1
|
Sinha S, Aggarwal N, Kumar A, Singh L, Iqbal A, Qureshi OA, Kumar S, Jameel J. K-Wire-Based External Fixator for Management of Salter-Harris Type-II Distal Femur Physeal Injury. Cureus 2023; 15:e46070. [PMID: 37900479 PMCID: PMC10608687 DOI: 10.7759/cureus.46070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
We present a case of a 16-year-old male with a Salter-Harris type II physeal slip of the distal femur managed with closed reduction and K wire and clamp-based external fixator. Knee range of motion exercises were initiated after one week. The union was observed at 10 weeks, and implant removal was done on an outpatient basis. At one year follow-up, the patient had good clinical and radiological outcomes. The K-wire-based external fixator frame is an effective fixation method for distal femur physeal slips in older children, providing favorable radiological and functional outcomes.
Collapse
Affiliation(s)
- Siddhartha Sinha
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Neel Aggarwal
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Arvind Kumar
- Orthopaedics, Jai Prakash Narayan Apex Trauma Centre (JPNATC) All India Institute of Medical Sciences, New Delhi, IND
| | - Lokendra Singh
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Asif Iqbal
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Owais A Qureshi
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Sandeep Kumar
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Javed Jameel
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| |
Collapse
|
2
|
Allen H, Barnthouse NC, Chan BY. Periosteal Pathologic Conditions: Imaging Findings and Pathophysiology. Radiographics 2023; 43:e220120. [DOI: 10.1148/rg.220120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Hailey Allen
- From the Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Nicholas C. Barnthouse
- From the Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Brian Y. Chan
- From the Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
| |
Collapse
|
3
|
Nguyen JC, Gendler L, Guariento A, Nguyen MK, Hong S, Grady MF, Caine D. MRI findings of growth plate fractures of the knee: are there age- and fracture-dependent differences? Skeletal Radiol 2023; 52:1321-1329. [PMID: 36598521 DOI: 10.1007/s00256-022-04262-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 10/20/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate MRI findings in children with physeal fractures of the knee with respect to age, location, and articular involvement. METHODS Children with physeal fractures who underwent knee MRI between 2008 and 2021 were included. Two radiologists retrospectively reviewed all examinations to determine articular involvement, findings of physeal instability (perichondral disruption, periosteal entrapment), and internal derangement (cruciate ligament injury, meniscal tear, chondromalacia). Independent samples t, Mann-Whitney U, Pearson's chi-square, and Fisher's exact tests were used to compare findings. RESULTS Fifty-six patients (37 boys, 19 girls; mean age: 12.2 ± 2.5 years; 32 distal femur, 24 proximal tibial fractures) included 24(43%) intraarticular fractures. Fractures were more common in the tibia than the femur (67% versus 25%, p = 0.004) and intraarticular fractures were more common in older than younger children (13.1 ± 2.0 versus 11.5 ± 2.7 years, p = 0.01), to associate with chondromalacia (46% versus 12%, p = 0.02) and undergo surgery (33% versus 10%, p = 0.04) when compared to extraarticular fractures. Perichondral disruption (n = 44, 79%) and periosteal entrapment (n = 13, 23%) did not significantly differ based on location or articular involvement (p > 0.05). At a median follow-up of 17.5 months (interquartile range: 1.25-34), 3 patients (2 intraarticular, 1 extraarticular fractures) developed osteoarthritis, osteochondral lesion, and leg-length discrepancy from growth arrest, which required additional surgery. CONCLUSION Intraarticular physeal fractures were more common with older children, associate with chondromalacia, and underdo surgical intervention when compared to extraarticular fractures of the knee. While MRI findings of physeal instability were common, no significant differences were found between fractures based on anatomic location or fracture pattern.
