Search

Introduction Campus board training in adolescent climbers is controversial. Evidence, albeit limited, suggests this type of training may lead to the development of finger epiphyseal stress fractures. The purpose of the present study was to investigate coaches’ attitudes toward campus board training in the United States. Methods Surveys were sent to 116 coaches at gyms across the United States with affiliated adolescent climbing teams. Outcomes collected included demographic information, training time, campus board use prevalence, coaches’ attitudes toward campus board use, and willingness to participate in future research. Results Seventy-three coaches representing 3090 adolescent climbers completed the survey. Forty-six coaches (63%) reported using full weight (no foot contact) campus board training in some or all of their climbers. A variety of factors were cited by coaches when deciding which climbers should or should not use the campus board, including physical maturity, climbing ability, and age, among others. Conclusions Climbing coaches in the United States disagree on the use of campus board training in adolescent climbers. Some coaches avoid using this training modality entirely, whereas others believe certain climbers can use it safely. There is lack of consensus in determining who those certain climbers are.

Introduction Finger growth plate injuries are the most common injury among youth climbers, and the association between these injuries and speed climbing, a mandatory discipline in the 2021 Olympics, has not been examined previously. Our primary purpose was to examine the demographic and training characteristics of adolescent competition climbers who reported a history of a finger growth plate injury compared to those who did not report a history of a finger growth plate injury. Our secondary purpose was to determine whether training characteristics differed between adolescent competition climbers who did and did not report speed climbing. Methods Our study was a cross-sectional study design. We surveyed adolescent climbers who competed in the 2017 USA Climbing Sport and Speed Youth National Championships. Questions assessed climbing injury history and current rock-climbing training characteristics. Results Two-hundred sixty-seven adolescent competition climbers, 14±3 (9–18) y of age (mean±SD with range), completed the survey. Those with a history of a finger growth plate injury reported greater approximate time spent speed climbing throughout the year (β=1.28, 95% CI 0.11–2.46, P=0.032) and training regularly on the International Federation of Sport Climbing speed wall (adjusted odds ratio=3.95, 95% CI 1.14–13.7, P=0.031). Conclusions Training regularly at practices on the speed wall was associated with a self-reported history of finger growth plate injuries among elite youth competition climbers. Speed climbing should be limited, especially during periods of rapid growth.

The growth plate is cartilage tissue found at the end of long bones in children, responsible for longitudinal bone growth. Injuries to the growth plate cartilage often lead to unwanted bony repair, resulting in growth disturbances such as limb length discrepancy and angulation deformity in children. There is currently no clinical treatment that can fully repair an injured growth plate. Tissue engineering is promising for regeneration of growth plate. Adipose-derived stromal vascular fraction highlight the promising potential as tissue engineering therapy for inducing regeneration of injured growth plate and able to reduce the formation of bony repair that can lead to deformity and limb length discrepancy. Using an animal model of growth plate injury, bone bridge formation is evaluated after 28 days using Enzyme-linked Immunoassay, radiology, histopathology and Immunofloresence examination. Radiological analyses performed by evaluation of grey value using ImageJ software and diameter bone bridge measured from the end to end distance between uninjured growth plate evaluated by histopatology examination. Enzyme-linked Immunoassay and immunofloresence are used to evaluate chondrocyte and chondrogenic marker within the defect. The result shows in group with Adipose-derived stromal vascular fraction have a significant lower bone bridge formation compare to positive control group. This current study represents the first work that has utilized this animal model to investigate whether Adipose-derived stromal vascular fraction can be used to initiate regeneration at the injured growth plate., Highlights • Injuries to the growth plate cartilage often lead to unwanted bony repair, resulting in growth disturbances • There is currently no clinical treatment that can fully repair an injured growth plate • Tissue engineering is promising for regeneration of growth plate. • Adipose-derived stromal vascular fraction (AD-SVF) highlight the promising potential as tissue engineering therapy • AD-SVF decrease bone bridge formation on growth plate injuries model on Rat

Inappropriate treatment of growth plate injury may cause complications such as malunion or early arrest of the growth plate. Identification of intra-articular lesions is mandatory in patients with a growth plate injury of the distal tibia. Arthroscopic assessment is useful in identifying intra-articular injury. We report three cases of intra-articular growth plate injury of the distal tibia that were treated via internal fixation with arthroscopic assessment in our hospital. All three cases were performed pre- and postoperative arthroscopic assessment and open reduction and internal fixation with a cannulated cancellous screw (CCS; Meira, Japan). All patients were then examined for postoperative complications, functional recovery, at the end of the final follow-up consultation. Intraoperatively, a small cartilage injury was found in the non-fracture area in two cases; the remaining case had a reversed cartilage fragment at the talus, which was arthroscopically removed. Arthroscopic assessment followed by internal fixation is a useful minimally invasive method for the identification of intra-articular lesions such as osteochondral injury or free bodies.

