The growth plate (physis) is a highly specialized cartilaginous organ that drives longitudinal bone growth and ultimately determines adult stature. Its zonal architecture, including the resting, proliferative, hypertrophic, and calcification zones, integrates stem-like progenitor activity, clonal chondrocyte expansion, matrix remodeling, vascular invasion, and replacement by bone. Here, we review how the structural organization of the growth plate emerges from the interplay among extracellular matrix composition, sulfation pathways, and canonical paracrine signaling pathways, including Ihh-PTHrP, BMP, Wnt, and FGF. We highlight advances in our understanding of chondrocyte fate, including lineage-tracing studies demonstrating that resting-zone PTHrP+ cells function as skeletal stem cells and that hypertrophic chondrocytes can transdifferentiate into osteoblasts or dedifferentiate into progenitors rather than undergoing obligatory apoptosis. We also summarize how endocrine axes, including the GH/IGF-1, thyroid hormone, sex steroids, glucocorticoids, and vitamin D, coordinate the tempo of growth, the dynamics of growth plate senescence, and the timing of epiphyseal fusion, with emphasis on species differences between rodents and humans. Finally, we use monogenic skeletal dysplasias, endocrine disorders, and acquired conditions such as rickets and slipped capital femoral epiphysis as "experiments of nature" that illuminate how specific molecular perturbations disrupt growth plate physiology. Together, these converging lines of evidence reframe the growth plate as a dynamic stem-cell and progenitor niche whose fate is plastic, highly regulated, and increasingly targetable for therapy in disorders of linear growth.

Age estimation is a critical component in forensic investigations. The fusion stages of bones, particularly the medial clavicular epiphysis, offer reliable markers for estimating age, especially in individuals below 25 years. Despite the available data in the literature, population-specific standards should be developed and validated using the contemporary geographical population. This study aimed to investigate the fusion patterns of the medial clavicular epiphysis in the North Indian population using post-mortem computed tomography (PMCT) scans. This study comprised 500 samples (327 males and 173 females) with ages below 25 years. Using PMCT scans, the ossification patterns of the medial clavicular epiphysis were classified into four stages: Stage 0 (absence of ossification center), Stage 1 (appearance without fusion), Stage 2 (partial fusion), and Stage 3 (complete fusion). This study revealed a significant correlation between fusion stages and chronological age, with Spearman’s correlation coefficients of ρ = 0.819 for males and ρ = 0.797 for females, and statistically significant gender differences. Linear regression models were developed for both sexes, predicting age with mean absolute errors (MAEs) of 1.36 for males and 1.88 for females. Validation of these models demonstrated their utility in estimating age with high accuracy, though the models tended to slightly underestimate age, especially in females. This study confirms that medial clavicular epiphyseal fusion patterns are reliable indicators for age estimation in the North Indian population. The findings emphasize the importance of population-specific criteria in forensic age estimation, providing a precise tool for forensic practice.

Age estimation is vital in medico-legal and forensic contexts, particularly in developing countries like India, where reliable birth documentation is often lacking. Accurate age determination supports legal decisions in criminal responsibility, marriage eligibility, civil rights, and identity verification. This study aimed to assess skeletal maturity through radiological evaluation of epiphyseal fusion in the humeral head, iliac crest, and ischial tuberosity among individuals aged 16–21 years in south-east Rajasthan. An observational, cross-sectional study was conducted at Jhalawar Medical College’s Department of Forensic Medicine, including 100 individuals (67 males, 33 females) aged 16–21 years. Participants underwent clinical and radiological examinations, with digital X-rays of the shoulder and pelvis analyzed for epiphyseal fusion by a blinded radiologist. Data were statistically analyzed using Microsoft Excel and relevant software tools; p < .05 was considered significant. Radiological findings demonstrated progressive fusion with age. In females, complete humeral head fusion was observed in all individuals aged 20–21, with an overall 60.61% showing complete fusion. The iliac crest and ischial tuberosity showed 30.30% and 21.21% complete fusion, respectively. In males, humeral head fusion was complete in 77.61% overall, including all those above 18. Iliac crest and ischial tuberosity fusion were complete in 47.76% and 37.31%, respectively. Fusion occurred earlier in females across all sites. The study confirms a consistent and age-progressive pattern of epiphyseal fusion, with earlier completion in females. Radiographic assessment of specific skeletal sites proves to be a reliable method for age estimation, particularly valuable in the 16–21-year age group in medico-legal investigations.

