Physeal Injuries Flashcards
Areas proximal and distal to the physis?
Proximal - Diaphysis and Metaphysis
Distal - Epiphysis
Horizontal and spherical growth plates are responsible for?
Horizontal - endochondral ossification and length
Spherical - epiphyseal growth in appositional direction
The cells closest to the epiphysis are?
Cartilaginous
Zone of growth
Resting, dividing and columnation
Contributes to appositional growth through the zone of ranvier
Zone of maturation
Hypertrophy and calcification
MOST COMMON area of fracture
Decreased vascularity
Zone of transformation
Vascular penetration and ossification
Zone of Ranvier
Surrounds the growth zone
Composed of fibrovacular tissue, mesenchyme, epiphyseal and physeal cartilage, and osseous ring of Lacroix
Ring of Lacroix
Extension of the metaphyseal cortex that acts as a peripheral restraint to the cell columns and provides stability to the physis
Remodeling Zone
Osteoblasts lay down primary spongiosa that is replaced by secondary spongiosa with NO cartilage remnants
Explain physeal growth ceasing with regard to capillary loops
Metaphyseal and nutrient arteries form closed capillary loops within the cartilage transformation zone and when the loops touch, physeal GROWTH CEASES
To allow ingrowth of metaphyseal vessels, what must cartilage do?
Cartilage MUST sufficiently calcify
Difference between epiphysis and apophysis?
Both are secondary ossification centers, however…
Epiphysis –> forms joints
Apophysis –> attachment for tendon
Describe SH I
Through the hypertrophic zone
SH 1 tx
Closed reduction
NWB cast 3 wks
WB cast another 3 wks
SH II
Partially splits the physis and through the metaphysis
What is a Thurston-Holland sign?
Metaphyseal triangular shaped piece of bone that results from SH II fracture
MOST common physeal fracture?
SH II
SHII
Partially extends through physis and exits through epiphysis into the joint.
SH III tx
ORIF
SH IV
Runs obliquely through the metaphysis, through the physis, and then through epiphysis and enters the joint.
SH IV tx
ORIF
SH V
Compression or crush of the physis that is difficult to diagnose b/c no fracture line evident
SH VI
Damage to the periosteum or perichondral ring with resultant bony bridge formation external to growth plate
SH VII
Damage to epiphysis and not to physis
SH VIII
Damage to the metaphysis and not to physis
SH IX
Injury to diaphyseal periosteum that may result in disruption of normal diaphyseal growth and remodeling
What to use when doing ORIF for physeal fractures
Only smooth pins
Parallel pins are safer
Remove pins EARLY
Transitional fractures
Result of external rotation force applied to the foot
Occur when the tibial physis is closing.
Includes tillaux and triplane fractures
What is the sequence of tibial physis closure?
Central > medial > posterior > anterolateral
What is a Tillaux fracture?
Anterolateral portion is fractured. Considered a SH III.
Fracture displaced anteriorly and laterally.
Triplane fracture
Involves external rotation, eversion, and plantarflexion forces.
One part always involves metaphysis of the tibia.
Displaced lateral or medial
Explain the follow-up process for these fractures
X-ray every 6-12 months to asses growth disturbance
Explain a Harris/Park line
Transverse sclerotic line that is proximal to the epiphysis. It is a growth arrest line that develops during periods of absent growth following trauma.
Difference b/w parallel and oblique Harris lines
Parallel harris lines result in minimal physeal damage
Non-parallel lines tend to converge with the physis and indicates damage
