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Physeal Injury

Tyler J Uppstrom, Meghan Price, Sheena Black, Elizabeth Gausden, Jonathan Haskel, Daniel W Green
PURPOSE: The purpose of this study was to assess the physeal safety associated with the use of an epiphyseal femoral socket for paediatric medial patellofemoral ligament (MPFL) reconstruction. METHODS: Fifty-four knees in 49 skeletally immature patients underwent physeal-sparing MPFL reconstruction performed by 1 surgeon at a tertiary care academic medical centre from 2007 to 2016. A femoral socket distal to the femoral physis was used for graft fixation in all the patients...
March 9, 2019: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Brandon J Yuan, Anthony A Stans, Dirk R Larson, Hamlet A Peterson
OBJECTIVE: In the 50 years since a premature partial physeal arrest (a physeal bar) was first excised from an epiphysis there have been no large in-depth studies reporting the results in patients followed to skeletal maturity. This paper reports the results of physeal bar resection surgery in a group of patients followed to skeletal maturity, documenting the restored growth of the affected physis, the affected bone, and the final limb-length discrepancy. METHODS: Forty-eight patients underwent physeal bar resection of the distal femur (21), proximal tibia (9), and distal tibia (18) by 1 surgeon (H...
February 25, 2019: Journal of Pediatric Orthopedics
Rok Kralj, Zoran Barcot, Tomislav Vlahovic, Mario Kurtanjek, Ivan Petracic
INTRODUCTION: Fractures of the phalanges in children can often be underappreciated by the physician of first contact. Therefore it is necessary to point out which of these fractures, because of the risk of possible future complications, need special mention. MATERIALS AND METHODS: A retrospective review of 512 fractures of the phalanges in children and adolescents during an one year period. Fractures were subdivided into the following categories - physeal fractures, intraarticular (phalangeal neck and condylar) fractures, shaft fractures, tuft fractures, "mallet finger" fractures, volar plate avulsion injuries and collateral ligament avulsion injuries...
February 13, 2019: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
Ricardo Santos-Pereira, Catarina Aleixo, Márcio Oliveira, André Sarmento, Mafalda Santos
Introduction: The Tillaux fracture is a rare subtype of tibial physeal fracture that usually occurs in adolescents. There are only a few case series or reports published in the literature and, to our knowledge, this is the first time, a painful nonunion is reported after this type of fracture. Case Report: A 13-year-old athlete presented to our orthopedic department because of persistent pain after an acute ankle injury 2months before. She was diagnosed with a Tillaux fracture that eventually progressed to nonunion after conservative treatment...
September 2018: Journal of Orthopaedic Case Reports
Alessio Pedrazzini, Paolo Bastia, Nicola Bertoni, Bianca Pedrabissi, Henry Claudel Yewo Simo, Vanni Medina, Francesco Ceccarelli, Francesco Pogliacomi
Radius and ulna fractures are the most common long bone fractures in children and adolescents. The majority of these injuries involve the distal metaphyseal portion of the radius associated or not to physeal plate injuries. Because of the high remodelling potential of the distal radius in growing children most injuries heal without complication after closed reduction and immobilization in a long arm cast. Nonunions of closed distal radius fracture are an extremely rare occurrence especially in paediatric population...
December 18, 2018: Acta Bio-medica: Atenei Parmensis
R F Wang, Y Lou, K Tang, G P Liu, M C Chen, G Lin
Objective: To investigate the early clinical outcomes of hip anterior short incision and open reduction and internal fixation for the treatment of children with Delbet Ⅱ femoral neck fracture. Methods: A retrospective analysis of 12 children with DelbetⅡ femoral neck fractures was performed with the anterior short incision approach at Department of Pediatric Orthopaedic, Children's Hospital, Nanjing Medical University from January 2014 to August 2016. There were 7 males and 5 females including 8 cases at left side and 4 cases at right side,aged (11...
