Partial Growth Arrest Research Articles

Physeal bar resection by modified arthroscopically assisted surgery in a closed osteocavity.

Physeal bar resection has been used for partial growth arrest treatment for a decade while removing the bony bar minimally invasively and accurately is challenging. This research aims to illustrate a modified arthroscopically assisted surgery, by which all the procedure was under all-inside visualization, without the constant exchange between burring under fluoroscopy, followed by irrigation, suction, and arthroscopy of the canal. We retrospectively reviewed the patients who sustained physeal bar resection under direct all-inside visualization of the arthroscope during 2016-2021. Patients who underwent physeal bar resection with the aid of an arthroscope for identifying the physeal cartilage but not resecting and visualizing the physeal bar simultaneously were excluded from this study. In total, nine patients with ten related joints were included in this study. All the patients were followed up for at least two years. The average following time was 28.5 ± 6.7 months. Eight patients with nine related joints had an improvement of angular deformity, averaging 8.3 ± 6.9 degrees, and one had a worsening of the angular deformity. All the patients had a leg length discrepancy improvement, while four patients still had LLD >1 cm. The surgery time was 3.1 ± 0.7 h. There were no postoperative fractures, infections, or intraoperative complications such as neurovascular injury. Using clamps to form a closed osteocavity could make physeal bar resection under all-inside arthroscopic visualization feasible, which is minimally invasive, accurate, and safe.

Surgical Correction of Posttraumatic Varus Deformity of the Distal Tibia Due to Medial Growth Arrest in Children and Adolescents: Surgical Technique

Background: Varus deformity of the distal tibia secondary to epiphyseal fracture and partial growth arrest is relatively common. Growth arrest of the medial part of the epiphysis leads to varus deformity of the distal tibia and fibular overgrowth. If the deformity is left untreated, the malalignment may lead to irreversible damage and early ankle joint osteoarthritis in the long term. Several surgical techniques have been described in the literature to achieve correction and prevent late complications. These include the closure of the remaining epiphysis and various osteotomies around the ankle, using internal and external fixation. Materials and Methods: We report a technique that includes medial open wedge supramalleolar osteotomy, insertion of a structural cortical allograft and fixation with an anatomically contoured locking plate, completion of closure of the distal tibial physis, and distal fibular epiphysiodesis to prevent tibiofibular relations distortion. Part of this protocol is osteotomy of the distal fibula to prevent excessive pressure on the talus, and at the end of the operation, fibular fixation should be performed as well. In children with open physis and potential for significant leg length discrepancy, we recommend closure of the contralateral physis of the distal tibia and fibula. To the best of our knowledge, precise details of this protocol have not been described. Conclusion: We believe that this protocol is a reliable, accurate, and relatively simple method that provides not only anatomic correction and restoration of the ankle joint to prevent early ankle and subtalar arthritis but also addresses late complications, such as ipsilateral fibular overgrowth and limb length discrepancy.

The regenerative treatment of costal osteochondral graft implantation for partial growth arrest using a rabbit model

PurposeTo investigate the feasibility of cylindrical costal osteochondral graft transplantation as a novel regenerative treatment in growth arrest. MethodsThe medial portion of the proximal tibial growth plate of 6-week-old male New Zealand White rabbits was resected to establish an experimental model of partial growth plate injury. The rabbits were divided into four groups: no-treatment, bone wax transplantation, costal chondral graft, and costal osteochondral graft groups. Radiographic and micro-computed tomography scan results were analyzed to evaluate angular deformity of the tibia and bony bridge formation at the injury site. In addition, repair of the injured growth plate cartilage was assessed histologically at 4, 8, and 12 weeks postoperatively. ResultsRadiographic examination revealed that bone wax transplantation continuously decreased the medial proximal tibial angle (MPTA) while the costal chondral graft implantation reduced the decrease of MPTA at 12 weeks postoperatively. The costal osteochondral graft implantation recovered the MPTA, close to the normal. Histologically, the costal osteochondral grafts retained the MPTA in the injured site compared to costal chondral grafts. Additionally, hypertrophic chondrocytes were observed at the graft site in the costal osteochondral graft group at 12 weeks, suggesting that endochondral ossification may occur at the graft site similar to normal ossification. The fluorescence in situ hybridization analysis of osteochondral grafts transplanted from male to female rabbits indicated that they were replaced by cells of host origin. ConclusionThe costal osteochondral graft can achieve regeneration without bony bridge formation in partial growth plate injury.