Disclosure: V.X. Yu: None. M.E. Geffner: Diurnal, Novo Nordisk, Neurocrine Biosciences: Research support, Advisory board/Consultant, Spruce Biosciences: Research support, Advisory board/Consultant, Ascendis: Advisory board/Consultant, Eton Pharmaceuticals: Advisory board/Consultant, Theratechnologies, Inc: Advisory board/Consultant, McGraw-Hill: Royalties, Up To Date. L.M. Randolph: BioMarin Pharmaceuticals- Advisory board/consultant. Z. Laron: None. A. Ryabets-Lienhard: Ultragenyx, Principal investigator receiving grant support for research, Takeda, Principal investigator receiving grant support for research, Alexion Pharmaceuticals, Inc., Advisory board/consultant, BioMarin Pharmaceuticals- Advisory board/consultant.Introduction: Laron syndrome (LS) is a rare autosomal recessive disorder with an estimated 500 global cases, characterized by GH resistance due to pathogenic variants in the GH receptor (GHR) gene, resulting in primary IGF-1 deficiency. Affected patients exhibit severe short stature, distinctive facial features, and extremely low levels of IGF-1 despite normal or elevated GH levels. The broad spectrum of pathogenic GHR variants in LS includes missense, nonsense, splice-site, and deletion variants that often involve the extracellular (EC) GH binding domain of the GHR (exons 1-7) and result in low GH-binding protein (GHBP) levels. We present a unique case of an adolescent male with severe LS associated with a novel missense variant in GHR exon 7, but normal GHBP levels. Case: An almost 16-yr-old male of Mexican ancestry with no known significant family history or consanguinity presented with severe relatively proportional short stature (height -7.06 SD, BMI 0.37 SD). He had an infantile face with round cheeks, depressed nasal bridge, high-pitched voice, slightly blue sclerae, Tanner Stage (TS) 2 puberty with testosterone 77 ng/dL (8-66), and bone age 11.6 yr. He was found to have undetectable IGF-1 (<10 ng/mL, 201-609) and low IGFBP-3 (0.8 mg/L, 3.5-10.0) with normal GH stimulation (peak GH 10.9 ng/mL) and GHBP (1446 pmol/L, 290-3140). TSH was elevated (6.43 mlU/mL, 0.50-5.00) with normal FT4 (1.09 ng/dL, 0.70-1.65). Genetic testing using the Discover Dysplasias gene panel (Invitae) identified a novel homozygous c.650T>G (p.Val217Gly) variant in GHR exon 7, classified as a variant of uncertain significance, in the last codon of the EC binding domain. There was no response in IGF-1 generation testing to GH 33 mg/kg/day x 7 days (IGF-1 averaged 11 ng/dL, 201-609; -5.5 SD), further supporting a diagnosis of LS. After 3 mo, height remained -7.08 SD while puberty progressed to TS3 with increased testosterone (526 ng/dL, 26-800). TSH increased further to 9.74 mlU/mL with normal FT4 1.13 ng/dL. Patient started recombinant human IGF-1 therapy at 0.1 mg/kg once daily x 1 wk, then increased to 0.18 mg/kg once daily x 1 wk and subsequently to 0.12 mg/kg twice daily (with no hypoglycemia or other side effects). Letrozole (2.5 mg daily) was also started to delay epiphyseal fusion. Conclusion: This unique case of severe Laron syndrome involves a novel homozygous missense variant of uncertain significance in the EC GH binding domain of GHR with unexpectedly normal GHBP levels, potentially expanding the scope of known GHR pathogenic variants. Its position in the last codon of the EC domain adjacent to the transmembrane domain may explain normal GHBP levels with disruption of GH action downstream. Functional studies are planned to further analyze this novel variant and confirm its pathogenicity. The co-occurrence of subclinical hypothyroidism also warrants further study regarding its contribution to the LS phenotype.Presentation: Saturday, July 12, 2025

