Physeal Injuries

Question 1

Areas proximal and distal to the physis?

Answer 1

Proximal - Diaphysis and Metaphysis

Distal - Epiphysis

Question 2

Horizontal and spherical growth plates are responsible for?

Answer 2

Horizontal - endochondral ossification and length

Spherical - epiphyseal growth in appositional direction

Question 3

The cells closest to the epiphysis are?

Answer 3

Cartilaginous

Question 4

Zone of growth

Answer 4

Resting, dividing and columnation

Contributes to appositional growth through the zone of ranvier

Question 5

Zone of maturation

Answer 5

Hypertrophy and calcification

MOST COMMON area of fracture

Decreased vascularity

Question 6

Zone of transformation

Answer 6

Vascular penetration and ossification

Question 7

Zone of Ranvier

Answer 7

Surrounds the growth zone

Composed of fibrovacular tissue, mesenchyme, epiphyseal and physeal cartilage, and osseous ring of Lacroix

Question 8

Ring of Lacroix

Answer 8

Extension of the metaphyseal cortex that acts as a peripheral restraint to the cell columns and provides stability to the physis

Question 9

Remodeling Zone

Answer 9

Osteoblasts lay down primary spongiosa that is replaced by secondary spongiosa with NO cartilage remnants

Question 10

Explain physeal growth ceasing with regard to capillary loops

Answer 10

Metaphyseal and nutrient arteries form closed capillary loops within the cartilage transformation zone and when the loops touch, physeal GROWTH CEASES

Question 11

To allow ingrowth of metaphyseal vessels, what must cartilage do?

Answer 11

Cartilage MUST sufficiently calcify

Question 12

Difference between epiphysis and apophysis?

Answer 12

Both are secondary ossification centers, however…

Epiphysis –> forms joints
Apophysis –> attachment for tendon

Question 13

Describe SH I

Answer 13

Through the hypertrophic zone

Question 14

SH 1 tx

Answer 14

Closed reduction
NWB cast 3 wks
WB cast another 3 wks

Question 15

SH II

Answer 15

Partially splits the physis and through the metaphysis

Question 16

What is a Thurston-Holland sign?

Answer 16

Metaphyseal triangular shaped piece of bone that results from SH II fracture

Question 17

MOST common physeal fracture?

Answer 17

SH II

Question 18

SHII

Answer 18

Partially extends through physis and exits through epiphysis into the joint.

Question 19

SH III tx

Answer 19

ORIF

Question 20

SH IV

Answer 20

Runs obliquely through the metaphysis, through the physis, and then through epiphysis and enters the joint.

Question 21

SH IV tx

Answer 21

ORIF

Question 22

SH V

Answer 22

Compression or crush of the physis that is difficult to diagnose b/c no fracture line evident

Question 23

SH VI

Answer 23

Damage to the periosteum or perichondral ring with resultant bony bridge formation external to growth plate

Question 24

SH VII

Answer 24

Damage to epiphysis and not to physis

Question 25

SH VIII

Answer 25

Damage to the metaphysis and not to physis

Question 26

SH IX

Answer 26

Injury to diaphyseal periosteum that may result in disruption of normal diaphyseal growth and remodeling

Question 27

What to use when doing ORIF for physeal fractures

Answer 27

Only smooth pins Parallel pins are safer Remove pins EARLY

Question 28

Transitional fractures

Answer 28

Result of external rotation force applied to the foot Occur when the tibial physis is closing. Includes tillaux and triplane fractures

Question 29

What is the sequence of tibial physis closure?

Answer 29

Central > medial > posterior > anterolateral

Question 30

What is a Tillaux fracture?

Answer 30

Anterolateral portion is fractured. Considered a SH III. | Fracture displaced anteriorly and laterally.

Question 31

Triplane fracture

Answer 31

Involves external rotation, eversion, and plantarflexion forces. One part always involves metaphysis of the tibia. Displaced lateral or medial

Question 32

Explain the follow-up process for these fractures

Answer 32

X-ray every 6-12 months to asses growth disturbance

Question 33

Explain a Harris/Park line

Answer 33

Transverse sclerotic line that is proximal to the epiphysis. It is a growth arrest line that develops during periods of absent growth following trauma.

Question 34

Difference b/w parallel and oblique Harris lines

Answer 34

Parallel harris lines result in minimal physeal damage Non-parallel lines tend to converge with the physis and indicates damage