Collapse
Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd , Philadelphia, PA, USA. .,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Liya Gendler
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd , Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd , Philadelphia, PA, USA
| | - Michael K Nguyen
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Shijie Hong
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd , Philadelphia, PA, USA
| | - Matthew F Grady
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dennis Caine
- Kinesiology and Public Health Education, Division of Education, Health and Behavior Studies, University of North Dakota, Grand Forks, ND, USA
| |
Collapse
|
4
|
Complicated Growth Plate Fracture: Torn Metaphyseal Periosteum with Physeal Interposition. J Belg Soc Radiol 2021; 105:83. [PMID: 34964020 PMCID: PMC8663739 DOI: 10.5334/jbsr.2644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022] Open
Abstract
Teaching point: Displacement of torn periosteum into the growth plate is an uncommon pediatric entity following trauma – which can be seen on an MRI as low signal intensity physeal interposition on all pulse sequences, and requires open surgical reduction, as it may lead to growth plate bridging and subsequent extremity length discrepancy.
Collapse
|
5
|
Adagaba RAG, Gatchou ALK, Loucheur N, Boboe J, Ganglo M, Guedehounsou L, Megninou MUB, Docquier PL. [Periosteum entrapped in growth plate cartilage in patients with epiphyseal fracture-separation: about a case]. Pan Afr Med J 2021; 39:235. [PMID: 34659608 PMCID: PMC8498677 DOI: 10.11604/pamj.2021.39.235.27764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022] Open
Abstract
L´incarcération de corps étranger dans le cartilage de croissance est une pathologie rare. Elle survient souvent lors d´un décollement épiphysaire. Son diagnostic est radiologique, reposant sur l'imagerie par résonnance magnétique (IRM) cérébrale. Nous rapportons ici, le cas d´une fille de 13 ans qui s´est présenté pour un genou douloureux post traumatique gauche. L´examen clinique et les radiographies standards réalisées était en faveur d´un décollement épiphysaire type 1 de Salter-Harris. Le traitement de première intention qui avait consisté en une immobilisation plâtrée pendant trois semaines était non satisfaisante. Devant cet échec thérapeutique, une IRM a été réalisée et mise en évidence une incarcération de corps étranger dans le cartilage de conjugaison. La prise en charge secondaire a été chirurgicale avec des suites opératoires simples.
Collapse
Affiliation(s)
| | | | - Naima Loucheur
- Service de Chirurgie Générale, Hôpital Saint Jean de Dieu de Tanguiéta, Tanguiéta, Bénin
| | - Jordan Boboe
- Service de Chirurgie Générale, Hôpital Saint Jean de Dieu de Tanguiéta, Tanguiéta, Bénin
| | - Maturin Ganglo
- Service de Chirurgie Générale, Hôpital Saint Jean de Dieu de Tanguiéta, Tanguiéta, Bénin
| | - Loriano Guedehounsou
- Service de Chirurgie Générale, Hôpital Saint Jean de Dieu de Tanguiéta, Tanguiéta, Bénin
| | | | - Pierre-Louis Docquier
- Service de Chirurgie Générale, Hôpital Saint Jean de Dieu de Tanguiéta, Tanguiéta, Bénin
| |
Collapse
|
6
|
Affiliation(s)
- Nancy A Chauvin
- Department of Pediatric Radiology, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA.
| |
Collapse
|
7
|
Sports-Related Injuries of the Pediatric Musculoskeleton. ACTA ACUST UNITED AC 2021. [DOI: 10.1007/978-3-030-71281-5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
AbstractWorldwide, more than 50 million children and adolescents participate in organized athletic programs annually. Despite the numerous health and well-being benefits, this widespread involvement also leads to acute and overuse injuries that account for millions of medical visits each year. Musculoskeletal injury in childhood may lead to growth disturbance and lifelong disability. Imaging plays a critical role in the diagnosis and management of these injuries. While radiography is sufficient for most long bone fractures, MRI is often necessary for optimal evaluation of injuries involving the radiolucent growth mechanism and articular structures. The following review will discuss the imaging features associated with many sports-related injuries unique to the pediatric musculoskeleton, specifically the lower extremity.