Background: Multiple studies have focused on stem cell-based therapies for growth plate injury.However, the results are not consistent.Objectives: This systematic review and meta-analysis were performed to evaluate the effects of stem cells on growth plate healing.Methods: A detailed search of relevant studies was conducted in three databases including Pub med, Cochrane library, and Embase databases, using the following keywords: “growth plate” or “physis” AND “stem cell” from inception to November 10, 2021. The standard mean difference (SMD) and 95% confidence interval (CI) for each individual study were extracted from the original studies based on relevant data and pooled to obtain integrated estimates using random effects modeling.Results: A total of 6 studies were identified. The results demonstrated that the angular deformity in the stem cell group was significantly lower than that in the control group at 4, 8,12 and 16weeks. The length discrepancy represented the degree of shortening deformity. In the stem cell group, the shortening deformity was milder than that of the control group at 16weeks. Meanwhile, at 16 weeks after surgery, the higher histologic scores in the stem cell group indicated that stem cell can significantly improve the repair quality of growth plate.Conclusions: This systematic review and meta-analysis confirmed that stem cell improved the rehabilitation of growth plate injury. However, larger-scale studies are needed to further support these findings.

Growth plate injury of the proximal humerus is rare. We herein report a traumatic growth plate injury of the proximal humerus in an elite diving athlete. A 16-year-old female diving athlete injured her left shoulder during 7.5 m platform hands-first diving practice. At the first visit, she presented with upper left shoulder tenderness and left shoulder range-of-motion limitation. There was no fracture or dislocation on X-ray and computed tomography (CT), but magnetic resonance imaging (MRI) showed a high-intensity zone in the left lateral epiphysis of the proximal humerus. We treated her conservatively by rest with sling and rehabilitation. She partially restarted diving practice five weeks post-injury and returned to competition eight weeks post-injury. Even if there is no sign of fracture or dislocation, we should consider MRI for patients who are before the age of growth plate closure.

Closed femoral-shortening osteotomy over an intramedullary nail for the treatment of leg length discrepancy (LLD) is a demanding surgical technique, classically requiring specialized instrumentation (intramedullary saw and chisel). Herein, we describe our experience with shortening osteotomy over a nail, using a percutaneous multiple drill-hole osteotomy technique to perform the bone section with the osteotomized bone smashed and let on-site. We operated on six patients with LLD due to: hemihypertrophy syndrome (three patients), congenital short femur, hemiplegic cerebral palsy, and growth plate injury. Mean femoral shortening was 4.2 cm. Osteotomy was performed via a multiple drill-hole technique, and femurs were stabilized using an intramedullary nail. Post-operative clinical and radiological data were recorded. Residual LLD was assessed through long-standing teleroentgenography. Shortening was achieved, with a final LLD of

BACKGROUND: Pediatric skeletal trauma presents a distinct approach to its treatment because of its unique auses and possibility of its troublesome complications. One of its major complications is growth plate injury which may disturb the longitudinal growth of child’s bone. AIM: In this study, the author combined stromal vascular fraction (SVF) and collagen scaffold as biomaterial for future treatment of physeal injury in skeletally immature patients using SOX9 and histological examination as a marker. METHODS: The study was conducted experimentally on Rattus norvegicus growth plate based on Erickson study, and the SVF was from R. norvegicus fat tissue with ZUK method. Histological examination was evaluated with 8 times magnification and SOX9 from the growth plate was measured with enzyme-linked immunosorbent assay. RESULTS: Histological examination showed that the best result was obtained in SVF + collagen group judging by the bony bridge diameter. The result was differed significantly from the positive control group with p < 0.05 in Tukey test. The result from SOX9 level measurement shows that all of the treatment groups SOX9 level almost the same as normal value (negative control group) and it is significantly differ from the positive control group with p < 0.05 in Mann–Whitney U-test. CONCLUSIONS: This study showed that the combination of collagen and SVF had a great effect on healing process in growth plate injury.

