Physeal Plate Research Articles

Radiographic pelvimetry and evaluation of radiographic findings of the pelvis in cats with dystocia

Summary Objective: The aim of this study was to determine reference values for pelvic dimensions in radiographically unremarkable native Turkish cats (similar to European Shorthair cats) and to evaluate radiographic findings of the pelvis in cats with dystocia and to compare their pelvimetric measurements with those of radiographically unremarkable cats. Material and methods: Pelvimetry was performed on ventro-dorsal and lateral radiographs of radiographically unremarkable male (n = 34) and female cats (n = 23) with no history of dystocia and cats presented with dystocia. Cats with dystocia were classified in groups according to radiographical findings: cats without obvious radiographical changes, cats with traumatic pelvic stenosis and cats with pelvic narrowing due to metabolic disease. Statistical analyses were performed to find out significant differences between both groups with respect to gender and age. Results: Pelvic dimensions of radiographically unremarkable cats are greater in males compared to females. These differences increase with increasing age, but are not significant in cats older than 2 years. Twenty-five out of 37 queens presented with dystocia had significantly smaller pelvic dimensions compared to radiographically unremarkable queens. Deformation/narrowing of the pelvis in 12 cats (32%) due to old fractures and metabolic bone disease occurred in 7 and 5 cases, respectively. Conclusion: Old, untreated pelvic fractures and metabolic disorders may cause stenosis of the birth canal and dystocia. However, there is a high rate of queens without deformation, but smaller pelvic dimension experiencing dystocia. As 80% of these cats are around 1 year of age they might still be growing or are underdeveloped, despite pelvic physeal growth plates are already closed. Clinical relevance: Pelvic radiographs and pelvimetry before mating enables to identify cats with pelvic narrowing due to traumatic, metabolic, or developmental reasons and may prevent the queen from potential dystocia.

Fracture-avulsion de la tubérosité tibiale antérieure avec refend articulaire: une nouvelle méthode d’ostéosynthèse

We report a rare avulsion fracture of the tibial tuberosity with a large sagittal plane anterior tibia fracture with articular extension in an adult. Avulsion fractures of the tibial tuberosity are uncommon fractures and are seen most frequently in adolescents with the disruption of the physeal plate. We report a variant of an Ogden type 3a fracture in an adult and describe a novel method of fixation.

Fechamento das placas epifisárias do metacarpiano principal, do rádio e da tíbia em potros Crioulos

Com o objetivo de determinar a idade do fechamento das placas de crescimento dos ossos longos, foram usados 92 potros da raça crioula com idades entre 6 a 29 meses, machos e fêmeas, provenientes de cinco criatórios diferentes. Foram radiografadas as placas epifisárias distais do terceiro metacarpiano, do rádio e da tíbia. A imagem radiográfica foi classificada quanto ao fechamento em: visível, parcialmente visível ou não visível. Foram avaliados a influência do sexo, da propriedade e do regime nutricional sobre o fechamento da placa epifisária. Observou-se que, aos sete meses de idade, a placa epifisária do metacarpiano principal já não era visível. A placa epifisária distal da tíbia não foi possível de ser identificada aos 23 meses. Na porção distal do rádio, a placa epifisária esteve visível até os 25 meses de idade. Os resultados deste estudo comprovam que o período de fechamento da placa epifisária dos ossos metacarpiano principal, rádio e tíbia de potros crioulos se assemelha ao descrito em outras raças.

Epifisiólise proximal do úmero em atleta de ginástica olímpica

CONTEXTO: Existem diversas causas de dor no ombro do atleta. Estruturas como tendões e ligamentos são freqüentemente acometidas por lesões. No atleta jovem com esqueleto imaturo, as afecções ósseas devem ser lembradas como possíveis causas de dor. RELATO DE CASO: Os autores relatam a ocorrência da epifisiólise proximal do úmero em um atleta de ginástica olímpica e discutem a literatura a respeito do assunto. CONCLUSÃO: A lesão da placa fisária proximal do úmero em atletas é pouco freqüente. O diagnóstico precoce e correto tratamento evitam que ocorra deformidades severas e déficits funcionais.