Introduction: Peripheral precocious puberty (PP) is far less commonly encountered compared to central precocious puberty (CPP) in pediatric endocrine practice. Long-standing non-diagnosis may cause rapidly advancing bone age, leading to CPP and resultant short stature. We aimed to report the clinical profile and current Indian experience in the management of children with peripheral PP due to autonomous gonadal activation.Methods: This multicentric retrospective study reports data on 23 children (20 girls) presenting with peripheral PP as a result of autonomous gonadal activation from eight pediatric endocrine centers across India. Their clinicodemographic, anthropometric, and laboratory measurements were reviewed.Results: The mean ± SD chronological age at the time of presentation was 4.9 ± 2.0 years, and the mean bone age was 7.6 ± 2.6 years. Nine (39%) children were tall for mid-parental height. Thirteen (57%) children were diagnosed with McCune Albright syndrome (MAS), one boy (4%) with familial male-limited PP, and nine (39%) with functional ovarian cysts. Ninety-five percent of girls had menarche as their presenting complaint, with mean age at menarche being 4.6 ± 2.3 years. Ovarian cysts were present in 16 girls, of whom seven (43.8%) had MAS. PP in seven (30%) children progressed to CPP, with mean age of CPP being 6.6 ± 2.1 years. Letrozole was the primary drug of choice, while leuprolide acetate was added in children who progressed to CPP.Conclusion: We report the clinical profile of children with peripheral PP due to autonomous gonadal activation. Clinical diagnosis and timely intervention to halt the progression of puberty and prevent early epiphyseal fusion, thereby improving final height, along with close follow-up, are vital in the management of these disorders.

Abstract Introduction: Age estimation of undocumented persons has become a concern, especially with the current global migration crisis. Many states are still using old techniques, such as clinical examination, which have been associated with a wide margin of error. In addition, the analytical techniques used for age estimation need to be updated in tandem with the new approaches. The goal of the present study was to assess the precision of Schmeling’s age estimation method using Bayesian concepts of analysis. Methodology: In the current study, the use of Bayesian analysis for age estimation employing a chronological process of fusion of the medial epiphysis was assessed. A Bayesian analysis is a new statistical approach which incorporates unknown parameters of data, such as observed age (prior estimate), and how the date is likely to align with the actual age of an individual (posterior probability). Chest digital X-rays of 3000 patients aged between 15 and 30 years were collected retrospectively, examined based on the appearance of ossification centers and the extent of fusion of the epiphysis of the inner end of the clavicle. After thorough selection criteria, only 1605 chest radiographs qualified for the study. The phase of maturity and fusion of the epiphysis of the medial clavicle were subsequently documented in chronological order in accordance with the criteria applied by the standard classification stages, as documented by several authors. The gathered data were analyzed using probit regression and Bayesian transition analysis to determine the degree of accuracy in determining age, especially as one transitions from one stage to the next. The tests were derived from R-program. Results: Of More than half (53.5%) of the radiographs used met the selection criteria. Out of the targeted samples, 52.2% (805) were males while 49.8% (800) were females. The mean and median age of the total 1605 samples selected was 22.70 ± 0.12 years and 23 years respectively. The Bayesian concept analysis observed an error of ± 1.2 years in determining the age of an individual using this approach. Conclusion: The Bayesian analysis thus proved more accurate in determining age in the living, especially in the transition of stages.

Introduction: Forensic age estimation is important in cases related to sexual assault, murder, skeletal remains, and juvenile crimes, where the age of the suspect or victim is unknown. The literature indicates that the age of fusion of the medial clavicular epiphyseal varies from region to region. Aim: To estimate age from medial clavicular epiphyseal fusion through computed tomographic analysis. Materials and Methods: This was a cross-sectional observational study with a sample size of 384, conducted over 24 months from January 2020 to December 2021 in the Department of Radiology at a tertiary care centre, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India. The study population included patients who underwent a Computed Tomography (CT) scan of the chest, aged between 18 and 35 years. They were arbitrarily divided into six age groups: 18-20 years, 21-23 years, 24-26 years, 27-29 years, 30-32 years, and 33-35 years. The Schmeling classification was used for age estimation. Chronological age served as the constant, while the stages of radiological fusion of the medial clavicular epiphyseal were the variables. Age estimation by this method involved observing the chronological age at a particular stage of fusion. The mean age of fusion at each stage was calculated. The association among variables was analysed using the Analysis of Variance (ANOVA) test for definite variables. In the present study, the level of significance was set at 0.05. Results: Of the 384 participants (mean age 26.3±5.1 years; 217 men), 279 (72.7%) showed complete fusion of the medial epiphyses of the clavicle (stage 4 and stage 5). The mean age for medial clavicular epiphyseal fusion in men was 22.66±1.3 years, while for women it was 21.86±1.09 years. The mean age at which stage 5 was achieved was 29.6±3.37 years, indicated by complete fusion without the epiphyseal scar. Conclusion: The study concludes that all men and women with complete fusion of the medial clavicular epiphyseal were older than 22.6 and 21.8 years of age, respectively