Running is a popular sport for children in the United States. However, review of available literature on health effects and safety recommendations for youth running has not been previously conducted. Unique factors for injury include periods of growth during puberty and potential for growth plate injury. Youth runners may benefit from activities that incorporate high-impact loading and multidirectional movement for optimal bone maturation, exercises to strengthen tendons and muscles, and strategies aimed at improving running biomechanics to reduce risk of injury. In addition, addressing lifestyle factors, including nutrition and sleep is essential for a runner's general health. Similar to other sports, sports specialization should not be encouraged in youth runners. Reducing running-related injury in growing children and assessing readiness for running should be based on a combination of physical, emotional, psychological, social, and cognitive factors. Youth runners require individualized training and competition to safely participate in the sport.

Faulty bony repair causes dysrepair of injured growth plate cartilage and bone growth defects in children; however, the underlying mechanisms are unclear. Recently, we observed the prominent induction of neurotrophin‑3 (NT-3) and its important roles as an osteogenic and angiogenic factor promoting the bony repair. The current study investigated its roles in regulating injury site remodelling. In a rat tibial growth plate drill-hole injury repair model, NT-3 was expressed prominently in osteoblasts at the injury site. Recombinant NT-3 (rhNT-3) systemic treatment enhanced, but NT-3 immunoneutralization attenuated, expression of cartilage-removal proteases (MMP-9 and MMP-13), presence of bone-resorbing osteoclasts and expression of osteoclast protease cathepsin K, and remodelling at the injury site. NT-3 was also highly induced in cultured mineralizing rat bone marrow stromal cells, and the conditioned medium augmented osteoclast formation and resorptive activity, an ability that was blocked by presence of anti-NT-3 antibody. Moreover, NT-3 and receptor TrkC were induced during osteoclastogenesis, and rhNT-3 treatment activated TrkC downstream kinase Erk1/2 in differentiating osteoclasts although rhNT-3 alone did not affect activation of osteoclastogenic transcription factors NF-κB or NFAT in RAW264.7 osteoclast precursor cells. Furthermore, rhNT-3 treatment increased, but NT-3 neutralization reduced, expression of osteoclastogenic cytokines (RANKL, TNF-α and IL-1) in mineralizing osteoblasts and in growth plate injury site, and rhNT-3 augmented the induction of these cytokines caused by RANKL treatment in RAW264.7 cells. Thus, injury site osteoblast-derived NT-3 is important in promoting growth plate injury site remodelling, as it induces cartilage proteases for cartilage removal and augments osteoclastogenesis and resorption both directly (involving activing Erk1/2 and substantiating RANKL-induced increased expression of osteoclastogenic signals in differentiating osteoclasts) and indirectly (inducing osteoclastogenic signals in osteoblasts). Refereed/Peer-reviewed

Avulsion fractures of the tibial eminence, although generally a rare injury pattern, are more common in children and adolescents than in adults. Many open and arthroscopic techniques are available with variable degrees of satisfying results and incidence of complications and adverse effects. Arthroscopic fixation appeared to improve the functional outcomes with fewer complications than the open fixation. New techniques were reported using commercially available suspension sling devices for the acromioclavicular joint that offers an easy and rapid method of fixation. However, this technique has the disadvantages of the presence of hardware (button) over the tibial anterior cruciate ligament attachment inside the joint and the need to drill a relatively large tunnel through the center of the avulsed fragment that may increase the chance of fracture. So small-diameter tunnels need to be drilled that will decrease bone loss and growth plate injury in children and adolescents. We describe here a technique that offers a better 4-point fixation through the anterior cruciate ligament with fewer complications by avoiding drilling through the avulsed fragment, absence of hardware inside the joint, and decreasing bone loss in adolescents by drilling only smaller transosseous tunnels and allowing for correction of the fixation using a special configuration of knots and cortical button.

The objective here was to report two rare cases of anterior avulsion fracture of the tibial tuberosity in adolescents. Case 1 was a 15-year-old male who became injured through landing on his left knee and presented limited extension. Case 2 was a 16-year-old basketball player who presented sudden pain in the right knee and functional incapacity, after a jump. Imaging examinations (radiographs and computed tomography) showed anterior avulsion fractures of the tibial tuberosity. Surgical fixation was performed using screws and anchors, while avoiding growth plate injury. The cases evolved without lower-limb deformities.