The effectiveness of physeal bar resection with or without Hemi-Epiphysiodesis to treat partial growth arrest

PurposeTo evaluate the outcomes of distal femoral, proximal tibial, and distal tibial physeal bar resection combined with or without the Hemi-Epiphysiodesis procedure and provide a better understanding of the application of physeal bar resection combined with Hemi-Epiphysiodesis procedure in the treatment of physeal bar growth arrest.MethodsWe retrospectively reviewed the patients who suffered physeal bar and underwent physeal bar resection with or without the Hemi-Epiphysiodesis technique during 2010–2020. All were followed up for at least 2 years or to maturity. A modified mapping method was used to determine the area of a physeal bar by CT data. The aLDFA, aMPTA, aLDTA, MAD, and LLD were measured to assess the deformity of the lower limb.ResultsIn total, 19 patients were included in this study. The average age was 8.9 years (range 4.4 to 13.3 years old). During the follow-up, 4 (21.1%) patients had an angular change < 5°; 12 (63.2%) patients had angular deformity improvement > 5° averaging 10.0° (range 5.3° to 23.2°), and 3 (15.8%) patients had improvement of the angular deformity averaging 16.8° (range 7.4° to 27.1°). Eleven patients (57.9%) had significant MAD improvement. After surgery, we found that 7 (36.8%) patients had an LLD change of < 5 mm and were considered unchanged. Only 2 (15%) patients had an LLD improvement > 5 mm averaging 1.0 cm (range 0.7 to 1.3 cm), and 7 (36.8%) patients had increasing of LLD > 5 mm averaging 1.3 cm (range 0.5 to 2.5 cm). There were no postoperative fractures, infections, or intraoperative complications such as neurovascular injury.ConclusionPhyseal bar resection combined with Hemi-epiphysiodesis is helpful for partial epiphysis growth arrest. Without statistically verifying, we still believe that patients with limited growth ability could benefit more from physeal bar resection combined with Hemi-epiphysiodesis.

Correction of Posttraumatic Medial Growth Arrest of the Distal Tibia in Adolescents.

Partial growth arrest of the medial part of the distal tibial physis following fractures that penetrated the epiphysis is relatively common. We present the results of treatment, based on a protocol of supramalleolar tibial and fibular osteotomy for ankle alignment correction, and contralateral epiphysiodesis of distal tibia and fibula to balance leg length discrepancy (LLD). This case series study describes the results of 7 patients with a median age of 14 years (range = 10-15 years) who were operated in our institution. All were treated by closed or open reduction and internal fixation after Salter-Harris (SH) types 3 and 4 fractures of the distal tibia. All patients had a partial medial growth arrest, distal tibial varus, relative overlengthening of the distal fibula, and slight leg shortening. Contralateral distal tibial and fibular epiphysiodesis to prevent significant LLD, completion of closure of the ipsilateral epiphysis, supramalleolar osteotomy of the distal tibia and fibula, and insertion of a triangular wedge cortical allograft into the tibial osteotomy creating a normal ankle joint orientation. The osteotomy was supported by a medial anatomically contoured locking plate. The fibula was fixed with an intramedullary wire. All patients had uneventful healing of the osteotomy after 6 weeks. At the latest follow-up (mean 3 years, range 1.5-5 years), 6 out of 7 patients reached maturity, and the lateral distal tibial angle was within normal limits. The LLD in all patients was less than 8 mm. Our protocol provides anatomic correction with the restoration of the ankle joint and prevents the progression of LLD. Level IV.

Treatment of partial growth arrest using cylindrical costal osteochondral graft

Treatment of partial growth arrest using cylindrical costal osteochondral graft

Treatment of pediatric patients with lower leg deformities associated with physeal arrest: analysis of 28 cases

