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Physeal Injury

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...
December 3, 2018: 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...
October 24, 2018: 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
Thomas Palocaren
Paediatric femoral neck fractures are uncommon injuries and are usually caused by high-energy trauma. Low-energy trauma can result in pathologic neck fractures and stress fractures of the neck, due to repetitive activity. Surgical options can vary based on age, Delbet classification and displacement of the fracture. Treatment for displaced fractures is by closed or open reduction and smooth/cancellous screw fixation. Compression screw and side plate fixation is indicated for basal fractures. Fixation should be supplemented by spica cast immobilization in younger children...
September 2018: Indian Journal of Orthopaedics
Samir Sabharwal, Sanjeev Sabharwal
Background: The presence of growth plates at the ends of long bones makes fracture management in children unique in terms of the potential risk of developing angular deformities and growth arrest. Materials and Methods: We discuss three distinct cases depicting various aspects of physeal injury of the lower extremity in children. Results: The case illustrations chosen represent distinct body regions and different physeal injuries: Salter-Harris II fracture of the distal femur, Salter-Harris VI perichondrial injury of the medial aspect of the knee region, and Salter-Harris III fracture of the distal tibia...
September 2018: Indian Journal of Orthopaedics
C Yang, S Weisbrode, J Yardley, E Schroeder, C Premanandan
Ischaemia-induced physeal injury has not been described previously in the horse. A 1-month-old Quarter horse foal was submitted for necropsy examination due to an acute onset of ataxia followed by a 4-week history of progressive decline. Focal narrowing of the spinal canal due to ventral compression by the rotation of the cranial aspect of the third cervical vertebra (C3) was observed. The metaphysis and diaphysis of C3 were markedly shortened and white-tan in colour. Microscopically, there was complete loss of the dorsal compact bone of C3 and replacement of 80% of the physis that runs parallel to the vertebral canal with fibrous tissue and thickened viable trabecular bone...
August 2018: Journal of Comparative Pathology
Gina Lesko, Kyle Altman, Grant Hogue
We present a case of a 10-year-old girl who sustained a Lisfranc fracture-dislocation after an all-terrain vehicle accident. She underwent open reduction and internal fixation with smooth Kirschner wires. At 5-year follow-up, she had developed functional pain and radiographic evidence of degenerative arthritis and partial fusion of her midfoot. There are several possible explanations for this outcome, including loss of reduction, traumatic or iatrogenic physeal injury, and severity of initial injury. Long-term outcomes in children with Lisfranc injuries are not well described...
March 2018: Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
Michelle T Sugi, Kali Tileston, Jeffery E Krygier, James Gamble
BACKGROUND: Pediatric ankle injuries are common, giving rise to ∼17% of all physeal injuries. An os subfibulare in a child with an ankle sprain may be confused with a type VII transepiphyseal fracture. Here, we evaluate the clinical and radiographic features of type VII transepiphyseal fractures to those of os subfibulare presenting with acute ankle trauma with the hypothesis that radiographs are necessary for final diagnosis and neither clinical history nor examination would be diagnostic...
November 2018: Journal of Pediatric Orthopedics
Innes Dm Smith, Ahmer Irfan, James S Huntley, Simon J Spencer
With the heightened popularity of childhood sporting activity, the number of paediatric anterior cruciate ligament (ACL) ruptures has increased. Management of these injuries presents a particular challenge due to the open femoral and tibial growth plates. Physeal damage has the potential to cause angular deformity or length discrepancy. This review was conducted to determine the best way to treat this injury. A primary search of Ovid MEDLINE (1 October 2017) used the terms: (ACL or anterior cruciate ligament) and (young or child or children or pediatric or immature or pre-pubescent)...
September 2018: Journal of Paediatrics and Child Health
Elliot M Greenberg, Christian Turner, Casey Huse, Theodore J Ganley, Philip McClure, J Todd Lawrence
OBJECTIVE: To present the case of a 15 year-old baseball player with Little League Shoulder (LLS) and describe how developmental changes in the angle of humeral retrotorsion (HRT) may contribute to the underlying pathology of this condition. DESIGN: Case report. SETTING: Two years earlier, the patient had participated in a healthy player screening program at which time measurements of height, weight, shoulder motion, and HRT were obtained...
November 2018: Physical Therapy in Sport
Dong Kyu Moon, Jin Sung Park, Young Jin Park, Soon Taek Jeong
INTRODUCTION: Distal radius physeal fractures are common in pediatric patients. Although most of these fractures heal without complication, some result in significant physeal arrest. If significant physeal arrest occurs, the various treatment methods can be applied depending on the severity of deformity and remaining growth of the patient. PRESENTATION OF CASE: We present a 16-year old female with distal radial physeal arrest who presented four years after initial injury...
2018: International Journal of Surgery Case Reports
Sai-Won Kwon, Si-John Hong, Jae-Hwi Nho, Sang Il Moon, Ki Jin Jung
RATIONALE: In competitive athletes, the upper extremity is subject to tremendous torsional forces with axial loading due to repetitive weight bearing. Approximately 25% of injuries in sports are related to the hand or wrist. Skeletal deformity on the wrist physis is common in athletes due to repetitive loading and presents at early ages between 6 and 13 years. Additionally, it is more common in female than in male athletes. PATIENT CONCERNS: An 11-year-old girl who was a climber complained of pain on her left wrist without direct trauma...
August 2018: Medicine (Baltimore)
N K Sferopoulos
Superficial local cryotherapy is frequently and safely used for pain relief following musculoskeletal injury or disease. However, serious skin complications have been reported in adults following inappropriate application. Skin burns following superficial local cryotherapy have not been previously reported in children. The consequences of inappropriate use of various forms of cryotherapy in four children following sport injuries are presented. They were all primarily misdiagnosed with a soft tissue injury. The incorrect usage was due to the high severity of the local symptoms and signs...
July 2018: Journal of Bodywork and Movement Therapies
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