Objective: To assess the frequency of physeal injuries and wrist pain in young competitive gymnasts according to their training characteristics . Methods: This is a cross-sectional study (January-June 2015) of a male gymnastics team in São Paulo, SP, Brazil. Nineteen gymnasts, mean age 13.3 years, were evaluated in three ways: a questionnaire, physical examination and radiographs . Results: On average, they trained since 6 years-old and during hours per week. Eighty-two percent had wrist pain and 65% had wrist physeal injury. The pain was worse in practitioners of (82%) and soil (17%) exercises. A greater frequency of physeal injury was found in those with more years of training and higher weekly working hours, wrist pain was more frequent in those with higher weekly working hours, and a decreased range of motion was observed in those with physeal injury, results statistically significant . Conclusions: We found that 65% of gymnasts had wrist physeal injury and 82% had wrist pain. There were statistically significant relationships between physeal injury and years of training, physeal injury and weekly working hours, pain and weekly working hours, and physeal injury and range of motion. Level of Evidence IV, Case Series.

PURPOSE The purpose of this study was to investigate the effects of transplantation of an in vitro-generated, scaffold-free, tissue-engineered cartilage tissue analogue (CTA) using a suspension chondrocyte culture in a rabbit growth-arrest model. MATERIALS AND METHODS We harvested cartilage cells from the articular cartilage of the joints of white rabbits and made a CTA using a suspension culture of 2×10⁷ cells/mL. An animal growth plate defect model was made on the medial side of the proximal tibial growth plate of both tibias of 6-week-old New Zealand white rabbits (n=10). The allogenic CTA was then transplanted onto the right proximal tibial defect. As a control, no implantation was performed on the left-side defect. Plain radiographs and the medial proximal tibial angle were obtained at 1-week intervals for evaluation of bone bridge formation and the degree of angular deformity until postoperative week 6. We performed a histological evaluation using hematoxylin-eosin and Alcian blue staining at postoperative weeks 4 and 6. RESULTS Radiologic study revealed a median medial proximal tibial angle of 59.0° in the control group and 80.0° in the CTA group at 6 weeks. In the control group, statistically significant angular deformities were seen 3 weeks after transplantation (p

Background To elucidate the association between growth plate injury size and the beginning of physeal growth disturbance by MRI. Methods Thirty-two 5-week-old male Japanese white rabbits were used. Injuries were made to the right tibial proximal growth plate central region with a 3.0-mm and a 1.2-mm drill. The left tibia was used as a control. MRI (7.04 Tesla [T], gradient echo: repetition time [TR], 71.68 ms; echo time [TE], 3.60 ms; proton-density weighted imaging: TR, 2000 ms; TE, 12 ms) of the growth plates was performed at 1, 4, 8, 10, and 12 weeks postinjury. Tibia length, histology, radiography, and microcomputed tomography (µCT) were studied. Results MRI showed that at 10 and 12 weeks postinjury in the 3.0-mm group, the medial and lateral growth plates in the noninjured regions were significantly reduced compared with the controls (P 0.05). Bony bridges developed in all the subjects of the 3.0-mm group and in five of eight subjects of the 1.2-mm group, as shown by µCT images. Conclusion This study suggested that growth plate injury size was associated with the timing of the beginning of physeal growth disturbance. J. MAGN. RESON. IMAGING 2015;42:1698–1704.

Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses to spon- dylolisthesis (forward slippage of the vertebral body). This slip progression is prevalent in children and occurs very rarely after spinal maturation. The pathomechanism and predilection for children remains controversial despite considerable clinical and basic research into the disorder over the last three decades. Here we review the pathomechanism of spondylolytic spondylolisthesis in children and adolescents, and specifically the Tokushima theory of growth plate slippage developed from our extensive research findings. Clinically, we have observed the slippage site near the growth plate on MRI ; then, using fresh cadaveric spines, we found the weakest link against forward shear loading was the growth plate. We subsequently developed an immature rat model show- ing forward slippage after growth plate injury. Moreover, finite element analysis of the pediatric spine clearly showed increased mechanical stress at the growth plate in the spondylolytic pediatric spine model compared with the intact pediatric spine. Thus, spondylolysis progresses to spondylolisthesis (forward slippage) in children and adolescents with the growth plate as the site of the slippage. Repetitive mechanical loading on to the growth plate may serve to separate the growth plate and subsequently progress to spondylolisthesis. J. Med. Invest. 62 : 11-18, February, 2015

