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A rare case of non-contact salter harris type 2 fracture of distal femur during a football match

Razzi M, Nordin A

Med J Malaysia, 2018 10;73(5):342-343.
PMID: 30350822 MyJurnal

Distal femoral physeal fractures in adolescents are often due to high velocity injuries. We present an unusual case of a non-contact distal femoral physeal fracture that occurred during a football match. A torsional force had been directed at the fracture site occurring at the growth plate causing a transverse fracture rather than a spiral fracture. It is important to be aware that such fractures can occur despite little or no evidence of contact. These type of injuries should also be treated as an emergency to reduce the risk of further complications.

Matched MeSH terms: Growth Plate
Comparison study of growth plate fusion using MRI versus plain radiographs as used in age determination for exclusion of overaged football players

George J, Nagendran J, Azmi K

Br J Sports Med, 2012 Mar;46(4):273-8.
PMID: 21173009 DOI: 10.1136/bjsm.2010.074948

MRI of distal radius fusion is currently being used in the U17 World Cup to exclude overaged players. Developing countries that cannot afford to perform MRI on their players are using plain radiographs based on the same MRI criteria of fusion.

Matched MeSH terms: Growth Plate/anatomy & histology*; Growth Plate/radiography
Fulltext Bilateral brachymetatarsia: a rare case report

Norliyana, M., Mohd Yazid, B., Abdul Muhaimin, A.

Medicine & Health, 2018;13(1):279-285.
MyJurnal

Brachymetatarsia is a conditioned which has been described as abnormal short metatarsal bone due to premature closure of the epiphyseal growth plate. It usually involves a single metatarsal bone with the fourth metatarsal being the most common. It may be congenital or acquired. We here report a case in a 53-yearold lady who presented with foot pain and shoe wearing problem. Examination revealed shortening of the bilateral fourth toe and the toes were tilted dorsally. She was diagnosed with bilateral brachymetatarsia and operation was done mainly for cosmetic reasons. Gradual lengthening with distraction osteogenesis was performed using a MiniRail external fixator (Orthofix) and K-wiring of the right fourth metatarsophalangeal joint. Adequate length of fourth metatarsal and good bony union were achieved at the end of treatment.

Matched MeSH terms: Growth Plate
Limb-length discrepancy in children : treatment by growth arrest

Ibrahim, S.

Malaysian Journal of Child Health, 1997;9(2):178-181.
MyJurnal

Percutaneous epiphysiodesis for arresting growth is a useful method for equalising moderate lower limb-length discrepancy. This paper reviews the result of this procedure performed at the Royal Hospital for Sick Children in Glasgowfrom 1989 to 1993. There were 8 children (5 girls and 3 boys) ranging in age (chronological) from 10 years 3 months to 13 years 3 months. Limb-length discrepancies (LLD) at the time of surgery were between 2.5 cm to 5.5 cm. The predicted LLD at maturity was obtained using the Moseleys graph. This ranged from 3.9 cm to 8.3 cm. The cause of discrepancy were hemihypertrophy (5), neurofibromatosis (1), AV malformation (1) and neonatal osteomyelitis (1). Bone age in 3 patients corresponded to their chronological age. In 2 patients their bone age were less than their chronological age by 1 year. In the remaining 3 patients their bone were less than their chronological age by 1 to 3 years. All patients had percutaneous epiphysiodesis of both the distal femur and proximal tibia. All patients except one had afinal LLD of 1 cm or less. There were 2 unsatisfactory results: one girl had a valgus knee due to asymmetric physeal closure. Another boy had a final LLD of 3.3 cm as the procedure was done near skeletal maturity. This technique is useful even with LLD greater than 5 cm in children whose predicted height is above average. The difference between chronological age and bone age ranged from I to 3 years.

