Distal Physis Research Articles

Growth disturbance lines after injury of the distal tibial physis. Their significance in prognosis

We reviewed 26 fractures involving the distal physis of the tibia to identify the patterns of formation and displacement of the subsequent growth disturbance lines. Twenty-one patients showed a regular "normal" pattern of line and healed with no deformity. Three patients had medical physeal arrest revealed by abnormal lines. Two other cases had a minor central physeal arrest without subsequent deformity. The pattern and character of the growth disturbance line can provide an early warning of potential deformity.

EFFECT OF FLOOR TYPE ON THE SEVERITY OF FOOT LESIONS AND OSTEOCHONDROSIS IN SWINE

Sixty-seven pigs were weaned at 5 wk of age and assigned to pens with either plastic-coated expanded metal or woven-wire floorings. The feet of each pig were examined at weaning and at the end of a 28-d starter period for soundness. Eleven gilts which had been on plastic-coated flooring and 12 gilts which had been on woven-wire flooring were moved at the end of the starter period to 1.2 × 1.2-m pens with the same floor types. These pigs were fed ad libitum until slaughter at 94 kg bodyweight. At weaning, the incidence of foot lesions was only 7%. Floor type did not have any significant (P > 0.05) effect on average daily gain, average daily feed intake or feed:gain ratios of pigs during the starter (8–22 kg), grower (22–55 kg) or finisher (55–94 kg) periods. Foot lesions were most severe (P < 0.01) in starter pigs which were penned on woven-wire flooring. There was also a tendency (P < 0.06) towards more severe hind-toe lesions in 94-kg gilts which were penned on woven-wire flooring. In general, the lateral digits of the feet of these gilts had more severe lesions (P < 0.01) than the medial digits. The severity of osteochondrosis of the condyles of the femur and humerus, of the articular cartilage of the proximal ulna and radius and of the distal ulnar physis were not significantly (P > 0.05) affected by floor type. The influence of floor type on the locomotory system appeared therefore to be confined to local foot abrasions and did not extend to the knee and elbow joints. Key words: Swine, floor, foot, lesion, osteochondrosis

SALTER-HARRIS TYPE-IV INJURIES OF THE DISTAL TIBIAL EPIPHYSEAL GROWTH PLATE, WITH EMPHASIS ON THOSE INVOLVING THE MEDIAL MALLEOLUS

Salter-Harris Type-IV fractures of the epiphysis extend through the articular cartilage, epiphysis, physis, and metaphysis and have a high rate of complications secondary to premature partial closure of the physis. In this study we attempted to determine which Type-IV fractures of the distal end of the tibia result in premature partial closure, how the various treatment modalities affect the risk of premature physeal closure, and how the complication itself might be best managed. Thirty-two Type-IV fractures of the distal end of the tibia were seen at the Mayo Clinic during a five-year period. Eighteen injuries involved the medial malleolus, thirteen were so-called triplane fractures, and one was a fracture of the lateral part of the plafond. In the eighteen ankles with a fracture that involved the medial malleolus, extension of the fracture into the metaphysis could often be appreciated only on oblique roentgenograms. The patients' ages at the time of fracture ranged from one year and one month to fifteen years and six months old. In nine of the eighteen tibiae with a fracture of the medial malleolus premature partial closure of the distal physis developed, resulting in angular deformity or limb-length discrepancy sufficient to require operative treatment (epiphyseodesis, corrective osteotomy, or excision of a physeal bar). A physeal bar was best detected by tomograms made in two planes and by scanograms. Bar formation may be treated by excision of the bar, arrest of the whole physis, osteotomy, or combinations of these procedures. Of the thirteen patients with a triplane fracture and the one with a Type-IV fracture of the lateral part of the plafond, all fourteen were near maturity at the time of injury, and no growth-arrest problems developed.

Salter-Harris Type-IV injuries of the distal tibial epiphyseal growth plate, with emphasis on those involving the medial malleolus.

Salter-Harris Type-IV fractures of the epiphysis extend through the articular cartilage, epiphysis, physis, and metaphysis and have a high rate of complications secondary to premature partial closure of the physis. In this study we attempted to determine which Type-IV fractures of the distal end of the tibia result in premature partial closure, how the various treatment modalities affect the risk of premature physeal closure, and how the complication itself might be best managed. Thirty-two Type-IV fractures of the distal end of the tibia were seen at the Mayo Clinic during a five-year period. Eighteen injuries involved the medial malleolus, thirteen were so-called triplane fractures, and one was a fracture of the lateral part of the plafond. In the eighteen ankles with a fracture that involved the medial malleolus, extension of the fracture into the metaphysis could often be appreciated only on oblique roentgenograms. The patients' ages at the time of fracture ranged from one year and one month to fifteen years and six months old. In nine of the eighteen tibiae with a fracture of the medial malleolus premature partial closure of the distal physis developed, resulting in angular deformity or limb-length discrepancy sufficient to require operative treatment (epiphyseodesis, corrective osteotomy, or excision of a physeal bar). A physeal bar was best detected by tomograms made in two planes and by scanograms. Bar formation may be treated by excision of the bar, arrest of the whole physis, osteotomy, or combinations of these procedures. Of the thirteen patients with a triplane fracture and the one with a Type-IV fracture of the lateral part of the plafond, all fourteen were near maturity at the time of injury, and no growth-arrest problems developed.