A third of all pediatric fractures involve the growth plate and can result in impaired bone growth. The growth plate (or physis) is cartilage tissue found at the end of all long bones in children that is responsible for longitudinal bone growth. Once damaged, cartilage tissue within the growth plate can undergo premature ossification and lead to unwanted bony repair tissue, which forms a "bony bar." In some cases, this bony bar can result in bone growth deformities, such as angular deformities, or it can completely halt longitudinal bone growth. There is currently no clinical treatment that can fully repair an injured growth plate. Using an animal model of growth plate injury to better understand the mechanisms underlying bony bar formation and to identify ways to inhibit it is a great opportunity to develop better treatments for growth plate injuries. This protocol describes how to disrupt the rat proximal tibial growth plate using a drill-hole defect. This small animal model reliably produces a bony bar and can result in growth deformities similar to those seen in children. This model allows for investigation into the molecular mechanisms of bony bar formation and serves as a means to test potential treatment options for growth plate injuries.

Injury to the growth plate is associated with growth disturbances, most notably premature cessation of growth. The goal of this study was to identify spatial changes in the structure and composition of the growth plate in response to injury to provide a foundation for developing therapies that minimize the consequences for skeletal development. We used contrast-enhanced microcomputed tomography (CECT) and histological analyses of a murine model of growth plate injury to quantify changes in the cartilaginous and osseous tissue of the growth plate. To distinguish between local and global changes, the growth plate was divided into regions of interest near to and far from the injury site. We noted increased thickness and CECT attenuation (a measure correlated with glycosaminoglycan (GAG) content) near the injury, and increased tissue mineral density (TMD) of bone bridges within the injury site, compared to outside the injury site and contralateral growth plates. Furthermore, we noted disruption of the normal zonal organization of the physis. The height of the hypertrophic zone was increased at the injury site, and the relative height of the proliferative zone was decreased across the entire injured growth plate. These results indicate that growth plate injury leads to localized disruption of cellular activity and of endochondral ossification. These local changes in tissue structure and composition may contribute to the observed retardation in femur growth. In particular, the changes in proliferative and hypertrophic zone heights seen following injury may impact growth and could be targeted when developing therapies for growth plate injury.

Objectives The purpose of this study is to evaluate the effects of allogenic costal cartilage transplantation on preventing bony bridge formation and angular deformities for the treatment of partial growth plate injury using a rabbit model. Methods An experimental model of partial growth injury was created by resecting the medial part of the proximal tibial growth plate in male six-week-old New Zealand White rabbits. The rabbits were divided into four groups: no surgery; no transplantation; bone wax transplantation; and allogenic costal cartilage transplantation. The angular deformities of the tibia and bony bridge were analysed using radiographs and microcomputed tomography, and the repair of the injured growth plate cartilage and bony bridge formation rate were histologically evaluated. Results On radiographic evaluation, the varus deformities in the costal cartilage group were significantly improved compared with the no transplantation group at four and eight weeks after operation and with the bone wax group at eight weeks after operation. Micro-computed tomography showed that the bony bridge formation was prevented in the bone wax and costal cartilage groups. Histological findings showed that the bony bridge formation in the bone wax and costal cartilage group was decreased. In addition, the growth plate was continuous and stained with safranin O and immunohistochemically stained for type II collagen. Conclusion Transplantation of costal cartilage improved angular deformities and decreased bony bridge formation in the partial growth plate injury. Costal cartilage might be a suitable graft for the treatment of growth plate injury.