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW Premature Physeal Closure (PPC) is the most common consequence of a mostly posttraumatic, physeal injury. They are of utmost importance because they can significantly alter physeal function and lead to disorders such as limb length discrepancies and angular deformities. RECENT FINDINGS The type of physeal fracture has not demonstrated a solid predictive value in the formation of PPC, especially in the knee where almost any type of fracture can produce it. The detection of physeal damage with imaging tests (simple radiology and MRI) is very accurate; however, their predictive capacity to foretell which injury will generate a physeal bridge is still poor. For this reason, it is not advisable to make surgical decisions at the first medical assessment. Direct surgical management of PPC's (resection-interposition technique) has generally shown high unpredictability. Nevertheless, the latest interposition materials (chondrocytes and mesenchymal stem cells) showed promising results. SUMMARY PPC is an often devastating consequence of physeal injury and as such deserves further research. To date little is known about etiopathogenesis, risk factors and natural history among other aspects. Until direct surgery offers more consistent results, acute osteotomies and bone distraction for progressive correction continue to be the most widespread treatments for PPCs.
Collapse
|
9
|
Tsai JA, Shah K, Sussman AR. Test yourself: right knee pain after fall. Skeletal Radiol 2020; 49:2103-2104. [PMID: 32627060 DOI: 10.1007/s00256-020-03524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Jau-Ann Tsai
- Department of Radiology, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA.
| | - Kush Shah
- Department of Radiology, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - A Ross Sussman
- Department of Radiology, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA.,University Radiology Group, 579A Road, East Brunswick, Cranbury, NJ, 08816, USA
| |
Collapse
|
10
|
Abstract
Distal femur physeal fractures are known to have a high incidence of complications. Our previous reported experience (pre-2007) showed a 40% complication risk, which prompted changes in our approach. The purpose of this study was to evaluate and compare the complication rate and outcome after implementation of these changes. This is a retrospective study of children with distal femur physeal fractures treated at a level 1 pediatric trauma center between 2007 and 2016. Patient demographics, fracture patterns, treatment and outcomes including complications and its risk factors were recorded and analyzed. We compared current results with our previously reported multicenter cohort (n = 73). Patients were male in majority (57/70) with a mean age of 13 ± 4 years. Fractures were most commonly Salter-Harris Type 2 (49/70) and displaced (59/70) on presentation, although neither characteristic was associated with complications. Most patients (63/70) were treated surgically, and the overall complication incidence was 36% (25/70), including growth arrest in 20 patients. The pre-2007 cohort was statistically significantly younger (P < 0.001) and was more commonly treated nonoperatively (P < 0.001). However, there was no statistically significant difference in complication incidence between studies (36% versus 40%, respectively, P = 0.751). Despite a lower threshold for surgery for distal femur physeal fractures in the past decade, the complication rate is still high and unchanged at 40%, and presenting patients are older. There were no new prognostic factors that showed statistically significant association with subsequent complications; however, patients with high-energy injury mechanisms and greater fracture displacements did have higher complication rates. These results demonstrate the inherent high complication risk for these injuries. Level of Evidence: III.
Collapse
|
11
|
Edmonds EW, Doan JD, Farnsworth CL. Periosteal incarceration versus interposition adipose tissue grafting in physeal fractures: pilot study in immature rabbits. J Exp Orthop 2019; 6:46. [PMID: 31788750 PMCID: PMC6885469 DOI: 10.1186/s40634-019-0214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/21/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose The purpose of this study is to evaluate bar formation following physeal fracture with incarcerated periosteum or adipose tissue graft using radiographic and histological methods in an immature rabbit model. Methods Ten-week-old rabbits underwent induced proximal tibia physeal fractures with a contralateral sham. Fractures had periosteum (n = 5) or adipose tissue (n = 5) interposed. Radiographs were compared over time by tibial medial-lateral side difference (TMLSD)(mm), femoral-tibial angle and tibia plateau angle, and physeal bars evidence. MicroCT was performed, growth plates reconstructed, and physeal area calculated and normalized to same animal contralateral physes. Physeal disruption and chondrocyte organization were evaluated histologically. Results Radiographic: After 6 weeks, physeal bars formed in both periosteum (4 of 4) and fat groups (3 of 5). The periosteum group showed a significant increase in the TMLSD between immediate post-op and 10 days later (p = 0.028); but, after 6 weeks, TMLSD change was not significantly different between the three groups (p = 0.161). MicroCT: The normalized physeal area of every physis in the fat group was more than 0.9 (0.99 ± 0.06). Only half of the periosteum group was over 0.9 (0.81 ± 0.24). Histology: Physeal disruption was seen by microscopic evaluation in none of the sham group, all 4 in the periosteum group and 4 of 5 in the fat group. Conclusions Fat interposition may prevent, or at least delay, the onset of bars across a fractured physis compared to periosteum, but it is not completely protective.