Aim. To retrospectively analyze the results of two treatment methods for lower leg deformities associated with partial growth arrest.&#x0D; Materials and methods. Group I comprised 15 children who underwent osteotomy, acute overcorrection, and external fixation by Ilizarov with subsequent lengthening of the segment. Group II comprised 13 patients who underwent epiphysiodesis of the healthy part of the growth plate by drilling, osteotomy with external fixation by use of an Ortho-SUV Frame, and subsequent gradual deformity correction and lengthening.&#x0D; Results. In group I, overcorrection of varus deformities by mechanical axis deviation (MAD) was 18.28 ± 5.25 mm, overcorrection by mechanical medial proximal tibial angle (mMPTA) was 14.86 ± 4.45°, and overcorrection by mechanical lateral distal tibial angle (mLDTA) was 12.85 ± 3.02°. Overcorrection of valgus deformities according to MAD was 15.12 ± 8.28 mm, overcorrection by mMPTA was 10.38 ± 2.77°, and overcorrection by mLDTA was 7.5 ± 3.9°. Recurrence of the deformity was observed in 11 (73%) cases (range, 5–16 months).&#x0D; In group II, the accuracy of correction (AC) in varus deformities for MAD was 98% and 94% for mMPTA and mLDTA. For valgus deformities, AC for MAD was 90% and 96% for mMPTA and mLDTA. The AC for anatomical proximal posterior tibial angle and anatomical anterior distal tibial angle was 96% for procurvation deformities and that for recurvation deformities was 92%. Deformity recurrence was observed in only one case within 6 months after frame removal. In 2 cases, repeat limb length discrepancy correction surgeries were performed.&#x0D; Conclusion. Use of epiphysiodesis of the healthy portion of the growth plate in combination with osteotomy, computer-assisted external fixation with subsequent gradual deformity correction, and lengthening in patients with deformities associated with partial physeal arrest significantly decreased the number of deformity recurrences.

Peut-on réduire le recours aux examens d’imagerie dans la prise en charge non chirurgicale des fractures de l’humérus proximal chez l’enfant ?

IntroductionThe majority of proximal humeral fractures in the skeletally immature are treated non-operatively. Operative indications vary but are largely based on degree of displacement. Non-union is rare. Non-operatively treated fractures are typically monitored radiographically to assess healing. HypothesisWe hypothesize that the decision to treat fractures operatively is made at the time of first imaging and that follow-up X-rays do not lead to a change in management. Material and methodsWe retrospectively reviewed the records of 239 patients treated for proximal humerus fractures over a 5-year period. There were 225 who were treated non-operatively. Records were reviewed for the number of clinic visits and radiographs, as well as any change to operative management based on follow-up X-rays. ResultsThe primary outcome of the study was the proportion of proximal humerus fractures, initially treated non-operatively, for which displacement or angulation on follow-up radiographs led to a change to operative treatment. Secondary outcomes were the number of follow-up radiographs obtained after the initial diagnosis and initiation of non-operative treatment. Of the 225 patients that were initially managed non-operatively, only 1 patient required subsequent surgical management. This patient underwent a proximal humerus epiphysiodesis 365 days from injury after development of a partial growth arrest. The mean number of fracture clinic visits for patients managed non-operatively was 2.67 (±1.24). The mean number of radiology department visits and radiographs obtained was 3.57 (±1.44) and 8.36 (±3.89) respectively. No clinical or radiographic non-unions were identified in these patients. No patients suffered a refracture during the review period. DiscussionThis study shows that of the 239 uncomplicated pediatric proximal humerus fractures treated at our hospital over a 5-year period, only 1 had a change in treatment plan, from non-operative to operative, based on follow-up radiographs. These data suggest that non-operative treatment of proximal humerus fractures seldom results in displacement that warrants operative intervention. Moreover, they suggest that there is little utility to the routine use of postoperative radiographs in follow-up of these patients. Study designRetrospective case series. Level of evidenceIV.

Reducing resource utilization during non-operative treatment of pediatric proximal humerus fractures