Finger growth plate injuries are the most common youth climbing injuries. The purpose of our study was to understand youth awareness of the most common youth climbing injury and safe training practices. We surveyed climbers, ages eight to 18 years old, at the 2017 USA Climbing Sport and Speed Youth National Championships. A total of 267 climbers completed the survey (mean age = 14 &plusmn, 2.7 years, 52% male). The A2 pulley injury was reported as the most common youth climbing injury by the largest portion of participants, 36%. The second most commonly identified injury was at the growth plate of the finger, 15% of participants, which was reported as significantly less than the A2 pulley injury, p &lt, 0.001. Six percent of climbers reported the correct safe age to start double dyno campus board training. Roughly 18% of athletes identified growth plate injuries exclusively as a stress fracture, whereas 29.2% of those climbers self-reported as informed about finger growth plate injuries, but only 7.4% of climbers who self-reported as uninformed answered this question correctly. Misperceptions about skeletally-immature climbing injuries are prevalent amongst youth climbers. Education on the prevalence of finger growth plate injuries and the scarcity of A2 pulley injuries in youth climbers can increase diagnostic accuracy, improve care, and reduce long-term complications.

Although elbow dislocation is the most common dislocation in children, anterior elbow dislocation is considered to be rare. When it occurs rarely as an isolated elbow dislocation with no associated fractures. This report is about a case of isolated elbow dislocation with a rare mechanism of injury. A 14-year-old girl presented to the emergency department with an acute closed injury to her right elbow after her arm got caught and twisted in a washing machine. There was no associated neurovascular injury. A trial of closed reduction failed, so open surgical reduction was performed to avoid growth plate injury or fracture. Urgent open reduction was successful with a good outcome. Anterior elbow dislocation without fracture is a very rare injury and can occur with a vigorous twisting mechanism. Proper management is important to regain normal function. The aim of reporting this case is to emphasize that a rare isolated anterior elbow dislocation can occur by a twisting injury and an open reduction may be needed if a gentle closed reduction could not reduce it, to avoid growth plate injury in a skeletally immature patient.

Background Tissue-engineered cartilage has provided a promising method in the treatment of physeal growth arrest. This study was designed to investigate transplantation of microencapsulated allogeneic chondrocytes to treat the injured growth plate.

To assess the MRI features of growth plate injury at the base of the coracoid process. Subjects were identified through retrospective search of our department imaging database and teaching files and the teaching files of two outside academic institutions. The coracoid base growth plate was examined with attention to widening, irregularity, abnormal signal intensity of the growth plate, and the presence of adjacent soft tissue edema. The apposing coracoid and scapular bony surfaces were examined for signal intensity and morphology. Shoulder MRIs in eight patients with coracoid base growth plate disturbances were retrospectively reviewed (7 males, 1 female, mean age 15 years). Growth plate injury manifested as widening, irregularity and increased signal, apposing bony marrow edema and hypertrophy, and surrounding soft tissue edema. Five subjects were athletes (football, archery, basketball, swimming, rugby), two had a history of neuromuscular disorders, and one subject presented after a fall. Clinical indications included: rule out labral tear (n = 3), rule out rotator cuff tear or fracture after fall (n = 1), nonspecific pain (n = 1), shoulder subluxation, rule out glenoid pathology (n = 1, patient with underlying neuromuscular disorder), muscular dystrophy with shoulder pain (n = 1), and impingement (n = 1). Coracoid growth plate injury was not suspected clinically in any of the patients. Awareness of the imaging appearance of coracoid base growth plate injury can aid in a more accurate diagnosis of shoulder MRI studies in young pediatric athletes. While uncommon, coracoid growth plate injury should be considered when assessing children with shoulder symptomatology.

This article highlights the unique patterns of sports-related injury of the upper extremity that radiologists are likely to encounter in children and adolescents. The injuries are classified as acute "use" injuries or chronic "overuse" injuries, and reviewed separately for the shoulder, elbow, and wrist. Recommendations for imaging strategies are provided and characteristic imaging findings are discussed and illustrated.

Aims The aim of this study is to investigate the health-related quality of life in children with severe lower limb trauma after at least 12 months post-injury and to assess patient and injury characteristics in association with the health-related quality of life scores. Methods All children in the state of Victoria, who were 18 years of age or younger, suffering from severe lower limb injury before 2006 were studied. Patient and injury characteristics were abstracted from medical records. The health-related quality of life (HRQOL) scores were obtained using the Paediatric Quality of Life Inventory. Results Thirty-two out of 64 eligible patients participated in this study. All aspects of health-related quality of life in children with severe lower limb trauma after at least 12 months post-injury were significantly poorer compared with non-affected children, particularly in the physical health domain (difference: −12.51 ± 7.43: P 0.05). Conclusions The HRQOL in children with severe lower limb trauma was significantly impaired even after 12 months post-injury, notably in patient group with bilateral limb involvement and need for soft tissue management. Traumatic amputation, gender, growth plate injury, joint bony injury and accident mechanism did not have an impact on quality of life.

