Epiphyseal Separation Research Articles

Healing of physeal fracture after fixation with biodegradable self-reinforced polyglycolic acid pins. An experimental study on growing rabbits

Physeal fractures occur at a frequency of 15% of all long bone fractures in children. Undisturbed continued bone growth is the main goal of the treatment of these fractures. After the operative reduction and fixation, whenever needed, a second operation for the removal of the pins is inevitable. The purpose of this study was to develop a biodegradable fixation device for transphyseal fracture fixation, abolishing the need of removal operation. Epiphyseal separation of the distal femoral physis was made on the right side in 18 five-week-old rabbits. The fixation of the physeal fracture was made with two self-reinforced polyglycolic acid (SR-PGA) pins 1 mm in nominal diameter and 25mm in length. The follow-up times were 3, 6, 12, 24, and 28 weeks. The distal femoral growth-plate of both femurs was analyzed by radiographic, microradiographic, oxytetracycline fluorescence, histological and histomorphometric studies. Histomorphometric studies showed normal features of growth. Two growth-plate-penetrating transcondylar SR-PGA implants, of 1 mm in diameter, provided sufficient stability for the fixation of a distal femoral physeal fracture in a growing rabbit, and did not cause any growth disturbance.

Traumatic Separation of Epiphyses

Four types of physeal fracture-separations, defined by the Salter-Harris classification, were created experimentally in the proximal physis of the right tibia of immature rats. The four types are: Type I, pure epiphyseal separation; Type II, separation of the epiphysis with a metaphyseal fracture; Type III, partial epiphyseal separation with a vertical fracture of the epiphysis; and Type IV, vertical epiphyseal and metaphyseal fractures. A sham operation performed on the left tibia served as the control. The animals were killed at various intervals up to 25 days after the operation. The findings were assessed by roentgenographic, histologic, and vessel injection methods. For Types I and II morphometric analyses were also performed. The influence of various types of lesions on the growth rate and the healing process was documented. For Types I and II lesions there was a transitory growth arrest and an increased thickening of the zone of hypertrophic cells. The alterations regressed after Day 15, and by day 25, a nearly normal plate was seen. For Type III lesions an angular deformity of the tibia occurred that increased with time. For Type IV lesions, a step-off developed on the articular surface that became more severe with time. Early vascular anastomoses between the epiphysis and the metaphysis led to the formation of bone bridges in Type III and Type IV lesions.

Epiphyseal Separation in Scurvy

The case of a 10-month-old boy with scurvy and epiphyseal displacement of both the distal femur and the right proximal tibia is presented. He was treated without reduction of the displacement.

Epiphyseal Separation in Scurvy

Summary: The case of a 10-month-old boy with scurvy and epiphyseal displacement of both the distal femur and the right proximal tibia is presented. He was treated without reduction of the displacement.

Phlegmon de la gaine des fléchisseurs après décollement épiphysaire ouvert. A propos d'un cas

Injuries of the distal phalanx of the digits in children may lead to various lesions. The association of avulsion of the nail with an epiphyseal separation is not uncommon. This is in fact an open fracture, with the risk of infection of the flexor digitorum tendon sheath. The authors report such an observation and discuss the mechanism and treatment.

Healing of epiphyseal fracture fixed with a biodegradable polydioxanone implant or metallic pins. An experimental study on growing rabbits

Epiphyseal separation of the distal femoral epiphysis was made on the right side in 40 rabbits at five weeks of age. In 20 rabbits the fixation of the epiphyseolysis was made with two Kirschner wires 1.0mm in diameter and in the other 20 rabbits with a centrally placed transepiphyseal polydioxanone implant of 3.2mm in diameter. The follow-up times were three, six, 12 and 24 weeks. The distal femoral growth plate of both femurs was analyzed by radiographic, microradiographic, oxytetracycline fluorescence, histological and histomorphometric studies. Histomorphometric studies served as an excellent means of an exact numerical description of the different cellular areas of the growth plate in experimental studies. The fixation with two Kirschner wires did not cause any growth retardation. A polydioxanone implant of 3.2mm in diameter provided sufficient stability for the fixation of distal femoral physeal fracture in a growing rabbit, but resulted in a growth retardation similar to that after a drill hole of equal bore.