IntroductionThe majority of proximal humeral fractures in the skeletally immature are treated non-operatively. Operative indications vary but are largely based on degree of displacement. Non-union is rare. Non-operatively treated fractures are typically monitored radiographically to assess healing. HypothesisWe hypothesize that the decision to treat fractures operatively is made at the time of first imaging and that follow-up X-rays do not lead to a change in management. Material and methodsWe retrospectively reviewed the records of 239 patients treated for proximal humerus fractures over a 5-year period. There were 225 who were treated non-operatively. Records were reviewed for the number of clinic visits and radiographs, as well as any change to operative management based on follow-up X-rays. ResultsThe primary outcome of the study was the proportion of proximal humerus fractures, initially treated non-operatively, for which displacement or angulation on follow-up radiographs led to a change to operative treatment. Secondary outcomes were the number of follow-up radiographs obtained after the initial diagnosis and initiation of non-operative treatment. Of the 225 patients that were initially managed non-operatively, only 1 patient required subsequent surgical management. This patient underwent a proximal humerus epiphysiodesis 365 days from injury after development of a partial growth arrest. The mean number of fracture clinic visits for patients managed non-operatively was 2.67 (±1.24). The mean number of radiology department visits and radiographs obtained was 3.57 (±1.44) and 8.36 (±3.89) respectively. No clinical or radiographic non-unions were identified in these patients. No patients suffered a refracture during the review period. DiscussionThis study shows that of the 239 uncomplicated pediatric proximal humerus fractures treated at our hospital over a 5-year period, only 1 had a change in treatment plan, from non-operative to operative, based on follow-up radiographs. These data suggest that non-operative treatment of proximal humerus fractures seldom results in displacement that warrants operative intervention. Moreover, they suggest that there is little utility to the routine use of postoperative radiographs in follow-up of these patients. Study designRetrospective case series. Level of evidenceIV.

Abstract POSTER-THER-1431: Combined Src and MEK inhibition decreases ovarian cancer (OVCA) cell growth, tumorigenicity and aldehyde dehydrogenase positive tumor-initiating-cells

Abstract Introduction: More effective treatments for recurrent OVCA are needed. Src kinase and the MAPK pathway are activated in OVCAs. Saracatinib, is a potent inhibitor of Abl and Src family kinases and selumetinib, is a potent, selective, ATP-noncompetitive inhibitor of MEK 1/2 kinases. Our earlier work has shown that resistance to saracatinib monotherapy emerges in vitro and in vivo. Since oncogenic activation of both Src and MEK pathways has been observed in OVCAs and because resistance to Src inhibition emerges with monotherapy, we hypothesized that blocking both kinases with combination therapy will more effectively inhibit OVCA cell proliferation than either drug alone. Experimental Design: Effects of dual Src and MEK blockade on cell cycle, autophagy, apoptosis and xenografts were assayed. Drug effects were confirmed in primary human OVCA tumor cells. Drug effects were evaluated by RPPA and gene expression analysis by microarray. Cells enriched for stem cell marker, aldehyde dehydrogenase 1 (ALDH1+) were sorted by FACS. Drug effects on ALDH1+ cells, and sphere formation were analyzed. Xenografts after treatment were dissociated and transplanted in vivo in a limiting dilution. Results: Analysis of TCGA high grade serous OVCAs by RPPA showed the majority express pSrc (T419) (n=300/408) and pMAPK (n=310/408) and patients with high pSrc /pMAPK expression had a poorer survival than those with low pSrc /pMAPK (p=0.004). Increased phosphorylation of MAPK was observed with prolonged saracatinib treatment. While each drug alone caused partial growth arrest, treatment with both saracatinib and selumetinib, decreased Src, MAPK, and Akt and caused synergistic cell cycle arrest, which was mediated by p27 binding to cyclin E/cdk2. Gene expression enrichment analysis showed the top 20 gene sets dowregulated by combination treatment involved cell cycle and the gene set most upregulated was autophagy. RPPA confirmed GEA and demonstrated that combination treatment decreased not only Src, MAPK pathways but the PI3K/AKT pathway. Combination treatment induced apoptosis and autophagy. Src and MEK phosphorylation was increased in ALDH1+ sorted populations and combination treatment decreased %ALDH1+cells and % spheres. Combination treatment was more effective in vivo than monotherapy. Transplantation of dissociated cells after treatment in a limiting dilution in vivo resulted in decreased tumor formation and stem cell frequency in the combination treated grp (p=0.01). Conclusion: MEK inhibition augments the effects of saracatinib by blocking bypass activation of the MAPK and PI3K/AKT pathway, increasing cell cycle arrest, impairing survival and targeting self-renewing subpopulations. These data support further pre-clinical and clinical evaluation of combined saracatinib and MEK inhibition in OVCA. Citation Format: F. Simpkins, K. Hew, D. Azzam, Z. Wei, G. Zhang, J. Sun, D. Zhang, K. Jang, W. Liu, Y. Lu, G. Mills, I. Tan, J. Slingerland. Combined Src and MEK inhibition decreases ovarian cancer (OVCA) cell growth, tumorigenicity and aldehyde dehydrogenase positive tumor-initiating-cells [abstract]. In: Proceedings of the 10th Biennial Ovarian Cancer Research Symposium; Sep 8-9, 2014; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(16 Suppl):Abstract nr POSTER-THER-1431.