Background:Anterior cruciate ligament reconstruction (ACLR) in skeletally immature patients can result in growth plate injury, which can cause growth disturbances.Purpose:To evaluate radiological tibial and femoral length and axis growth disturbances as well as clinical outcomes in skeletally immature ACLR patients treated with a transphyseal drilling technique.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 39 pediatric patients with ACL injury and open physes at time of surgery, as diagnosed clinically and with magnetic resonance imaging (MRI), were treated using transphyseal ACLR using hamstring graft. Mean patient age was 11.7 years (range, 9.0-14.0 years). Patients were evaluated with full extremity radiographs measuring leg length discrepancy and malalignment, as well as clinical evaluation with KT-1000 arthrometer measurements and Tegner activity scale and Knee injury and Osteoarthritis Outcome Score (KOOS) outcomes after follow-up of 68 months (range, 29-148 months).Results:Of the 39 initial patients, 33 were evaluated both clinically and radiographically. We found a mean femoral length shortening of 3.5 mm ( P = .01) on the operated leg. Eight patients (24%) had a more than 10-mm shortening of the operated leg, whereas only 1 patient (3%) had a 10-mm shortening of the nonoperated leg. In 27 of 33 patients (82%; P < .001), the anatomic femoral axes of the operated leg were found to be more than 2° of valgus compared with the nonoperated leg. The tibial anatomic axes changed into a less pronounced varus angulation ( P = .02). The femoral-tibial anatomic axes were not significantly different when comparing the 2 legs. We did not find any statistical difference in growth arrest comparing patients treated surgically at the ages of 13 to 14 years to patients younger than 13 years. Tegner and KOOS scores were significantly lower among girls compared with boys. Side-to-side KT-1000 arthrometer difference improved from 5.2 mm preoperatively to 1.6 mm at follow-up.Conclusion:This study shows that transphyseal ACLR in children results in minor length growth disturbances in 24% of patients. The surgically induced distal femoral valgus angulation is counterbalanced by a proximal tibial varus angulation. Growth disturbance after surgery is not associated with a certain pediatric age group. Otherwise, transphyseal ACLR has satisfactory clinical outcomes, with good subjective outcomes, function level, and knee stability.

In brief: Children are at high risk of growth plate injury, contrary to previous research data. Of 134 consecutive growth plate injuries seen at the University of Arizona Hospital in Tucson over a six-year period, 22% occurred in team sports and 20% in activities such as using playground equipment, horseback riding, roller and ice skating, skateboarding, and bicycling. The authors review clinically useful anatomical and biomechanical aspects of the growth plate and its injuries, reflecting their own research as well as other studies. They also discuss prevention and diagnosis of this common source of childhood injury.

The skeleton of a subadult individual from the medieval graveyard of La Madeleine (Orleans, France) exhibits varus deformity of its right humerus. The affected bone is shortened, the diaphysis is angulated and the head is grossly deformed. The skeleton is otherwise normal. Several diagnoses are debated, including mucopolysaccharidoses, thalassemia, infection and trauma, the latter being preferred. The severity of the bone changes suggests that the growth disturbance occurred early in the life of the individual. We therefore suppose that the causative trauma occurred at the time of birth or during the early postnatal period. Copyright © 2011 John Wiley & Sons, Ltd.

We compared the effects of amifostine and melatonin in preventing radiation-induced epiphyseal growth plate injury in rats.Four-week-old (65-85 g), growing male Sprague-Dawley rats were randomly assigned to receive radiation alone, at 25 Gy in three fractions (group R), or this dose of fractionated radiation proceeded by prophylactic amifostine 200 mg/kg i.p. (group A), melatonin 15 mg/kg i.p. (group M), or amifostine + melatonin (group AM). The right rear extremity of each animal was irradiated while the contralateral leg was shielded from radiation, as a control. Bone growth based on the length of the tibia, femur, and overall limb was calculated 6 weeks after the treatment.In groups R, A, M, and AM, the mean growth loss (GL) for the overall limb was 56.9 +/- 8.1%, 46.8 +/- 7.7%, 36.6 +/- 4.3%, and 38.5 +/- 5.1%, respectively. The limb length discrepancies (LLD) in groups R, A, M, and AM were 13.8 +/- 1.4%, 10.5 +/- 0.3%, 7.4 +/- 0.7%, and 8.8 +/- 1.1%, respectively. Differences in LLD were significant between each treatment group and group R (range: p = 0.0001-0.001). Differences in either of mean GL and LLD were not significant between groups M and AM; however both of these groups had significantly less GL and LLD than group A.We observed a superior radioprotective function of melatonin over amifostine in preventing radiation-induced epiphyseal growth plate injury, without any increase in radioprotective effect by adding amifostine to melatonin.