The effect of dietary nutrients on osteochondrosis lesions and cartilage properties in pigs (2006)

A total of 80 gilts (PIC 327 × 1050; 86 lb initial BW) were used in an 84-d study to determine the effect of different nutrients on the occurrence of osteochondrosis (OC) lesions, several cartilage criteria, growth performance, and carcass composition. Eight dietary treatments were formulated, consisting of 1) control (standard corn-soy diet, 3.5% choice white grease (CWG)) or the control diet plus 2) fish oil (3.5%) replaced CWG, 3) proline and glycine (Pro/Gly; 300 and 200% of lysine), 4) leucine, isoleucine, and valine (BCAA; 200, 100, and 100% of lysine, respectively), 5) silicon (1,000 ppm), 6) copper and manganese (Cu/Mn; 250 ppm and 100 ppm, respectively), 7) methionine and threonine (Met/Thr; 150 and 100% of lysine), and 8) combination of ingredients in diets 2 through 7. The diets were formulated slightly in excess of the pig’s requirement for lysine and to meet minimum true ileal digestibility (TID) ratios for the other essential amino acids. The diets were also formulated to be isocaloric by slightly adjusting the fat (CWG) content, and were fed in three phases (1.07, 0.94, and 0.80% TID Lys). Upon completion of the feeding period, pigs were harvested, and the distal aspect of the left femur was evaluated by gross examination for OC lesions. The external surface was evaluated for abnormalities and given a severity score. Then each femur was sliced into 3-mm sections, and lesions were assigned a severity score for the underlying articular cartilage, and physeal growth plate. Overall (d 0 to 84), growth performance was unaffected by dietary treatment (P>0.21). Pigs fed diets containing fish oil or silicon tended (P<0.07) to have a higher severity score for external abnormalities (or defects in cartilage surface), compared with pigs fed the other dietary treatments, with pigs fed the control diet, Pro/Gly, or Cu/Mn intermediate. Pigs fed high Met/Thr, Cu/Mn, or silicon tended (P<0.08) to have lower articular cartilage severity scores than scores of pigs fed the control diet or BCAA, with the other dietary treatments intermediate. The occurrence of OC lesions at the growth plate, total faces with lesions, and total number of abnormalities were not affected by dietary treatment (P>0.23); there was a trend (P<0.14) for pigs fed diets containing high Met/Thr or fed the combination diet to have lower total severity scores than scores of pigs fed the control diet or fish oil, with the other treatments intermediate. Pigs fed additional Cu/Mn, Met/Thr, or

Avulsion fractures of the lateral tibial condyle in children

Avulsion fractures of the lateral tibial condyle are very rare in children and adolescents. Seven patients were treated between 1986 and 2000. They were all involved in sporting activities and an acute contraction of the fibres of the iliotibial band was considered to be their common pathogenetic factor. A subdivision in two types of avulsion fractures according to the anatomic location of the lesion was used. The Segond fracture, a small vertical avulsion fracture involving the midportion of the lateral tibial condyle distal to the plateau but proximal to the physis, was diagnosed in five patients. In two of them it was associated with a fracture of the anterior intercondylar eminence. The avulsion fracture of the Gerdy's tubercle was diagnosed in two other patients. The detached fragment was bigger, more anterior and involved a part of the articular surface of the lateral tibial plateau as well as a part of the physeal plate. All patients were treated conservatively and were free of symptoms after a mean follow-up of 9 years.

Transphyseal spread of benign tumors and infections in pediatric patients: A series of six cases

Epiphyseal extension of benign pathology is regarded as an infrequent occurrence. This observation has been attributed to anatomical and biochemical phenomenon unique to physeal cartilage. We report a retrospective series of six patients over a period of 4 years, diagnosed with benign pathologies that showed crossing of an open physeal plate by the disease. Four of these cases were infections and two were benign tumors. The patients were aged between 5 and 11 years, all of them were treated at a tertiary referral centre and followed up for a minimum period of 6 months to evaluate the progress of disease. The findings are more than just a pathological curiosity as they alter the management and surgical procedure that needs to be performed for these conditions. The recognition of the fact that benign tumors may occasionally present with transphyseal spread will prevent unjustified radical procedures that are best reserved for aggressive malignant conditions.

Transphyseal Spread Of Benign Conditions In Pediatric Patients: A Series Of Six Cases

Epiphyseal extension of benign pathology is regarded as an infrequent occurrence. This observation has been attributed to anatomical and biochemical phenomenon unique to physeal cartilage. We report a retrospective series of six patients over a period of four years, diagnosed with benign pathologies that showed crossing of an open physeal plate by the disease. Four of these cases were infections and two were benign tumors. The patients were aged between 5 and 11 years, all of them were treated at a tertiary referral centre and followed up for a minimum period of six months to evaluate the progress of disease. We believe that this is the first time that a large series has shown that the epiphysis does not necessarily act as a barrier to spread in all benign pathologies. The findings are more than just a pathological curiosity as they alter the management and surgical procedure that needs to be performed for these conditions. The recognition of the fact that benign tumors may occasionally present with transphyseal spread will prevent unjustified radical procedures that are best reserved for aggressive malignant conditions. DEPARTMENT(S) AND INSTITUTION(S) WHERE WORK WAS DONE Department Of Orthopaedics, KEM Hospital, Parel , Mumbai, India.