Posterior Dislocation of the Hip Associated with Separation of the Capital Epiphysis A Case Report

A 14-year-old boy with a posterior dislocation of the femoral head suffered an epiphyseal separation with reduction of the femoral neck into the acetabulum during an attempted closed reduction. He was treated by an open reduction with care taken not to damage the retinacular blood supply to the head. He did not develop avascular necrosis and is totally asymptomatic four years following his injury.

Epiphyseal Separation of the Coracoid Process Associated with Acromioclavicular Sprain

A rare injury of traumatic separation of the epiphysis of the coracoid process associated with Grade I acromioclavicular sprain occurred in a nine-year-old girl. The accident occurred when she was asleep. The mechanism of injury was unknown. Tenderness and mild swelling around the coracoid process were seen. The anteroposterior radiograph of the shoulder with the arm abducted 150 degrees (abduction view) clearly demonstrated the epiphyseal separation with subtle displacement at the base of the coracoid process. She was treated by simple immobilization and recovered fully with normal shoulder arm function.

尺側手根伸筋が整復障害因子となった尺骨遠位骨端線離開の１例

We reported a case with epiphyseal separation of the distal ulna which could not be reduced by nonsurgical manipulation due to interposion of the extensor carpi ulnaris tendon. The case was a 14-year-old boy who was injured by falling down from a running bicycle. X-ray findings showed markedly separated distal epiphysis of the left ulna with fracture of the distal radius. In spite of manipulation under anesthesia. the epiphyseal separation was irreducible. Operative findings showed that the extensor carpi ulnaris tendon was interposed between the separated ulnar fragments. Each radius and ulna were fixed by Kirschner wires following surgical reduction.

Bilateral Calcaneal Epiphysiolysis in a Dog

Ununited epiphyses were seen in the calcanei of a 13‐month‐old Rottweiler with abnormal rear limb conformation. Histologic examination of the tissues showed a nonunion with neoarthrosis formation. Surgical management included use of tension band and lag screw techniques to achieve epiphysiodesis that was radiographically evident 12 weeks postsurgery. There was no sign of lameness when examined 8 months after surgery. Similarities exist between this case and that of osteochondrosis in other domestic species, and with Osgood‐Schlatters disease in humans. Osteochondrosis and/or abnormal angulation of the hocks were suspected as the underlying cause of the epiphyseal separations.

Experimental Epiphyseal Separation by Torsional Force

Experimental Epiphyseal Separation by Torsional Force

Experimental Epiphyseal Separation by Torsional Force

Separation of the proximal tibial epiphysis from the metaphysis by torsional force was experimentally studied using cadaver bone preparations from 19 adolescent sheep. The energy needed to displace the epiphysis increased in correlation with an increase in the age of the animal. The separated epiphyseal and metaphyseal surfaces were examined using scanning electron microscopy. In the younger animals the separation line passed through the area of hypertrophied chondrocytes. In the animals more near skeletal maturity the separation occurred in a more sinuous fashion and also through spongious bone.

尺側手根伸筋（ＥＣＵ）が整復障害となった両側尺骨遠位骨端線離解の１例

We reported a case with epiphyseal separation of the distal ulna which could not be reduced by nonsurgical manipulation due to interposition of the ext. carpi ulnaris tendon. The case was a 13-year-old boy who injured by falling clown from a running motorbike. X-ray findings showed markedly separated distal epiphysis of the bilateral ulna with fracture of the distal radius. In spite of manipulation under anesthesia, the epiphyseal separations were irreducible. Operative findings showed that the ext. carpi ulnaris tendons were interposed between the separated ulnar fragments. Each radius and ulna were fixed by Kirschner wires following surgical reduction.