February 1, 2019: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Raghav Badrinath, Cordelia W Carter
Multiligamentous knee injuries occur rarely in the pediatric population. Few reports are available in the existing literature; furthermore, no longitudinal studies regarding the choice of treatment and long-term outcomes for this unique population have been published. To fill this knowledge gap, the literature on multiligamentous injuries of the knee in the adult population is commonly used as a guideline in clinical decision making for children and adolescents. However, the developing bone and physis are often weaker than the ligamentous structures of the knee-particularly during periods of rapid growth-and may be the first to fail in the event of injury or trauma...
October 2018: Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews
Allison Binkley, Charles Mehlman, Ellen Freeh
OBJECTIVES: The purpose of this study was to determine the correlation of Salter-Harris II fracture patterns with premature physeal closure (PPC) and resultant angular deformity of the ankle. DESIGN: Retrospective review SETTING:: Cincinnati Children's Hospital Medical Center (Outpatient level of care)Patients/Participants: We searched the digital ankle radiographs taken at our institution from 2001 thru 2010, identifying all skeletally immature patients with confirmed ankle fractures...
January 8, 2019: Journal of Orthopaedic Trauma
Jinhee Park, Yunsik Cha, Michael Seungcheol Kang, Soo-Sung Park
OBJECTIVES: to investigate the fracture pattern and periosteal entrapment in adolescent distal tibial physeal fractures. DESIGN: Retrospective case series SETTING:: Level I academic trauma centerPatients/Participants: Fifty patients (age 10-16 years) with displaced Salter-Harris type II, III, or IV distal tibial physeal fractures were retrospectively reviewed. INTERVENTION: periosteal involvement, fracture pattern MAIN OUTCOME MEASUREMENTS:: We investigated the incidence and location of periosteal entrapment in those fractures and the angle of the fracture plane of metaphyseal fragments on axial plane by using MRI...
January 8, 2019: Journal of Orthopaedic Trauma
Zachary R Ashwell, Michael L Richardson
We describe a case of chronic overuse injury of the distal radial physis (gymnast's wrist). While the radiographic appearance of this entity has been reported, there are limited studies highlighting the MR appearance of this entity. This lesion is being seen with increasing frequency in young, elite gymnasts. If this injury goes unrecognized, there is potential for abnormal osseous development, with premature physeal fusion, abnormal joint inclination and even Madelung deformity.
March 2019: Radiology Case Reports
Sedat Giray Kandemirli, Feyza Kabar, Guzin Cakir Kandemirli, Nadide Basak Gulleroglu, Zeynep Yazici
Clavicle duplication is a rare entity with limited number of cases reported. Congenital origin and trauma related mechanisms are the main hypotheses to explain this anatomical variation. In skeletally immature patient, trauma may cause physeal-metaphyseal injury in the distal clavicle rather than acromioclavicular strain. The distal epiphysis remains in continuity with acromion and has an intact periosteal sleeve. The periosteal sleeve is extremely osteogenic, and may lead to new bone formation between epiphysis and displaced metaphysis...
December 8, 2018: Surgical and Radiologic Anatomy: SRA
Neeraj M Patel, Christopher J DeFrancesco, Nakul S Talathi, Joshua T Bram, Theodore J Ganley
INTRODUCTION: Complication rates after physeal-sparing anterior cruciate ligament reconstruction (ACLR) are known to be high in the paediatric population compared with the adult population. However, the outcomes of these skeletally immature patients after all-epiphyseal reconstruction have not been compared with those after transphyseal reconstructions in a more similar age group. This study compares clinical outcomes and complications between all-epiphyseal and pediatric transphyseal ACLR...
December 10, 2018: Journal of the American Academy of Orthopaedic Surgeons
Maria Tuca, Nazira Bernal, Eva Luderowski, Daniel W Green
PURPOSE OF REVIEW: The purpose of this review is to summarize and clarify the current framework for treating tibial spine avulsion fractures (TSAFs). We will discuss how these fractures are classified both on plain radiographs and MRI as well as report the incidence of concomitant soft tissue injury, an important consideration that guides treatment. We will also compare guidelines for nonsurgical versus surgical treatment and summarize frequently used surgical techniques. Finally, we will review outcomes following treatment, including common complications...