Proteomic analysis of human glioblastoma cell lines differently resistant to a nitric oxide releasing agent.

Glioblastoma multiforme is the most aggressive astrocytoma characterized by the development of resistant cells to various cytotoxic stimuli. Nitric oxide (NO) is able to overcome tumor resistance in PTEN mutated rat C6 glioma cells due to its ability to inhibit cell growth by influencing the intracellular distribution of ceramide. The aim of this study is to monitor the effects of NO donor PAPANONOate on ceramide trafficking in human glioma cell lines, CCF-STTG1 (PTEN-mutated, p53-wt) and T98G (PTEN-harboring, p53-mutated), together with the assessment of their differential molecular signature by 2D-DIGE and MALDI mass spectrometry. In the CCF-STTG1 cell line, the results indicate that treatment with PAPANONOate decreased cell proliferation (<50%) and intracellular trafficking of ceramide, assessed by BODIPY-C5Cer, while these events were not observed in the T98G cell line. Proteomic results suggest that CCF-STTG1 cells are characterized by an increased expression of proteins involved in NO-associated ER stress (i.e. protein disulfide-isomerase A3, calreticulin, 78 kDa glucose-regulated protein), which could compromise ceramide delivery from ER to Golgi, leading to ceramide accumulation in ER and partial growth arrest. Conversely, T98G cell lines, resistant to NO exposure, are characterized by increased levels of cytosolic antioxidant proteins (i.e. glutathione-S-transferase P, peroxiredoxin 1), which might buffer intracellular NO. By providing differential ceramide distribution after NO exposure and differential protein expression of two high grade glioma cell lines, this study highlights specific proteins as possible markers for tumor aggressiveness. This study demonstrates that, in two different high grade glioma cell lines, NO exposure results in a different ceramide distribution and protein expression. Furthermore, this study highlights specific proteins as possible markers for tumor aggressiveness.

Clinical application of computer navigation in physeal bridge resection in pediatric partial epiphyseal plate closure

To report our experience of using image-guided computer navigation for bone bridge resection in children. Between August 2008 and March 2011 at our hospital, computed tomography (CT)-based navigation system for bone bridge resection was used in 42 children with lower extremity deformities due to partial physeal growth arrest. There were 26 males and 16 females with an average age of 9.8 (5.0-13.0) years. Six patients were lost to follow-up. In other 36 patients, the average duration of radiographic and clinical follow-up was 25 (15-44) months. Among them, 13 were corrected to neutral while 15 had insufficient correction. The average correction angle of deformities was 14 (8-25) degrees. The image-guided computer navigation system enhances the accuracy and safety of bone bridge resection in children.

Triplane fracture of distal radius treated surgically

Only four cases of triplane distal radius fracture have been described in the literature. We report the first that has been treated with open reduction and internal fixation. A 15-year-old boy sustained a triplane fracture of the distal radius. After an unsuccessful attempt at closed reduction, open reduction and internal fixation were performed. Six months after injury, the patient is asymptomatic, but radiographs show a partial growth arrest. The goal of treatment is to achieve anatomic reduction of the articular surface. In this case interposed periosteum prevented anatomic reduction, requiring open reduction and internal fixation. Because of the patient's advanced age the partial physeal arrest should advance to complete arrest before length impairment or occurrence of angular deformity.

Abstract B50: Preclinical efficacy of combined MEK and Src inhibition: MEK inhibitor reverses resistance to Src inhibitor therapy in ovarian cancer cells