INTRODUCTION/BACKGROUNDPrimary amenorrhea and delayed puberty are frequently encountered in primary care, prompting suspicion of Turner syndrome, especially in cases with short stature. This case underscores the importance of considering Swyer syndrome even when significant growth impairment is present. CASEA 28-year-old phenotypic female, born of a non-consanguineous union, presented with primary amenorrhea and a short stature of 1.31 meters. Physical examination revealed absent secondary sexual characteristics (Tanner stage 1). External genitalia were unambiguously female. Bone age assessment identified significant delay, corresponding to a 15-year-old. The hormonal evaluation showed hypergonadotropic hypogonadism. Thyroid function and insulin growth factor-1 levels were normal. Pelvic MRI demonstrated an atrophic uterus, absent fallopian tubes and ovaries. Karyotype analysis confirmed a 46, XY genotype, consistent with Swyer syndrome. Following pubertal induction for 3 months, she developed regular menstruation and progression to Tanner stage 3. Swyer syndrome is a rare disorder of sex development featuring female phenotype, hypergonadotropic hypogonadism and streak gonads. While 15–20% of cases result from SRY gene mutations impairing testis-determining factor function, other genes have also been implicated. Swyer syndrome classically causes tall stature from estrogen-deficient delayed epiphyseal fusion. However, our case exhibited profound short stature and severely delayed bone age, explained by the complete prepubertal estrogen deprivation abolishing both growth spurt and fusion. Additional factors, like SHOX gene variations, may have contributed to her growth impairment. Diagnostic complexity arose from initial Turner syndrome overlap; however, the absence of other Turner stigmata and 46, XY karyotype confirmed Swyer syndrome. This emphasises karyotyping’s diagnostic importance in primary amenorrhea with hypergonadotropic hypogonadism, regardless of phenotype. Hormone replacement therapy remains crucial for puberty induction, bone health and cardiovascular protection. CONCLUSIONSwyer syndrome may mimic Turner syndrome in cases of primary amenorrhea with short stature. Accurate diagnosis requires comprehensive hormonal, imaging and genetic evaluation beyond clinical phenotype alone.

Short-statured midpubertal boys with predicted adult height (PAHt) below the third percentile are a therapeutic challenge. Aromatase inhibitors (AI) delay estrogen-driven epiphyseal fusion and possibly enhance adult height (AHt). To assess the efficacy of AI treatment on AHt in midpubertal boys with a short PAHt due to advanced bone age (BA) or idiopathic short stature (ISS). Retrospective study. Tertiary pediatric endocrine referral center. Two groups of midpubertal boys treated with AI were studied: 27 boys with fast puberty compared to matched untreated controls and 16 boys with ISS treated with GH and AI (GH&AI) compared to those treated with GH only. Anthropometric measurements, BA and PAHt, were tracked. AHt was compared across groups. Achieved AHt in AI-treated boys vs controls and the PAHt. The median duration of AI treatment was 2.8 years for the AI-only group and 2 years for the GH&AI group. Throughout treatment, AI-treated groups gained height similarly to controls and showed a decrease in BA SD score (AI only: P = .009; GH&AI: P = .029) and an improvement in PAHt (AI only: P = .003; GH&AI: P = .037). Compared to controls, AI-treated children achieved greater AHt (AI only: 166.6 ± 3.1 cm vs 163.4 ± 1.3 cm, P = .003; GH&AI: 167.3 ± 6.1 cm vs 164.9 ± 3.5 cm, P = .194). The difference between AHt and PAHt at baseline was more pronounced in the AI-treated groups (AI only: 3.8 ± 3.5 cm vs -0.3 ± 5.0 cm, P = .001; GH&AI: 7.5 ± 5.2 cm vs 4.3 ± 3.6 cm, P = .050). AI treatment extends the growth period, resulting in an AHt surpassing initial predictions. Our findings underscore the potential of AI treatment in midpubertal boys with a short PAHt due to advanced BA and in those treated with GH for ISS.

