.2% vs. 9.5%, P =0.007). SH III and IV fractures are more common injury patterns in the distal ulna compared with the distal radius. Growth disturbance or growth arrest occurs in ~20% of distal ulnar physeal fractures. Displaced fractures, intra-articular fractures, fractures requiring open reduction, and older children are at increased risk of distal ulnar growth arrest and should be followed more closely. Level IV--case series.

THE EFFICACY OF DISTAL TIBIAL GROWTH MODULATION IN THE TREATMENT OF PAEDIATRIC FOOT AND ANKLE DISORDERS: A RETROSPECTIVE STUDY OF CASES FROM 2003 TO 2022

AbstractObjectivesEpiphysiodesis is a commonly used treatment for lower limb angular deformities. However, in recent years, distal tibial growth modulation using ‘eight plates’ or screws has emerged as an alternative treatment for paediatric foot and ankle disorders, such as CTEV. Our objective was to assess the efficacy of distal tibial modulation in correcting various paediatric foot and ankle disorders.MethodsThis retrospective study analysed 205 cases of paediatric foot and ankle disorders treated between 2003 and 2022, including only cases where the eight plate or screw was fixed on the anterior surface of the distal tibia. Our aim was to measure post-operative changes in dorsiflexion, the distal tibial angle, and the tibiocalcaneal angle by examining clinical records and radiology reports.ResultsWe identified nine cases (nine feet) meeting the full inclusion criteria, comprising seven cases of CTEV, one case of arthrogryposis, and one case of cavovarus foot. The cohort consisted of five male and four female patients, with a mean age of 10 years and 9 months at the time of surgery. Seven cases involved the left tibia, and two cases involved the right tibia. The mean time between pre-operative X-ray to surgery was 168 days, and the mean turnaround time between surgery and post-operative X-ray was 588 days. A mean change in the distal tibial angle of 4.33 degrees was noted. However, changes in dorsiflexion were documented in only one case, which showed a change of 13 degrees. Notably, our average distal tibial angle was significantly lower than reported in the literature, at 4.33 degrees. Additionally, some studies in the literature used the Oxford Ankle Foot Questionnaire for Children to assess pre- and post-operative outcomes, but it is important to note that it is validated only for children aged 5 to 16. Furthermore, most cases reported an improved tibiocalcaneal angle except for an anomaly of 105 degrees. We assessed satisfactory patient outcomes using patient notes. Out of the 6 procured notes, one has been discharged. The rest are still under yearly or 6-monthly review and are at various stages, such as physiotherapy, removing the eight plate, or requiring further surgery. The most common presentations at review are plantaris deformity and pain.ConclusionsOur study suggests that distal tibial growth modulation can be an effective treatment option for selected paediatric foot and ankle disorders. However, due to the limited number of cases in our study, the lack of documentation of changes in dorsiflexion, and a lack of pre- and post-operative outcomes using a standardised method, further research is needed to investigate this procedure's long-term outcomes and potential complications.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Prospective review of open reduction and internal fixation with Kirschner wires (K-wires left exposed) fixation in displaced and rotated (Song V) lateral humerus condyle fractures in children

Background: Fractures of the lateral condyle of the humerus account for 10-15% of all elbow fractures in children. These include Salter Harris type 2 and type 4 growth plate injuries in which the fracture crosses the distal humeral growth plate and enter the elbow joint. Open reduction and internal fixation with K wire is treatment of choice for the displaced as well as minimally displaced lateral condyle fractures of children to prevent malunion, nonunion and further displacement. Methods: This was prospective analytical study conducted in Rajendra Institute of Medical Sciences, Ranchi from December 2020 to December 2022 which consisted of 30 patients (of whom only 27 were present for follow ups) who were treated by ORIF with K-wires fixation. We followed the classification pattern given by Song et al. Results were evaluated according to the criteria given by the Hardacre et al. Results: Major culprit for injuries was fall from height (44.4%), followed by playing indoor games (25.9%). RTA and sports each constituted of (14.8%). Functional outcomes based on Hardacre criteria are excellent (85.1%), good in 11.1% cases and fair in 3.7% cases. Conclusions: Our findings demonstrate that open reduction and internal fixation with 2 or 3 K-wires (which were left exposed) and immobilization with casting for 3-4 weeks is sufficient for most of displaced and rotated fractures of the lateral condyle of the humerus.