診断および治療に難渋した新生児上腕骨近位骨端線離開の１例

A case of epiphyseal separation of the proximal humerus was reported. The lesion occurred by a birth trauma at pelvic presentation. As the proximal humerus did not appear on X-ray, the diagnosis was established by clinical findings. The new-born was treated by skin traction at abduction of 70 degrees in an incubator, aligning the humeral shaft to the scapular glenoid with difficulties. On the 12th day, callus developed on the lateral aspect of the proximal humerus, and the skin traction was discontinued on the 15th day. The patient was discharged from the hospital without fixation of his arm on the 19th day.Remodelling of the callus was recognized in 2 months, and the humerus showed its normal shape on X-ray and no restriction of ROM of the shoulder was noticed in 6 months.

Compound Fracture of Leg, Paré's Personal Care (MII, 328)

Ambroise Paré (1510-1590) was the greatest surgeon of his century. He was born in Laval in northern France, where, it is thought, his father was valet de chambre and barber to a nobleman. At the time barbers customarily performed such surgical procedures as blood letting. Paré's older brother was a barber-surgeon, and his sister had married a barber-surgeon. Poorly educated and knowing neither Latin nor Greek but nonetheless ambitious, Ambroise Paré became a barber-surgeon through apprenticeship; he then served for three or four years as a “house surgeon” in l'Hôtel Dieu in Paris. His subsequent medical career was spent alternately on the battlefield with the French army during the interminable wars of the period and in practice in Paris during the frequent lulls in fighting. Because of his intelligence, skills, and personality, Paré rose to become the surgeon to four kings of France. His reputation and political position led to his admission to the Collège de St. Côme, the elite group of academic surgeons in France. In this manner he formed a bridge between the barber-surgeons, surgeons of the short robe, and the academic surgeons of the long robe. His accomplishments helped to launch the progression of surgery from a hereditary craft to an intellectual yet pragmatic discipline. Because Paré was an accomplished and prolific writer, a great deal is known about his life, opinions, and practice. His books, written in French rather than the Latin of the academicians, enjoyed a wide circulation. His personal and autobiographic account, The Apologie and Treatise of Ambroise Paré, Containing the Voyages Made into Divers Places, gives a good description of the circumstances in which he practiced.3 His importance in the history of surgery has been delineated by Geoffrey Keynes: Parés contribution to surgery is usually summarized by mentioning his three important “discoveries”-the harmfulness of treating gunshot wounds with boiling oil, the use of the ligature in amputation, and podalic version in obstetrics-but in reality his contribution was far greater than this. He was, in fact, by virtue of his personality and his independent mind, the emancipator of surgery from the dead hand of dogma. There was no comparable practitioner, during his time, in England or in any other country, and his influence was felt in every part of Europe. He left in his collected “Works” a monument to his own skill and humanity which is unsurpassed in the history of surgery …3 Of particular interest is Paré's description, the first, of intracapsular fractures of the femoral neck and epiphyseal separations of the proximal femoral epiphysis. The following account of his own open fracture of the tibia and fibula is from his collected works.1,2 LEONARD F. PELTIER, M.D.

Les fractures du col du cinquième métacarpien

The authors reviewed 129 cases of fractures of the neck of the fifth metacarpal. The radiological work-up of this fractures should include an anterio-posterior film with the hand supinated, and an oblique ulnar view with the hand pronated. This fractures can be separated into 4 categories: true cervical fractures; cervico-cephalic fractures; cervico-diaphysary fractures; and epiphyseal separations. In 78 patients an immediate mobilisation was performed. 51 fractures have been treated by multiple medullary pinning because of an unacceptable volar angulation associated with mal-rotation. Good and excellent results were obtained in 86% of cases.