This study evaluates the effect of sex on mortality risks in medieval Ireland to advance our understanding of the social, biological, and environmental factors that were deleterious to female health and survival in the past. Data on age-at-death and sex was collected on 335 skeletonized individuals from 10 archaeological sites dating to the early medieval (500-1150 ce) and late medieval (1150-1550 ce) periods in Ireland. Transition analysis (TA2) was used to estimate age-at-death for all individuals with visibly fused pelvic and long bone epiphyses. For all other individuals, age-at-death was estimated using dental development and epiphyseal fusion. Morphological traits of the pelvis and cranium and metric measurements were used to estimate sex. A Gompertz-Makeham hazards model with a proportional hazards specification was used to examine the effect of the sex covariate on mortality risks. The Gompertz-Makeham hazards model failed to reveal an effect of sex on mortality risks in this context. No significant temporal variation in the effect of sex on the model was observed across sites. The results failed to find an effect of the sex covariate on the mortality profile using hazards analysis. However, the similar mortality profiles observed between medieval Irish males and females could reflect cultural barriers and/or differential environmental exposures that counteracted the innate female survival advantage observed today.

First articulating os coxae, femur, and tibia of a small adult Paranthropus robustus from Member 1 (Hanging Remnant) of the Swartkrans Formation, South Africa.

In humans, the growth plate cartilage is completely replaced by bone in late puberty, resulting in epiphyseal fusion. However, in rats and mice, commonly used experimental model systems, the growth plate does not fuse completely even after sexual maturation, making it difficult to elucidate mechanisms involved in epiphyseal fusion. In this study, we investigated age-related changes in the mouse growth plate to better understand the process of epiphyseal fusion. We used scanning electron microscopy and energy-dispersive X-ray spectroscopy (SEM/EDS) to examine the distributions and concentrations of minerals in the growth plate. In SEM images, the hypertrophic zone was observed as a bright area and other zones as dark areas at 10 weeks of age (W10). The bright area was further expanded at W55 than at W10. EDS analysis showed that P and Ca concentrations were high in this area, while C and O concentrations were low, indicating that the growth plate had calcified during aging. Alcian blue histochemistry revealed that the glycosaminoglycans of aggrecan were distributed in the growth plate at both W10 and W55. Immunohistochemistry showed that aggrecan and type II collagen were expressed throughout the growth plate at W10, but sparsely at W55. Type I collagen was expressed weak at both W10 and W55. Type X collagen and MMP-13 expression were observed in the hypertrophic zone at W10 but not at W55. This study demonstrated that although the mouse growth plate calcifies with age, it remains calcified cartilage for an extended period without being replaced by bone.

Objective: To determine the frequency of extent of fusion of epiphysis in the bones of elbow joint (lower ends of humerus and upper ends of radius and ulna). Study Design: Descriptive observational study. Place and Duration of Study: This study was conducted at the Forensic Medicine and Radiology Departments, Govt. Hospital, J.L.N Medical College from January 2023 to September 2024. Materials and Methods: 50 patients between aged 13-21 years were selected for this study. X-rays of elbow joint were taken in antero-posterior view to visualize the changes in epiphysis and diaphysis and extent of union. Subjects with fractured, malnourished and congenitally malformed elbow joint were excluded from the study after expert opinion from orthopaedic surgeon. Results: The complete fusion of epiphyses of the bones around elbow joints was observed at age of 19-21 years (Stage 4) in males and at age of 16-18 years (Stage 4) in females. Present study found that union of epiphyses of distal humerus and proximal radius and ulna appear in females earlier than in males. Conclusion: 100% complete union of elbow joint bones, in male cases is at 19-21 year, and 100% complete union of bones of elbow joint in female cases is at the age of 16-18 years.