Abstract Introduction: More effective, less toxic treatments for recurrent ovarian cancer are needed. Up to 80% of ovarian cancers show activation of the Src kinase and up to 40% show MEK/MAPK pathway activation. Therapies targeting signaling pathways that drive proliferation have shown promise in ovarian cancers but the development of drug resistance presents a major problem. Saracatinib, is a potent inhibitor of Abl and Src family kinases and selumetinib, is a potent, selective, ATP-uncompetitive inhibitor of MEK 1/2 kinases. Our earlier work has shown that resistance to saracatinib monotherapy emerges within weeks in cell culture and within months in xenograft models. Since oncogenic activation of both Src and MEK pathways has been observed in ovarian cancers and because resistance to Src inhibition rapidly emerges with monotherapy, we hypothesized that blocking both kinases with dual therapy might more effectively decrease ovarian cancer cell proliferation than either drug alone. Experimental Design: Dual Src and MEK blockade effects on cell cycle and survival were assayed in ovarian cancer lines, and a primary human ovarian cancer tumor cultured immediately in vitro. Cells enriched for the stem cell marker, aldeflour dehydrogenase 1 (ALDH1+) were sorted by flow cytometry. Drug effects on tumor sphere formation and on cell cycle profiles of ALDH+ cells and those lacking this activity were analyzed. In vivo experiments are ongoing. Results: Src activity is greater in ovarian cancer lines than normal human ovarian epithelial cells (HOSE). In saracatinib naïve ovarian cancer cells, Src inhibition led to partial growth arrest after 48 hrs of treatment. However, resistance of ovarian cancer cells to saracatinib monotherapy emerged rapidly, over a period of weeks of continuous drug exposure in vitro and in vivo. Activation of the MEK and Akt pathways developed with prolonged saracatinib treatment. While each drug alone caused a partial growth arrest in saracatinib naïve lines, treatment with both saracatinib and the MEK inhibitor drug, selumetinib, caused synergistic cell cycle arrest which was mediated by p27 binding to cylin E/cdk2. Combination treatment decreased Src, Akt and MAPK activities. Combination treatment was required for cell cycle arrest in saracatinib resistant cells. Combination treatment also induced apoptosis by an increase in cleaved PARP and induced autophagy as shown by an increase in LC3-II. Src and MEK activities were increased in ALDH1+ sorted populations compared to the ALDH- population and combination treatment decreased the % of ALDH1+cells and the % of sphere-generating cells. Conclusions: MEK inhibition augments the effects of saracatinib by blocking bypass activation of MEK and Akt pathways, increasing cell cycle arrest, impairing survival and targeting self-renewing subpopulations. These data support further pre-clinical and clinical evaluation of combined saracatinib and MEK inhibition in ovarian cancer. Citation Format: Fiona Simpkins, Diana Azzam, Joyce M. Slingerland. Preclinical efficacy of combined MEK and Src inhibition: MEK inhibitor reverses resistance to Src inhibitor therapy in ovarian cancer cells. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: From Concept to Clinic; Sep 18-21, 2013; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2013;19(19 Suppl):Abstract nr B50.

Growth Plate Fractures of the Distal Femur

Growth plate fractures of the distal femur are challenging to treat, with complications that require a secondary surgery 40% to 60% of the time. These fractures often necessitate operative intervention, even in the youngest patients and even with minimal apparent displacement. Treatment varies with the Salter-Harris (SH) classification and with the extent of initial displacement, ranging from simple casting for nondisplaced SH I fractures to open reduction and internal fixation for almost all SH III and IV fractures. Poor outcomes have been associated with pediatric fracture care of SH III and IV in 29% to 32% of cases. There are many pitfalls that have to be avoided in the treatment of these fractures to prevent malunion, growth arrest, and posttraumatic arthritis.

Treatment of Partial Growth Arrest Using an In Vitro-generated Scaffold-free Tissue-engineered Construct Derived From Rabbit Synovial Mesenchymal Stem Cells

Injuries to the epiphyseal plate sometimes result in partial growth arrest, which can lead to the development of angular deformities and limb length discrepancies in growing children. The aim of this study was to develop a new treatment for partial growth arrest of the physis. For this purpose, we investigated the feasibility of an in vitro-generated scaffold-free tissue-engineered construct (TEC) derived from synovial mesenchymal stem cells (MSCs) in a rabbit growth arrest model. An experimental model for growth arrest was created by excising the medial half of the proximal growth plate of tibias from 6-week-old New Zealand White rabbits. Three experimental groups were set to evaluate TEC implantation: group 1, no implantation as controls; group 2, implantation of bone wax as additional controls; and group 3, implantation of TEC in the lesion. In group 1, all damaged growth plates were arrested and angular deformities appeared 4 weeks later. In groups 2 and 3, angular deformities were less than in the control group. Histologic images showed bone bridges developed at the damaged growth plate in group 1. Regeneration of growth plates was recognized in groups 2 and 3. Histologic examination showed greater regeneration of the growth plate in group 3 than in group 2. In addition, MSCs in the TEC differentiated into proliferative and prehypertrophic chondrocyte-like cells. A scaffold-free 3D TEC made using cultured synovium-derived MSCs differentiated into proliferative and prehypertrophic chondrocyte-like cells. The results of this experimental study suggest that scaffold-free 3D TEC made using cultured synovium-derived MSCs can be a new approach for the repair of epiphyseal injury. Clinical effectiveness of a scaffold-free 3D TEC for growth arrest remains to be determined.

