Triplane fracture of the proximal tibial epiphysis.

Our purpose is to report a very rare case of proximal tibia triplane fracture, focusing the particular pattern of fracture and the long-term follow-up result. The triplane fracture is an exceptional fracture that occurs in the 3 planes (coronal, sagittal and transverse) close to the end of the growth period. A 15-year-old boy was admitted to our Center for a left femoral diaphyseal fracture and an ipsilateral lateral proximal tibia triplane fracture following a road accident. The femur was fixed with an intramedullary nail, the triplane fracture was anatomically reduced and percutaneously fixed. After 4 years follow-up, the knee was stable and with no complaints. Its range of motion was complete. Radiographs and MRI did not show any abnormality on the left leg and knee. In order to stabilize a proximal tibia triplane fracture a surgical internal fixation is usually required, with the possibility of a good long-term outcome also due to the growth potential remaining, if physeal arrest does not occur.     

Treatment of an open distal tibia fracture with segmental bone loss in combination with a closed proximal tibia fracture: a case report

The treatment of open distal tibia fractures remains challenging, particularly when the fracture is infected and involves segmental bone loss. We report the case of a 38-year-old man who sustained an open distal tibiofibular fracture with segmental bone loss and a closed proximal tibial fracture. The fractures were initially fixed with a temporary external fixator. The open distal tibial fracture was infected, and the skin was covered after the wound became culture negative. The tibia was then internally transported with a ring external fixator; the closed fracture of the proximal tibia served as the corticotomy for internal transport without conventional corticotomy. After 5?cm internal transport, the docking site of the distal tibia was fixed with a locking plate and autogenous cancellous bone graft. Bone graft was also used to the distal tibiofibular space to achieve distal tibiofibular synostosis. We describe one treatment option for an infected open fracture of the distal tibia with segmental bone loss that is accompanied by a closed fracture of the proximal tibia. This method can treat two fractures simultaneously.     

Salter-Harris type III fracture of the proximal humeral physis

Salter-Harris type III, IV and V injuries of the proximal humeral physis are rare. We report an undisplaced Salter-Harris type III injury of the humeral head physis in a 10-year-old girl. The fracture united with non-operative treatment.     

Differential development of the distal and proximal femoral epiphysis and physis in mice

Many pathologic conditions of hip development result from aberrant vascularity with subsequent effects on physeal resorption and epiphyseal fusion. To elucidate the mechanisms of these developmental disorders, researchers have mainly focused on larger mammals as they have been well characterized and are known to provide a model similar to humans in which a secondary ossification center is formed through an independent blood supply followed by physeal resorption. Murine models of hip development, however, have never been characterized as it was previously assumed that all physes in rodents never resorb and therefore not suitable as a model of the human condition. The purpose of this study was to determine if murine hip development was comparable to humans as laboratory mice provide an ideal model in which genetic knockouts are readily available with a short developmental time span. Here we show for the first time the unique developmental patterns of the murine hip in which a secondary ossification center never develops. Instead, the epiphysis undergoes a prolonged phase of mineralization through chondrocyte, not osteoblast, dependent mechanisms. After skeletal growth, transphyseal vessels develop from the metaphysis resulting in resorption of the physis, ossification of the mineralized cartilage of the epiphysis, and epiphyseal fusion. Although the development of the murine hip is markedly different from that in humans, we believe that these findings have direct implications for studying the vascularity of developing bone, particularly during physeal resorption, chondrocyte-mediated mineralization and more importantly, developmental diseases of the human physis and epiphysis.     

Primary aneurysmal bone cyst of the proximal tibia crossing the open physis

An aneurysmal bone cyst (ABC) is a hyperplastic reactive lesion of unknown etiology consisting of cystic cavities containing blood lined by mesenchymal reactive tissue. It occurs more often in females (2:1), usually before the age of 20 years, and most commonly in long bones [1]. The extension of the primary ABC to the epiphysis after crossing the viable physis is an exceptional finding, and very few such cases have been reported in the literature [2–6]. Although uncommon, ABC can cause severe destruction of long bones in children and young adults. The suggested treatment for such aggressive cases ranges from simple curettage to wide resection and structural reconstruction [7, 8]. Here, we report the follow-up for a 10-year-old girl with large, aggressive ABC of the proximal tibia with transphyseal extension to the epiphysis, which was treated with intralesional excision, curettage and bone grafting.     

Triplane fracture of the proximal tibia

We report a case of successful treatment of a very rare triplane fracture of the proximal tibia in an adolescent boy. The fracture was internally fixed using cannulated Herbert screws. The final result was excellent.     

A valgus angulation fracture of the proximal humeral epiphysis.

The case presented illustrates a previously unreported form of valgus angulation of a proximal humeral epiphyseal fracture. For reduction this fracture requires traction and adduction, not abduction, of the arm.     

Posterior fracture through the sternoclavicular physis associated with a clavicle fracture: a case report and literature review.

Three reported cases of fractures in teenagers of the medial clavicle associated with a posterior disruption at the sternoclavicular joint have similar findings. The medial fragment is rotated 90 degrees to the coronal plane. The medial fragment is usually stripped of its periosteum. Treatment requires open reduction and internal fixation of the clavicle fracture. We are reporting similar findings in a fourth case.     

Stress fracture of proximal tibia after proximal fibula osteotomy: A case report

IntroductionProximal fibula osteotomy (PFO) is a new method for treating medial compartment osteoarthritis of the knee, which is based on the theory of differential settlement (nonuniform settlement). This procedure has been widely recognized for its advantages of relative simplicity, low rate of postoperative complications, and low postoperative costs. Stress fracture of the proximal tibia after PFO has not been previously reported.Case presentationWe report a 62-year-old woman with chronic rheumatoid arthritis (RA) underwent left PFO for chronic knee pain, who developed a stress fracture of the proximal tibia more than 1 year after PFO.Clinical discussionIn the early stage of proximal tibia stress fracture, due to the concealment of radiography manifestations, doctors from another hospital performed total knee arthroplasty (TKA) for the patient. They ignored the treatment of stress fracture of the proximal tibia, and the stress fracture was further aggravated after surgery. Six months later, the patient underwent open reduction and internal fixation with a plate and screw in the left proximal tibia fracture at our hospital. The patient was followed up at the hospital three months after open reduction, and the proximal tibia stress fracture began to heal.ConclusionRA is usually not confined to the medial compartment and its pathogenesis is different from that of osteoarthritis. Therefore, PFO is not an appropriate procedure for this type of patient.     

Lateral growth arrest of the proximal femoral physis: a new technique for serial radiological observation

Purpose  

Lateral growth arrest is recognised as the most common form of avascular necrosis (AVN) seen in the management of developmental dysplasia of the hip (DDH). The purpose of this report is to present a new technique that is of benefit in the early identification and subsequent radiological monitoring of lateral growth arrest and which may permit appropriate timely surgical intervention.