Collapse
Affiliation(s)
- Eric W Edmonds
- Division of Orthopedic Surgery, Rady Children's Hospital, 3020 Children's Way, MC 5054, San Diego, CA, 92123, USA. .,Department of Orthopaedic Surgery, University of California San Diego, 3020 Children's Way, MC 5054, San Diego, CA, 92123, USA.
| | - Joshua D Doan
- Division of Orthopedic Surgery, Rady Children's Hospital, 3020 Children's Way, MC 5054, San Diego, CA, 92123, USA
| | - Christine L Farnsworth
- Division of Orthopedic Surgery, Rady Children's Hospital, 3020 Children's Way, MC 5054, San Diego, CA, 92123, USA
| |
Collapse
|
12
|
O'Dell MC, Jaramillo D, Bancroft L, Varich L, Logsdon G, Servaes S. Imaging of Sports-related Injuries of the Lower Extremity in Pediatric Patients. Radiographics 2017; 36:1807-1827. [PMID: 27726754 DOI: 10.1148/rg.2016160009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
With increasing participation and intensity of training in youth sports in the United States, the incidence of sports-related injuries is increasing, and the types of injuries are shifting. In this article, the authors review sports injuries of the lower extremity, including both acute and overuse injuries, that are common in or specific to the pediatric population. Common traumatic injuries that occur in individuals of all ages (eg, tears of the acetabular labrum and anterior cruciate ligament) are not addressed, although these occur routinely in pediatric sports. However, some injuries that occur almost exclusively in high-level athletes (eg, athletic pubalgia) are reviewed to increase awareness and understanding of these entities among pediatric radiologists who may not be familiar with them and thus may not look for them. Injuries are described according to their location (ie, hip, knee, or foot and ankle) and pathologic process (eg, apophysitis, osteochondritis dissecans). Examples of abnormalities and normal variants of the anatomy that are often misdiagnosed are provided. The injuries reviewed represent a common and growing subset of pathologic processes about which all pediatric and musculoskeletal radiologists should be knowledgeable. Understanding physeal injury is especially important because missed diagnoses can lead to premature physeal closure and osteoarthritis. ©RSNA, 2016.
Collapse
Affiliation(s)
- M Cody O'Dell
- From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.)
| | - Diego Jaramillo
- From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.)
| | - Laura Bancroft
- From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.)
| | - Laura Varich
- From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.)
| | - Gregory Logsdon
- From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.)
| | - Sabah Servaes
- From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.)
| |
Collapse
|
13
|
Abstract
While some fractures may be managed similarly in adults and children, physeal fractures are uniquely limited to the pediatric population and require special consideration. Although physeal fractures about the knee are relatively rare, they are occurring more frequently due to increasing youth participation in sports and high-energy recreational activities. The evaluation and management of distal femoral and proximal tibial physeal fractures are similar to one another, but fractures of the tibial spine and tibial tubercle are approached somewhat differently. A thorough understanding of the pertinent developmental anatomy is critical for correlating the clinical findings with the imaging work-up, and for anticipating the most common and the most serious complications of each fracture. Diagnosis is usually made with appropriate plain radiographs with advanced imaging often used for preoperative planning. In general, fracture pattern and degree of displacement determine the need for surgical intervention and the overall outcome. While a variety of fixation techniques or constructs may be used, because of the importance of restoring physeal and articular anatomy for avoidance of growth disturbance and degenerative joint disease, respectively, achieving anatomic, rigid fixation is of greater importance than with many other fracture locations in the growing skeleton.
Collapse
|