Idiopathic central precocious puberty (CPP) precipitates epiphyseal fusion of growth plates in long bones, leading to reduced adult stature. Gonadotropin-releasing hormone analogues (GnRHa) are the treatment of choice for idiopathic CPP, but their benefit on height gain is unclear. We aimed to elucidate the effects of GnRHa treatment on adult height in girls with idiopathic CPP. This prospective observational descriptive study analyzed data of girls with idiopathic CPP diagnosed at 55 centers in Spain between January 1, 1998 and December 31, 2012 included in the Spanish Society for Pediatric Endocrinology's national registry. We included girls with idiopathic CPP (thelarche < 8 years, positive LHRH stimulation test, bone age > 1 year older than chronological age, and normal brain imaging) treated with triptorelin (3.75 mg monthly, adjusted according to LHRH test results and clinical findings). We assessed weight, height, BMI, and secondary sexual characteristics every 6 months and bone age every 12 months until adult height (AH) was attained. The primary outcome was the difference between AH and target height (TH). A total of 465 girls (18.90% adopted) were included; we analyzed data recorded at treatment end in 358 girls and at AH in 216. Mean difference between AH and TH was -1.5 (95%CI: -2.56- -0.45) cm and between AH and PAH 2,57 (95%CI:-3.56- -1.58) cm. GnRHa treatment helps preserve genetic growth potential in girls with idiopathic CPP.

Background and Objectives: To investigate postoperative courses after hemi-percutaneous epiphysiodesis using transphyseal screws (PETS) for genu varum. We especially focused on the degree of skeletal maturation that results in undercorrection. Materials and Methods: We identified patients with idiopathic genu varum treated with hemi-PETS at the proximal tibia and followed-up to the completion of skeletal maturation. The acceptable correction was defined as the (1) final deformity < varus 1.0° or (2) final correction angle obtained by surgery (f-CA) > mean value of preoperative deformity. Results: In our cohort of 29 patients and their 29 lower limbs (one side was randomly selected in bilateral cases), the mean hip-knee-ankle (HKA) alignment was varus 6.5 ± 1.3° at the time of hemi-PETS. The mean f-CA was 5.8 ± 2.0° with a rebound of 0.3 ± 1.0°. Ten patients showed the finding of partial or complete fusion of the epiphysis of distal phalanges in the hand at the time of hemi-PETS (the fusion group, FG). Their f-CA was 4.0 ± 1.9° (with preoperative deformity of 6.9 ± 1.4°), which was significantly smaller than that (6.7 ± 1.3°, p = 0.001) of remaining 19 patients (the open group, OG). The acceptable correction was obtained in all 19 patients of the OG. Otherwise, it was obtained in two patients in the FG (p < 0.001). The other two patients in the FG preoperatively showed a complete epiphyseal fusion of the distal phalanges in the hand, and their f-CA was 0.7 and 1.1°, respectively. Conclusions: The degree of skeletal maturation corresponding to epiphyseal fusion of distal phalanges in the hand results in undercorrection after the hemi-PETS performed at the proximal tibia for genu varum.

Premature thelarche is the most common pubertal disorder in girls. The condition should be differentiated from central precocious puberty which may result in early epiphyseal fusion and reduced adult height, necessitating treatment. The purpose of this article is to familiarize physicians with the clinical manifestations of premature thelarche and laboratory tests that may help distinguish premature thelarche from central precocious puberty. A search was conducted in September 2022 in PubMed Clinical Queries using the key term "Premature thelarche". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used to compile the present article. Premature thelarche denotes isolated breast development before the age of 8 years in girls who do not manifest other signs of pubertal development. The condition is especially prevalent during the first two years of life. The majority of cases of premature thelarche are idiopathic. The condition may result from an unsuppressed hypothalamic-pituitary-gonadal axis in the early years of life, an "overactivation" of the hypothalamic-pituitary axis in early childhood secondary to altered sensitivity to steroids of the hypothalamic receptors controlling sexual maturation, increased circulating free estradiol, increased sensitivity of breast tissue to estrogens, and exposure to exogenous estrogens. The cardinal feature of premature thelarche is breast development which occurs without additional signs of pubertal development in girls under 8 years of age. The enlargement may involve only one breast, both breasts asymmetrically, or both breasts symmetrically. The breast size may fluctuate cyclically. The enlarged breast tissue may be transiently tender. There should be no significant changes in the nipples or areolae and no pubic or axillary hair. The vulva, labia majora, labia minora, and vagina remain prepubertal. Affected girls have a childlike body habitus and do not have mature contours. They are of average height and weight. Growth and osseous maturation, the onset of puberty and menarche, and the pattern of adolescent sexual development remain normal. Most cases of premature thelarche can be diagnosed on clinical grounds. Laboratory tests are seldom indicated. No single test can reliably differentiate premature thelarche from precocious puberty. Premature thelarche is benign, and no therapy is necessary apart from parental reassurance. As enlargement of breasts may be the first sign of central precocious puberty, a prolonged follow- up period every 3 to 6 months with close monitoring of other pubertal events and linear growth is indicated in all instances.

