Epiphyseal Injuries in Sports

In brief: About 10% of skeletal trauma in childhood involves epiphyseal injury, which can result in major skeletal growth disturbances. Limb-length discrepancies and joint angle deformities can be prevented by understanding (1) the mechanism and patterns of longitudinal bone growth, (2) the significance of skeletal maturational variances at different ages, (3) the probable locations of epiphyseal injuries, (4) the physical and radiographic signs of epiphyseal injury, and (5) the procedures available for treating deformities that result from epiphyseal injuries. Salter-Harris type I and II injuries are usually successfully treated by closed manipulation and adequate immobilization. Type III, IV, and V injuries often require surgery to achieve satisfactory alignment.     

体育运动所致小儿髌骨骨折及其诊断

小儿髌骨骨折比较少见。本文报告１３例体育运动所致小儿髌骨骨折，其中男ｌｌ例，女２例，年龄９－１４岁，平均ｌｌ．２岁。横形骨折３例，袖套骨折８例，粉碎骨折１例。有２例分别于伤后２天和５天方明确诊断。作者认为，髌骨袖套骨折是小儿髌骨骨折的一个显著特征，诊断时应注意与二分髌骨、胫骨结节撕脱骨折、Ｏｓｇｏｏｄ－Ｓｃｈａｌａｔｔｅ病、ｓｉｎｄｉｎｇ－Ｌａｒｓｅｎ－Ｊｏｈａｎｎｓｏｎ病等相鉴别。     

Epiphyseal involvement in osteosarcoma

Plain radiography and magnetic resonance (MR) imaging were used to assess the extent of transphyseal involvement in 15 consecutive patients with long bone osteosarcoma and nonfused epiphyses. The findings were correlated with those from surgical and microscopic pathologic examinations. There were no cases of false-positive findings with either MR imaging or plain radiography. Conventional radiography accurately helped predict transphyseal spread in only nine of 15 cases (60%). Spread to the epiphysis was present in 12 of the 15 cases (80%) and was accurately predicted with MR imaging in all 12 cases. This finding contradicts the common misconception that the physis acts as a "barrier" to tumor spread.     

Epiphyseal clefts

Defects of clefts may be seen in the growing epiphysis and are usually observed just before puberty. The basal epiphysis of the proximal phalanx of the great toe is the most common site but similar defects have been observed in a number of other epiphyses. At least some of these defects develop within a single normal appearing epiphysis and are not associated with signs or symptoms suggestive of fracture. The mechanism of formation of these defects is not clear. The defects probably close spontaneously sometime around late puberty.     

Epiphyseal osteoblastoma-like osteosarcoma

Osteoblastoma-like osteosarcoma is a rare variant of osteosarcoma occurring in this instance in a highly unusual location: the lateral femoral condyle of a 13-year-old girl. The radiological features were non-aggressive and, although slightly unusual, were most suggestive of chondroblastoma.Presented at the Closed Meeting of the International Skeletal Society, Geneva, Switzerland, September 2003     

Epiphyseal involvement in unicameral bone cysts

Twelve patients are reported in whom a unicameral bone cyst was found to involve the epiphysis or apophysis across an open growth plate. Nine patients showed pathologic fracture. In four patients a growth disturbance was found. A varying amount of varus angulation was present in most cases. No patient had functional impairment.     

关节镜下骺板近端三维缝合固定治疗少年胫骨髁间前棘撕脱骨折

目的:探讨关节镜下骺板近端三维缝合固定治疗少年胫骨髁间前棘撕脱骨折的临床疗效。方法:2008年5月~2010年5月,对10例少年胫骨髁间前棘骨折移位患者,在关节镜下行骨折断端清理、复位,C臂机透视下避开骨骺建立胫骨隧道,自制缝针、钩针导引普通丝线于前交叉韧带前1/3、1/2处镜下两次穿越,普通丝线导引钢丝及PDS-Ⅱ线穿越前交叉韧带。固定物在冠状面两次穿越骨隧道-前交叉韧带-骨隧道,骑跨式三维固定撕脱骨块,有效防止撕脱骨块前后旋转、左右摆动和上下浮动。拉紧钢丝及PDS-Ⅱ线,关节外打结固定。术后下肢支具外固定并早期进行功能康复。术后采用Lysholm评分标准评估疗效。结果:全部病例均获随访,随访时间6～36个月,平均18.2个月。X线片示骨折均愈合。患者膝关节无疼痛,前抽屉试验阴性,Lachman试验阴性。术前Lysholm评分(45.8±7.6)分,术后(97.2±9.1)分,手术前后评分差异有统计学意义。结论:关节镜下骺板近端三维缝合固定治疗少年胫骨髁间前棘撕脱骨折创伤小,不损伤骺板,操作简单,疗效可靠。     