Matched MeSH terms: Growth Plate
Fulltext Multipurpose contrast enhancement on epiphyseal plates and ossification centers for bone age assessment

Chai HY, Swee TT, Seng GH, Wee LK

Biomed Eng Online, 2013;12:27.
PMID: 23565999 DOI: 10.1186/1475-925X-12-27

The high variations of background luminance, low contrast and excessively enhanced contrast of hand bone radiograph often impede the bone age assessment rating system in evaluating the degree of epiphyseal plates and ossification centers development. The Global Histogram equalization (GHE) has been the most frequently adopted image contrast enhancement technique but the performance is not satisfying. A brightness and detail preserving histogram equalization method with good contrast enhancement effect has been a goal of much recent research in histogram equalization. Nevertheless, producing a well-balanced histogram equalized radiograph in terms of its brightness preservation, detail preservation and contrast enhancement is deemed to be a daunting task.

Matched MeSH terms: Growth Plate/physiology*
Fulltext Role of C-type natriuretic peptide signalling in maintaining cartilage and bone function

Peake NJ, Hobbs AJ, Pingguan-Murphy B, Salter DM, Berenbaum F, Chowdhury TT

Osteoarthritis Cartilage, 2014 Nov;22(11):1800-7.
PMID: 25086404 DOI: 10.1016/j.joca.2014.07.018

C-type natriuretic peptide (CNP) has been demonstrated in human and mouse models to play critical roles in cartilage homeostasis and endochondral bone formation. Indeed, targeted inactivation of the genes encoding CNP results in severe dwarfism and skeletal defects with a reduction in growth plate chondrocytes. Conversely, cartilage-specific overexpression of CNP was observed to rescue the phenotype of CNP deficient mice and significantly enhanced bone growth caused by growth plate expansion. In vitro studies reported that exogenous CNP influenced chondrocyte differentiation, proliferation and matrix synthesis with the response dependent on CNP concentration. The chondroprotective effects were shown to be mediated by natriuretic peptide receptor (Npr)2 and enhanced synthesis of cyclic guanosine-3',5'-monophosphate (cGMP) production. Recent studies also showed certain homeostatic effects of CNP are mediated by the clearance inactivation receptor, Npr3, highlighting several mechanisms in maintaining tissue homeostasis. However, the CNP signalling systems are complex and influenced by multiple factors that will lead to altered signalling and tissue dysfunction. This review will discuss the differential role of CNP signalling in regulating cartilage and bone homeostasis and how the pathways are influenced by age, inflammation or sex. Evidence indicates that enhanced CNP signalling may prevent growth retardation and protect cartilage in patients with inflammatory joint disease.

Matched MeSH terms: Growth Plate/metabolism*
Osteoarticular allografts in paediatric bone tumor reconstruction of the knee

Campanacci DA, Dursky S, Totti F, Frenos F, Scoccianti G, Beltrami G, et al.

J Biol Regul Homeost Agents, 2015 Oct-Dec;29(4 Suppl):111-9.
PMID: 26652497

Osteoarticular allografts represent a reconstructive option after bone tumor resection around the knee in growing children. The major advantage is the chance to preserve the growth plate of the remaining bone, but the disadvantage is the high failure rate eventually requiring definitive prosthetic replacement at skeletal maturity. We retrospectively reviewed 22 patients who underwent osteoarticular allograft reconstructions of the distal femur (16) or proximal tibia (6). There were 12 females and 10 males with an average age at surgery of 11 years (7-15). The diagnosis was osteosarcoma in 19 cases and Ewing sarcoma in 3. All patients underwent pre- and post-operative chemotherapy. At an average follow-up of 103 months (12-167), 18 patients (82%) were alive and 4 had died (18%). We observed 10 allograft failures requiring prosthetic replacement, 6 in distal femur and 4 in proximal tibia reconstructions. At last follow-up 8 allografts (36%) were still in place. Overall allograft survival was 79.6% at five and 45.8% at ten years. In distal femur, allograft survival was 86.2% at five and 59.1% at ten years. In proximal tibia, allograft survival was 62.5% at 5 years and 31.2% at 67 months. Average limb shortening was 3 cm (0- 5) in 8 patients with the allograft still in situ and 2 cm (0-4) in 10 patients after prosthetic replacement. Average MSTS functional score of the whole series was 25 (83.7%). The MSTS score of patients after revision with prosthetic replacement was 24 (80%) while patients who still had the allograft retained had an average MSTS scores of 26.8 (89.3%). In conclusion, osteoarticular allograft reconstruction of the knee after bone tumor resection in pediatric age can be considered a temporary solution with the aim to limit limb length discrepancy before definitive prosthetic replacement after skeletal maturity.