The objective: to analyze the significance of tubular bone epiphyseal plate malformations in the practice of a pediatric orthopedist and surgeon using the example of Blount’s disease, bone-cartilage exostoses for the purpose of timely diagnosis, treatment and prevention of secondary complications. Materials and methods. In order to achieve the set task, a retrospective analysis of the results of the examination of children who were on inpatient treatment in the regional children’s hospital was carried out. X-ray examination method was the main one. An in-depth analysis of scientific articles on this topic in journals indexed in the Web of Science, Scopus, Medline, ResearchGate, Google Scholar databases was also conducted. The search was conducted using the following keywords: “Epiphyseal Plate Malformation”, “Long Bones”, “Growth Plate Injury”, “Physiologic Overview”, “Physical Activity Effects”, “Physeal Fractures”, “Musculoskeletal Imaging”, “Epiphyseal Fusion”, “Achondroplasia”, “Blount Disease”, “Corrective Osteotomy”, “Peroneal Nerve Injury”, “Osteochondroma”, “Guided Growth”, “Craniofacial Osteomas”, “Chondroblastoma”. Results. The epiphyseal plate is a hyaline cartilage that is located between the epiphysis and metaphysis of tubular bones, it is unique only to children. The shape and length of the bone depends on its function, after the end of growth it disappears and is replaced by full-fledged bone tissue. Blount’s disease which is caused by improper function of the epiphyseal plate of the proximal metaphysis of the tibia, usually occurs in children aged 3 to 6 years. It leads to progressive varus curvature, lameness, muscle hypotonia and curvature of the spine. Four variants of Blount’s disease have been identified, the main diagnostic tool of which is radiology. Treatment varies from conservative methods to various surgical interventions. Juvenile osteocartilaginous exostoses, a hereditary disease with a dominant pattern of inheritance, lead to abnormal bone growth. Radiographic characteristics and surgical removal of symptomatic exostoses were critical to treatment. Surgical techniques have demonstrated high success rates in correcting deformities and improving function. Conclusions. Malformations of the epiphyseal plate significantly affect the development of Blount’s disease and bonecartilaginous exostoses, as well as both minor and significant bone deformities in children. That is why this question is important for the routine practice of children’s orthopedic traumatologists. An analysis of modern scientific sources provides insight into the diagnosis and treatment of malformations of the epiphyseal plate, emphasizing the importance of early diagnosis and individualized treatment plans.