Perinatal Fractures in Arthrogryposis Multiplex Congenita

Thirty-six patients with arthrogryposis have been followed at The James Lawrence Kernan Hospital of Baltimore since 1951. In this group, nine patients sustained 16 perinatal fractures. Femoral shaft fractures and epiphyseal separations were found more commonly in patients with fixed knee extension or dislocated hips and were related to relative stiffness and obstructed delivery. Femoral fractures were more common than humeral or tibial fractures. Arthrogrypotic infants displaying irritability and poor feeding are suspect of skeletal trauma. Thickening of limbs or joints may be the only clinical indication of fracture of epiphyseal injury. Plain radiographs of joints were inadequate for the diagnosis of epiphyseal separation when the epiphysis was not yet ossified. Arthrography is therefore recommended as a primary diagnostic tool.

Fractures Involving the Distal Epiphyseal plate of the femur.

Forty-two fractures involving the distal femoral epiphyseal plate in 41 patients were reviewed. The average age at injury was 11.2 years. The follow up period ranged from one year to 20.3 years, with an average of 6.3 years. The Salter-Harris classification of epiphyseal plate injures proved to be a good indicator of the mechanism of injury and prognosis. Using stringent criteria to classify the end results, 2 out of 3 of the total group and 3 out of 4 of 29 Salter-Harris Type I and Type II injuries had good or excellent results. Type V crushing injuries of the growth plate, open injuries, fractures caused by high velocity motor vehicle accidents with severe displacement or multiple associated fractures, and incompletely reduced epiphyseal injuries gave only poor or fair results. Major problems responsible for poor or fair results were varus or valgus angulation, loss of joint motion and shortening due to premature epiphyseal closure. Orthoradiographs revealed the presence of some degree of shortening in 20 of 29 Salter-Harris Type I and Type II injuries which averaged 1.0 cm, but was of no clinical significance in most patients. These injuries must be reduced accurately. In the Type II epiphyseal separations unsatisfactory results were due to inadequate reduction or to associated injuries.

Fracture-separation of the distal humeral epiphysis: J. C. DeLee, K. E. Wilkins, L. F. Rogers, et al. J Bone Joint Surg 62A:46–51, (January), 1980; and Epiphyseal Separation of the Distal End of the Humerus With Medial Displacement. N. E. Holda, A. Manoli, and R. L. LaMont. J Bone Joint Surg 62A:52–60, (January), 1980

Fracture-separation of the distal humeral epiphysis: J. C. DeLee, K. E. Wilkins, L. F. Rogers, et al. J Bone Joint Surg 62A:46–51, (January), 1980; and Epiphyseal Separation of the Distal End of the Humerus With Medial Displacement. N. E. Holda, A. Manoli, and R. L. LaMont. J Bone Joint Surg 62A:52–60, (January), 1980

Classification of ankle fractures in children

The roentgenograms of 310 children treated for ankle fractures were evaluated for grouping according to the classifications of Ashhurst-Bromer-Weber, Lauge-Hansen, and Salter-Harris. The mean age of the children at the time of injury was 11.1 years (range 2-14 years). Two hundred twenty-one (71.3%) children had malleolar fractures, 71 (22.9%) had tibial epiphyseal fractures, and 18 (5.8%) had syndesmotic lesions. The age distribution of fractures was typical: malleolar fractures predominated among the younger children, epiphyseal fractures among the older. Only the oldest children had avulsion fractures of the syndesmosis. Grouping of the fractures according to Lauge-Hansen and Ashhurst-Bromer-Weber, classifications suited to adults was largely unsuccessful. Epiphyseal fractures, moreover, were easily classified according to Salter-Harris. In spite of their complexity, ankle fractures in children can be roughly divided into avulsional and epiphyseal fractures. Adequately reduced avulsional fractures can be expected to heal well; epiphyseal fractures, however, may five rise to late complications. We propose, therefore, that ankle fractures in children be classified on the basis of roentgenological findings with respect primarily to epiphyseal lesions as well as on an additional simple grouping as to risk for clinical purposes: Group I, low risk, avulsional fractures and epiphyseal separations; Group II, high risk, fractures through the epiphyseal plate.