Epiphyseal marrow in infancy: MR imaging

Hypointense epiphyseal marrow on T1-weighted magnetic resonance images often suggests disease. To determine whether hypointense marrow sometimes represents normal red marrow in a recently ossified epiphyseal center, the authors studied 38 infants without known marrow disease. Patients with hypointense epiphyseal marrow on T1-weighted images were younger (3.9 months +/- 3.2) than those with hyperintense marrow (9.6 months +/- 3.9) (P less than .001). T1-weighted imaging and histologic correlation were also performed in animals. The signal was hypointense and the marrow was red in the epiphyseal centers of all newborn animals, while all 6-week-old animals had hyperintense signal and yellow marrow. The authors conclude that hypointense marrow on T1-weighted images represents normal red marrow in a recently formed ossification center in newborn rabbits and lambs, and the same is probably true in humans. Epiphyseal marrow becomes hyperintense within a few months of development of the secondary center of ossification.     

Epiphyseal fractures about the knee

The knee is a focus of significant growth and tensile forces. Physeal injuries may be occult and only manifest by focal tenderness on examination. Comparison side radiographs are sometimes helpful. Stress views of undisplaced fractures are not indicated because they may cause further damage to the physis and they do not alter treatment. Fracture outcome is proportional to the type of fracture, accuracy of reduction, and the amount of growth remaining. Follow-up is necessary because even fractures with a benign initial appearance can cause deformity from growth asymmetry. This is especially true of distal femoral physeal fractures.     

Epiphyseal giant cell tumour in an immature skeleton

It is well known that giant cell tumours of the bone rarely occur below the age of 20 years. Many radiologists and orthopaedicians do not even consider giant cell tumours as a differential diagnosis from a lytic lesion before epiphyseal closure. This is a rare case report of a 14-year-old girl with proven giant cell tumour of the epiphysis of the distal femur.     

多发性骨骺发育异常1例报告

病人,女,6岁,诉右膝关节疼痛、僵硬、跛行、行走速度慢于同龄儿童1年。体检:身高98cm,体重19kg,摇摆步态,双膝内翻畸形,双膝关节略大,智力正常。其它物理检查及实验室检查无阳性发现。既往史及家族史无特殊、居住区无地方病。1　X线表现两膝关节组成骨对称性骨骺及干骺端不规则,发育不良。骨骺内薄外厚,其内外两侧呈分节状和斑点状碎裂,胫骨干骺端呈斜坡状并向外突出,股骨髁及胫骨髁成角见方。髁间凹变浅,髌骨呈斑点状。干骺端及骨骺无骨增生硬化现象。双侧髋臼、股骨近侧干骺端及大粗隆骨骺粗糙不齐、股骨颈变短。双侧肱骨滑车、肱骨小头…     

多发性骨骺软骨发育不全1例

患者男,1岁7个月,因发现双小腿弯曲内翻畸形5个月,体格检查发现身材相对于同龄儿童矮小,四肢粗短,下肢弯曲,手指自然分开;智力正常.实验室检查:血常规正常;X线检查表现双侧肱骨、桡骨、股骨、胫腓骨骨骺对称性变扁、变小,骨骺边缘不规则,干骺端增宽向两侧突出,骺线稍变窄,双侧胫骨对称性增粗变短、弯曲,内侧骨皮质增厚,远侧骨骺呈楔形改变;腓骨下段增长、向内侧弯曲,双踝关节呈内翻畸形改变;手指自然分开,呈"三叉手"畸形改变(图1～4);诊断为多发性骨骺软骨发育不全.     

Epiphyseal extension of a unicameral bone cyst

 Epiphyseal extension of a unicameral bone cyst is rare. We report a case of a 13-year-old boy with three pathological fractures through a unicameral bone cyst with epiphyseal involvement in the proximal humerus. These lesions initially tends to expand the humeral epiphysis laterally and progress medially. They also commonly cause a slip of the epiphysis in a medial direction. They also have a greater association with growth retardation and lesser degree of recurrence than their metaphyseal counterpart.     

CT诊断骺生软骨瘤1例报告

软骨瘤发生于骨骺者少见 ,国内外文献报告不多。我院发现 1例 ,经手术和病理证实 ,报道如下。患者　女 ,16岁。右腕关节外侧疼痛 ,可见一硬性肿块 3月余。查体 :右尺骨下端外侧肿胀 ,触之质较硬 ,局部触痛 ,皮肤颜色正常 ;腕关节功能尚可。X线检查 (腕关节正侧位 ) :右尺骨下端骨骺关节面不平 ,近外侧可见半圆形骨缺损区 ,其上缘骨密度较高 ,局部软组织未见肿胀。CT检查 (右腕关节CT平扫 ) :右尺骨骨骺可见不规则低密度影 ,CT值为 82 .0HU ;其内、边缘部见斑条状高密度影 ,CT值为 5 62 .0HU ;软组织未见异常。诊断为右尺骨下端软骨瘤…