Matched MeSH terms: Growth Plate
Breakage of an intramedullary rod after bone union in congenital pseudoarthrosis of the tibia: a report of two cases

Sulaiman AR, Simbak N, Wan Ismail WF, Wan Z, Halim AS

J Orthop Surg (Hong Kong), 2011 Aug;19(2):250-3.
PMID: 21857057

We report 2 patients with congenital pseudoarthrosis of the tibia who underwent intramedullary Rush rod transfixation through the ankle joint following refracture and nonunion of vascularised fibular grafting 6 and 8 months earlier. After 9 and 5 years, both Rush rods were broken at the level of the ankle joints, while the reconstructed area was solidly united. The growth of the distal tibia increased the distance of the tips of the broken rod and hence the ankle joint motion. The broken tips may damage the articular cartilage and result in valgus deformity of the ankle and limb length discrepancy.

Matched MeSH terms: Growth Plate/physiology
Fulltext Pachydermoperiostosis: a rare mimicker of acromegaly

Abdullah NRA, Jason WLC, Nasruddin AB

Endocrinol Diabetes Metab Case Rep, 2017;2017.
PMID: 28567291 DOI: 10.1530/EDM-17-0029

Pachydermoperiostosis is a very rare osteoarthrodermopathic disorder whose clinical and radiographic presentations may mimic those of acromegaly. In the evaluation of patients with acromegaloid appearances, pachydermoperiostosis should be considered as a differential diagnosis. In this article, we report a 17-year-old boy who presented with 2-year history of acral enlargement and facial appearance changes associated with joint pain and excessive sweating. He had been investigated extensively for acromegaly, and the final diagnosis was pachydermoperiostosis.
LEARNING POINTS: There is a broad range of differential diagnosis for acromegaloid features such as acromegaly, pseudoacromegaly with severe insulin resistance, Marfan's syndrome, McCune-Albright and a rare condition called pachydermoperiostosis.Once a patient is suspected to have acromegaly, the first step is biochemical testing to confirm the clinical diagnosis, followed by radiologic testing to determine the cause of the excess growth hormone (GH) secretion. The cause is a somatotroph adenoma of the pituitary in over 95 percent of cases.The first step is measurement of a serum insulin-like growth factor 1 (IGF1). A normal serum IGF1 concentration is strong evidence that the patient does not have acromegaly.If the serum IGF1 concentration is high (or equivocal), serum GH should be measured after oral glucose administration. Inadequate suppression of GH after a glucose load confirms the diagnosis of acromegaly.Once the presence of excess GH secretion is confirmed, the next step is pituitary magnetic resonance imaging (MRI).Atypical presentation warrants revision of the diagnosis. This patient presented with clubbing with no gigantism, which is expected in adolescent acromegalics as the growth spurt and epiphyseal plate closure have not taken place yet.

Matched MeSH terms: Growth Plate
Tooth mineralization stages as a diagnostic tool for assessment of skeletal maturity

Surendran S, Thomas E

Am J Orthod Dentofacial Orthop, 2014 Jan;145(1):7-14.
PMID: 24373650 DOI: 10.1016/j.ajodo.2013.09.007

The objective of this study was to determine whether dental calcification can be used as a first-level diagnostic tool for assessment of skeletal maturity.

Matched MeSH terms: Growth Plate/growth & development; Growth Plate/radiography