Chondroblastoma of the hands and feet.

To review the imaging findings, age and gender distribution of chondroblastoma of the hands and feet. Twenty-five cases of pathologically proven chondroblastoma of the hands and feet were reviewed. Available imaging modalities included radiographs (n=24), CT (n=3), MRI (n=5), and radionuclide bone scintigraphy (n=1). The following imaging features for each case were tabulated: location, presence of sclerotic margin, calcification, expansion, presence of fluid/fluid levels on cross-sectional imaging and surrounding edema on MRI. The images were evaluated for skeletal maturity using closure of the physeal plate in the region as a standard. The average age at time of diagnosis was 23 years (range 7-57 years). Eighty-four percent (n=21) of the patients were skeletally mature. Males (20 of 25) outnumbered females by a ratio of 5:1. The bones of the foot accounted for 22 cases: calcaneus (n=8), talus (n=8), metatarsals (n=3), and the cuboid (n=3). The bones of the hand accounted for three cases: phalanx (n=1), triquetrum (n=1), and a metacarpal (n=1). Radiographically all lesions were osteolytic with identifiable calcification in 54% (13 of 24). Fluid/fluid levels were seen in four of five cases on MRI. Edema on MR images was seen in 40% (2 of 5). The size of the lesions ranged from 2 to 41 cm(2). Chondroblastomas of the hands and feet share many of the radiographic characteristics seen in the long bones, but manifest in skeletally mature patients with a higher male to female ratio than in long bone chondroblastoma. Talar and calcaneal lesions were encountered only in males. Chondroblastoma of the wrist and hand appears to be exceptionally rare.

Three-dimensional MR imaging in the assessment of physeal growth arrest.

The purpose of this study is to describe an imaging method for identifying and characterising physeal growth arrest following physeal plate aggression. The authors describe the use of three-dimensional MRI performed with fat-suppressed three-dimensional spoiled gradient-recalled echo sequences followed by manual image reconstruction to create a 3D model of the physeal plate. This retrospective series reports the analysis of 33 bony physeal bridges in 28 children (mean age 10.5 years) with the use of fat-suppressed three-dimensional spoiled gradient-recalled echo imaging and 3D reconstructions from the source images. 3D reconstructions were obtained after the outlining was done manually on each source image. Files of all patients were reviewed for clinical data at the time of MRI, type of injury, age at MRI and bone bridge characteristics on reconstructions. Twenty-one (63%) of the 33 bridges were post-traumatic and were mostly situated in the lower extremities (19/21). The distal tibia was involved in 66% (14/21) of the cases. Bridges due to causes other than trauma were located in the lower extremities in 10/12 cases, and the distal femur represented 60% of these cases. Of the 28 patients, five presented with two bridges involving two different growth plates making a total of 33 physeal bone bars. The location and shape of each bridge was accurately identified in each patient, and in post-traumatic cases, 89% of bone bars were of Ogden type III (central) or I (peripheral). Reconstructions were obtained in 15 min and are easy to interpret. Volumes of the physeal bone bridge(s) and of the remaining normal physis were calculated. The bone bridging represented less than 1% to 47% of the total physeal plate volume. The precise shape and location of the bridge can be visualised on the 3D reconstructions. This information is useful in the surgical management of these deformities; as for the eight patients who underwent bone bar resection, an excellent correspondence was found by the treating surgeon between the MRI 3D model and the per-operative findings. Accurate 3D mapping obtained after manual reconstruction can also visualise very small physeal plates and bridges such as in cases of finger physeal disorders. MR imaging with fat-suppressed three-dimensional spoiled gradient-recalled echo sequences can be used to identify patterns of physeal growth arrest. 3D reconstructions can be obtained from the manual outlining of source images to provide an accurate representation of the bony bridge that can be a guide during surgical management.

The distal femoral and proximal tibial growth plates: MR imaging, three-dimensional modeling and estimation of area and volume.