February 2019: Current Opinion in Pediatrics
Adam Margalit, Ethan Cottrill, Derek Nhan, Lingjia Yu, Xin Tang, Jan Fritz, R Jay Lee
BACKGROUND: The spatial order of physeal maturation around the distal tibia has been shown to place adolescent patients at risk for certain transitional injuries, such as Tillaux or triplane fractures. Less is known about physeal maturation around the knee. The purpose of this study was to establish the spatial order of physeal maturation in the normal human knee using magnetic resonance imaging (MRI). METHODS: We retrospectively collected all knee MRI scans from patients presenting to our institution from January 2004 to January 2014...
November 16, 2018: Journal of Pediatric Orthopedics
J Hendrych, T Pešl, P Havránek
PURPOSE OF THE STUDY The triplane fracture of the distal tibial epiphysis is characterised by the fracture line in typical three planes which can, however, differ case by case. The authors use the CT imaging as the perfect examination method to determine the nature of the fracture to plan the osteosynthesis. MATERIAL AND METHODS In the five-year retrospective study of a group of patients treated at their own department in the period 2011-2015 the authors assess a total of 55 patients with a triplane fracture...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
C Siebenmann, F Ramadani, G Barbier, E Gautier, P Vial
Physeal fractures of the medial clavicle with posterior displacement of the metaphysis are very rare injuries, but additional injuries can be life-threatening. Due to the specific clavicular ossification process, skeletally immature patients present usually not true sternoclavicular joint (SCJ) dislocations accordingly to adults but rather displaced physeal fractures. There is no consensus in the current literature on the best treatment of this lesion. Conservative treatment is not resulting in good outcome; closed reduction is often not successful, and open reduction with internal fixation is finally required...
2018: Case Reports in Orthopedics
James S Lin, James E Popp, Julie Balch Samora
BACKGROUND: Seymour fractures are distal phalanx fractures in children with a juxta-epiphyseal pattern. The purpose of our study was to investigate the treatments, outcomes, operative ;indications, and antibiotic choice for acute Seymour fractures (presenting within 24 h of injury), to better define optimal management. We hypothesized that: (1) cephalexin provides adequate antibiotic coverage for acute Seymour fractures; (2) most injuries will achieve good outcomes with management in the emergency department (ED) alone; and (3) indication for operative intervention is unsuccessful or unstable reduction in the ED...
January 2019: Journal of Pediatric Orthopedics
M Razzi, A Nordin
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...
October 2018: Medical Journal of Malaysia
Nariyoshi Ishii, Noboru Matsumura, Takuji Iwamoto, Kazuki Sato, Masaya Nakamura, Morio Matsumoto
CASE: A 15-year-old boy with a posterior physeal fracture-dislocation of the medial aspect of the clavicle and a 14-year-old boy with a posterior sternoclavicular joint dislocation were successfully treated with temporary sternoclavicular stabilization using an innovative blocking technique with Kirschner wires. CONCLUSION: When treating posterior sternoclavicular joint injuries, posterior instability should be securely stabilized. Temporary blocking stabilization of the sternoclavicular joint using Kirschner wires does not rigidly fix the sternoclavicular joint, but it prevents posterior displacement of the proximal aspect of the clavicle...
July 2018: JBJS Case Connector
Alexandr Aylyarov, Mikhail Tretiakov, Sarah E Walker, Claude B Scott, Khalid Hesham, Aditya V Maheshwari
Pediatric intrasubstance anterior cruciate ligament (ACL) tears have a significant epidemiologic impact as their numbers continue to grow globally. This review focuses on true pediatric intrasubstance ACL tears, which occur >400,000 times annually. Modifiable and non-modifiable risk factors include intercondylar notch width, ACL size, gender, landing mechanisms, and hormonal variations. The proposed mechanisms of injury include anterior tibial shear and dynamic valgus collapse. ACL tears can be associated with soft tissue and chondral defects...
September 2018: Indian Journal of Orthopaedics
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