This case report describes a unique pediatric patient, the first and youngest in India, who underwent total hip replacement (THR) for right ankylosed hip. Patient presented with preoperative musculoskeletal deformities, posing challenges for postoperative rehabilitation. This 11-year-old female presented with non-traumatic insidious right hip pain, limping, right hip flexion and abduction deformity. Patient was diagnosed with idiopathic chondrolysis of the hip through exclusion and clinico-radiological findings. Patient underwent surgery for ceramic-on-ceramic THR. Fusion of triradiate cartilage and epiphysis and Risser’s skeletal maturity staging were confirmed. Postoperative examination revealed right hip flexion and abduction deformity resulting in pelvic obliquity, which led to limb length discrepancy and functional scoliosis. There was increased anterior pelvic tilt, altering the gait pattern. Adhering to THR restrictions, rehabilitation strategies were tailored to restore normal pelvic orientation and address deformities through manual stretching of right hip abductor, tensor fascia latae, iliopsoas and rectus femoris. A left-sided shoe raise was also given. Lumbar segmental muscle activation, pelvic floor muscle training and gait training were crucial parts of the rehabilitation protocol. At ten-week, prodigious outcomes were achieved in the form of complete pain relief, complete correction of abduction and flexion deformity, normal pelvic alignment in the frontal plane and independent, stable full weight-bearing ambulation after two years of disabling ordeal suffering. However, minimal compensation of the anterior pelvic tilt persisted. Rehabilitation of this challenging patient with multiple deformities achieved excellent outcomes at ten-week post-rehabilitation. Thus, a tailored meticulous rehabilitation program can significantly improve quality of life.

Despite representing over half of all pediatric patella fractures, inferior pole patellar sleeve fractures (PSFs) are a relatively uncommon pediatric injury. As a result, existing literature on PSFs is limited to case reports and small case series. The purpose of this study was to evaluate the radiographic and clinical characteristics of operatively treated PSFs as well as outcomes following surgical management. A retrospective review of all inferior pole PSFs requiring surgery from 2007 to 2023 was performed at a single urban tertiary care children's hospital. Cases were identified using diagnostic and billing codes. Patient demographics, injury characteristics, surgical techniques, and postoperative rehabilitation practices were recorded. Regional skeletal maturity, fracture characteristics, and postreduction patellar height were recorded. Postoperative complications were recorded and categorized using the modified Clavien-Dindo Classification System (CDS). Thirty-eight inferior pole PSFs were identified meeting study criteria. The majority of patients were male (86.8%), and the mean age at injury was 11.0 years (range: 7.2 to 15.0). Mean BMI was 21.1. Radiographically, the majority of patients were Epiphyseal Fusion Stage 0 (nonunion), with a median postreduction Caton-Deschamps index (CDI) of 1.2 (IQR: 1.1 to 1.3). These fractures were predominantly treated with suture-based fixation (84%). Postoperative immobilization varied within the cohort, and the initiation of knee ROM was permitted at a median of 3.5 (IQR: 2.0 to 4.6) weeks. All patients regained full range of motion and straight leg raise without extensor lag, and return-to-sport was achieved by a median of 17.6 weeks (IQR: 12.8 to 30.3). Complications occurred in 10 (26.3%) patients, with 3 (7.9%) requiring a return to the OR (CDS Grade III). Inferior pole PSFs appear to occur most commonly among prepubertal males of normal BMI and normal patellar height. Despite variable rehabilitation protocols, operative management resulted in restoration of extensor mechanism function. Eight percent of patients experienced complications requiring unplanned surgery. This large series improves our understanding of the epidemiology, injury characteristics, and postoperative outcomes of an operatively treated cohort of a rare injury pattern. Level IV.

Background: Although femur length is the preferred method for fetal age assessment, the humerus is sometimes the right choice, especially in the second half of pregnancy. Fetal bone development significantly impacts adult bone quality and senescent bone disorders, including osteoporosis. Purpose of the study: The present study aimed to ascertain the histological changes in the human fetal humerus across the three trimesters. After the institutional ethical committee clearance and parent consent, the study was carried out on stillborn or medically terminated human fetuses from the 10th to the 32nd week of intrauterine life. Results: First trimester: The primary bone collar appeared with the primary ossification center, marked by more vascular invasion and a pool of mesenchymal cells. Trabeculations begin from the bony collar and insignificant periosteum. Second trimester: The changes showed longitudinal growth of periosteal bone towards the proximal and distal ends of the growing bone. Growth plate with distinguished zones and gradual fusion of epiphysis with growth plate were observed. Third trimester: Trabeculation number and thickness increase with calcification. Towards the third trimester, the marrow cavity with increased and prominent trabeculations is consistent. Conclusion: Understanding normal microstructural and cellular events chronologically is an ideal platform for future studies to develop cell-based or cell-targeted therapies for adult bone disorders, traumatic bone injuries, or bone engineering. KEYWORDS: Histology, Developing Bone, Humerus, Fetuses, Embryology.