To explore how the size of the growth plate changes with age using three-dimensional (3D) models of the distal femoral and proximal tibial growth plates in pediatric patients. We retrospectively created 3D models of the normal unaffected distal femoral (n=20) and proximal tibial (n=10) growth plates in 14 patients (9 males, 5 females) age range 3.8-15.6 years who were referred for evaluation of premature partial closure of the growth plate or hyaline cartilage abnormality. All patients had one or more 3D fat-suppressed spoiled GRASS sequence from which models were made of normal growth plates. Total projected area was estimated from standardized maximum intensity projection (MIP) views, and volume was computed from the entire model. We also included the total projected area of the distal femur (n=7) or proximal tibia (n=8) in 11 patients (8 males, 3 females, 5-13 years) who had previously been evaluated for bone bridging. The 3D femoral and tibial growth plate anatomy was displayed. Femoral growth plate area varied from 804 mm2 to 3,463 mm2. Femoral physeal cartilage volume varied from 2.1 cm3 to 12.6 cm3. Tibial growth plate area varied from 736 mm2 to 3,026 mm2. Tibial physeal cartilage volume varied from 1.9 cm3 to 13.2 cm3. The growth plate area values appear to increase linearly with increasing age. The distal femoral and proximal tibial physeal plates have complex anatomy. Both area and volume of the growth plates appeared to follow a linear increase with age and reached a plateau in adolescence, although there was some scatter. Area appears to have less measurement variability than volume, and may be a more reliable predictor of growth plate tissue quantity.

The acrophysis: a unifying concept for understanding enchondral bone growth and its disorders. II. Abnormal growth.

In order to discuss and illustrate the effects common to normal and abnormal enchondral bone at the physes and at all other growth plates of the developing child, the term "acrophysis" was proposed. Acrophyses include the growth plates of secondary growth centers including carpals and tarsals and apophyses, and the growth plates at the nonphyseal ends of small tubular bones. Abnormalities at acrophyseal sites are analogous to those at the physeal growth plates and their metaphyses. For example, changes relating to the zone of provisional calcification (ZPC) are often important to the demonstration of such similarities. Lead lines were an early example of the concept of analogy from abnormality due to physeal and to acrophyseal disturbance. The ZPC is a key factor in understanding patterns of rickets and its healing. Examples (including hypothyroidism, scurvy and other osteoporosis, Ollier disease, achondroplasia, and osteopetrosis, as well as the family of frostbite, Kashin-Beck disease, and rat bite fever) illustrate the acrophysis principle and in turn their manifestations are explained by that principle.

Rotational injuries of the distal tibial growth plate

Nine rotational injuries of the distal tibial growth plate in combination with spiral fracture of the fibula were treated in our department between 1993 and 2000. The average age of the patients was 12 years. The injury was a result of sudden, forceful external rotation of the ankle and foot. Pain and slight swelling of the ankle and external rotation of the distal tibia of 20°–40° were present. Radiologically, irregularity and widening of the growth plate of the distal tibia were obvious. In all these cases we noted, on lateral views, the characteristic sign of an “open fish mouth,” due to the changes in the shape of the physeal plate. The spiral fracture of the fibula was not obvious in all radiographic views. The treatment in all eight fresh cases was closed reduction and manipulation by reversing the mechanism of injury and long leg cast application in all nine cases (including the one neglected case) for 6–8 weeks. The final results were either excellent or very good in all nine patients after a mean follow-up of 6 years.

DEVELOPMENTAL HIP DYSPLASIA AND DISLOCATION

Both nonsurgical and surgical options are available for the treatment of developmental hip dysplasia and dislocation. The advantages, pitfalls, and techniques for using the Pavlik harness should be thoroughly examined before treatment. Other closed and open treatments are aimed at concentric reduction and prevention of residual subluxation and dysplasia. Early diagnosis and treatment lead to the best long-term results for these conditions.

Osteochondral Sequelae of Meningococcemia: Radiographic Aspects

The authors retrospectively analyzed the files of 11 patients with osteochondral sequelae of meningococcemia, which were referred to this service between 1988 and 1996. The purpose of this study was to radiographically evaluate bone and physeal injuries observed in these patients, deformities caused by them and correlate these findings with the current literature. During radiographic evaluation of patients with sequelae of meningococcemia, two distinct parameters should be observed: bone injury and physeal plate injury patterns. The most frequent bone injury pattern was lytic lesion and the most common physeal plate injury pattern was peripheral asymmetric physis destruction. The most frequent deformities were lower limb length discrepancy, angular deformities and digital amputations. Based upon the findings of the present research, a descriptive radiographic classification was proposed.

Atypical Growth Plate Closure: a Possible Chronic Salter and Harris Type V Injury

Salter-Harris Type V epiphyseal injury is relatively uncommon. The authors present a case involving the proximal tibia diagnosed both by radiologic and histologic findings. The findings suggest that Salter-Harris Type V injury can be a possible outcome when the disappearance of the physeal plate is reported in a patient who has great physical activity in childhood, even if the patient has suffered from no major injury.