Physeal fractures: basic science, assessment and acute management

Abstract Physeal fractures account for approximately one-third of all paediatric fractures. Although many of these injuries heal without negative sequelae, this fracture type is at risk of partial or complete growth arrest. The anatomy of the physis, and the basic science behind its growth and function are presented. We also present the epidemiology of physeal fractures, as well as outcomes following physeal injuries at various locations. General guidelines for treatment are discussed. A thorough understanding of the basic science, epidemiology, and treatment options for physeal fractures may help the clinician optimize management for children with this type of injury.

Deformity correction using supramalleolar gigli saw osteotomy and Taylor spatial frame

Supramalleolar osteotomy (SMO) is useful for the correction of various deformities around the ankle joint,especially deformities of the distal tibia secondary to partial growth arrest, foot equinus, and hind foot deformities. By definition, this osteotomy cuts through the tibia and fibula approximately 2–3 cm above the ankle joint.It can be performed by various techniques, each of them have advantages and disadvantages. Gigli saw SMO can be performed percutaneously with minimal soft tissue dissection, leaving a very smooth bone surface, which is especially useful for the correction of rotational deformities. Over a period of 6 years we performed eight gigli saw SMO in seven male patients and one female patient with a mean age of 13.6 years. All patients had multiplanar deformities with some shortening (range 15–40 mm) and underwent correction and lengthening by Taylor spatial frame. Treatment goal was achieved in all patients with minimal complications. On the basis of our experience, we believe that gigli saw SMO can be performed safely. This osteotomy, in conjunction with the Taylor spatial frame, became our treatment of choice for the correction of ankle and hindfoot deformities.The evidence is level 4, case series.

Report of a Case of Genu Recurvatum Following Tibial Eminence Avulsion Treated by Proximal Tibial Flexion Osteotomy and Review of the Literature

We report a case of acquired genu recurvatum treated with a proximal tibial flexion osteotomy. A partial growth arrest at the anterior portion of the proximal tibial physis following a conservatively treated Meyers-McKeever type II injury of the tibial eminence. This is a reliable method in the correction of genu recurvatum. By using tricortical autogenous iliac crest graft, the osteotomy may be made very stable intra-operatively circumventing the need for fixation.

Measurement of bone turnover in prostate cancer patients receiving intermittent androgen suppression therapy

PurposeReports on clinical measurements of bone mineral density (BMD) in prostate cancer patients undergoing intermittent androgen suppression therapy (IAS) that allows for hormonal recovery between treatment cycles indicate decreased osteoporosis compared to continuous androgen suppression therapy (CAS). In the present study the effect of IAS on bone metabolism by determinations of CrossLaps, a biochemical marker of collagen degradation, were examined.MethodIn total 100 IAS treatment cycles of 75 patients with prostate cancer stages ≥ pT2 were studied. Clinical data and monthly laboratory tests (testosterone, prostate-specific antigen; PSA) of these patients were monitored together with measurements of C-terminal telopeptide collagen fragments using CrossLaps® ELISA assays.ResultsDuring phases of androgen suppression (AS) lasting for 9 months serum testosterone (<1 ng/mL) and PSA (<2 ng/mL) levels were reversibly reduced, indicating partial growth arrest and apoptotic regression of the prostatic tumors. Serum CrossLaps concentrations peaked at the last 2 months of the AS phases (0.91 ± 0.25 μg/L; mean ± SEM) and were reduced below initial values (0.21 ± 0.43 versus baseline of 0.43 ± 0.06 μg/L) during therapy cessation periods until tumor progression-related increases.ConclusionMeasurements of the serum concentration of CrossLaps in prostate cancer patients receiving IAS indicated that treatment cessation phases rapidly reversed increased bone degradation associated with AS phases, in strong agreement with the clinical observations reporting reduced loss of BMD in IAS when compared to CAS. In terms of clinical outcomes, IAS seems to be as effective as CAS while showing reduced side effects, as demonstrated here by the reduction of androgen-induced bone matrix degradation.