Ligamentous rupture of the ACL associated with dislocated fracture of the proximal tibial physis in a 12-year-old boy.

BackgroundDislocated fracture of the proximal physeal plate of the tibia with or without metaphyseal fragment is rare in children. This unusual fracture classically excludes rupture of the anterior cruciate ligament due to the ligament's stability. A combination of both injuries has not been previously published in the literature.Case presentationThe authors report the case of a 12-year-old boy who presented with a dislocated fracture (Salter-Harris II) of the proximal tibia combined with ligamentous rupture of the anterior cruciate ligament after a sporting accident.

The relationship of the femoral origin of the anterior cruciate ligament and the distal femoral physeal plate in the skeletally immature knee. An anatomic study.

We defined the anatomic relationship of the anterior cruciate ligament femoral origin to the distal femoral physis in the skeletally immature knee with use of 12 fresh-frozen human fetal specimens (ages, 20 to 36 weeks). Each specimen underwent magnetic resonance imaging, was dissected free of soft tissue, sectioned in the sagittal plane, and stained. The spatial relationship of 1) the epiphyseal side of the physeal proliferative zone to the nearest point of bony attachment of the anterior cruciate ligament and 2) the origin of the anterior cruciate ligament to the over-the-top position were measured. The same measurements were made in 13 skeletally immature knees (ages, 5 to 15 years). We found that the femoral origin of the fetal anterior cruciate ligament developed as a confluence of ligament fibers with periosteum at 20 weeks, vascular invasion into the epiphysis at 24 weeks, and establishment of a secure epiphyseal attachment by 36 weeks. In the fetus, the distance from the anterior cruciate ligament femoral origin to the epiphysis was 2.66+/-0.18 mm (range, 2.34 to 2.94). There was no significant change in this distance in adolescent specimens (2.92+/-0.68 mm; range, 2.24 to 3.62). The over-the-top position was at the level of the distal femoral physis.

Growth plate chondrocytes inhibit neo-angiogenesis – a possible mechanism for tumor control

Clinically, tumors seldom grow across the articular cartilage and physeal plate. It is believed that avascular cartilage may inhibit the neo-vascularization of tumor spread. The conditioned medium of growth plate chondrocytes resisted the migration of ECV304 by approximately 41% in invasion assay. Growth plate chondrocytes were shown by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay to have an insignificant effect on the viability of human endothelial cells and fibroblasts. However, the proliferation of human endothelial cells was significantly inhibited by growth plate chondrocytes. The inhibitory activity was up to 35% and specific to endothelial cells. Inhibition of blood vessel formation was also demonstrated in the chick chorioallantoic membrane (CAM) assay. These findings demonstrated that growth plate chondrocytes secrete anti-angiogenesis factor(s) which specifically inhibit both the migration and proliferation of endothelial cells.

Anterior cruciate injuries in the skeletally immature athlete: a review of treatment outcomes.

The documentation of anterior cruciate ligament (ACL) injuries in the skeletally immature athlete has significantly increased over the past decade, primarily due to increased awareness of these injuries within this younger athletic population. The evaluation of these injuries are similar to that in the adult population. Diagnostic studies such as plain radiographs, as well as magnetic resonance imaging, can delineate the location of the ACL failure. Physical presentation most commonly includes an acute haemarthrosis and ligamentous insufficiency. Several studies have demonstrated that the diagnostic reliability of the physical examination is poor in children, especially in patients less than 12 years old. The site of ACL failure in this adolescent population is most commonly at the tibial insertion. We recommend arthroscopic or arthroscopically assisted open reduction and internal fixation with nonabsorbable sutures for all displaced tibial eminence fractures. Mid-substance ACL failures also occur in this athletic age group. The association of meniscal injuries with these ACL failures appears to be greater than 50%. Historically, poor subjective and objective outcomes have been associated with primary and extra-articular repairs. Intra-articular reconstruction is the gold standard. The issue of placing the graft across open physeal plates is under investigation. Recent animal studies as well as human clinical series have demonstrated safety in placing soft tissue, i.e. hamstring grafts, across open growth plates without subsequent angular or leg length discrepancy. Historically, non-operatively treated ACL failures are associated with poor functional outcomes as well as a high incidence of meniscal re-injury. If the treatment of an adolescent athlete with an ACL failure is to be rehabilitation until skeletal maturity, close follow-up is essential to detect functional instability, which may prompt earlier surgical reconstruction.