Physeal cartilage is known to have poor self-repair capacity after injury. Evaluation of the ability of cultured mesenchymal stem cells to repair damaged physis is the topic of current research. In 10 immature New Zealand white rabbits autogenous mesenchymal stem cells were transplanted into a iatrogenic physeal defect in a lateral portion of the distal growth plate of the right femur. The same defect without stem cells transplantation in the left femoral distal physis served as a control. In our study, we used our own technique of implantation of MSCs with a newly modified gel scaffold (New Composite Hyaluronate/Collagen Type I/Fibrin Scaffold). The rabbits were euthanized 4 months after transplantation. Bone length discrepancy and valgus deformity were measured from femoral radiographs. Healing of the defect was investigated histologically. The ability of mesenchymal stem cells to survive and promote cartilage healing in the physeal defect was assessed by immunofluorescence. Average difference in femur length measured from surgery to euthanasia (4 months) was 0.61 ± 0.19 cm after preventive transplantation of MSCs in the right femur, but only 0.11 ± 0.07 cm in the left femur. Average angular (valgus) deformity of the right femur with MSCs preventively transplanted to iatrogenically damaged distal femoral physis was 1.2 ± 0.72 °. Valgus deformity in the left femur was 5.4 ± 2.5 °. Prophylactic transplantation of autogenous mesenchymal stem cells to iatrogenically damaged distal growth plate of the rabbit femur prevented a bone bridge formation and resulted in healing of the physeal defect with hyaline cartilage. Immunofluorescence examination showed that the chondrocytes newly formed in growth zone are the result of implanted MSCs differentiation. Femur growth in traumatized physis was maintained even after transplantation of autogenous MSCs. As compared with the opposite femur (with physeal defect but without transplanted MSCs), the bone showed no significant shortening or valgus deformity (p = 0.018).

Gal P., A. Neaas, L. Planka, H. Kecova, L. Kfien, P. Krupa, J. Hluailova, D. Usvald: Chondrocytic Potential of Allogenic Mesenchymal Stem Cells Transplanted without Immunosuppression to Regenerate Physeal Defect in Rabbits. Acta Vet. Brno 2007, 76: 265-275. Mesenchymal stem cells (MSCs) from bone marrow are multipotent cells capable of forming cartilage, bone, and other connective tissues. The objective of this study was to determine whether the use of allogenic mesenchymal stem cells could functionally heal a defect in the distal femoral physis in rabbits without the use of immunosuppressive therapy. A iatrogenic defect was created in the lateral femoral condyle of thirty-two New Zealand white rabbits, 7 weeks old, weighing 2.25 ± 0.24 kg. Each defect, 3.5 mm in width and 12 mm in length, in the right distal femoral physis was treated with allogenic mesenchymal stem cells in new composite hyaluronate/collagen type I/fibrin scaffold. The healing response was evaluated radiographically, by MRI (three weeks and four months after implantation) and also histologically, by Pearl’s reaction and with immunofluorescence (four months after implantation). The results were compared with the data for the control defects (without stem cell implantation) in left distal femoral physes. On average, right femurs with a damaged distal physis and transplanted MSCs grew more in length (0.55 ± 0.21 cm) compared with left femurs with a physeal defect without stem cell transplantation (0.46 ± 0.23 cm). Valgus deformity of right femurs with a physeal defect and transplanted MSCs was mild (0.2 ± 0.1 °). On the contrary, left femurs with a physeal defect without transplanted MSCs showed a significant valgus deformity (2.7 ± 1.6 °). For defects treated with allogenic mesenchymal stem cell implants, no adverse immune response and implant rejection were detected in this model. Histologically, no lymphocytic infiltration occurred. At four months after transplantation, hyaline cartilage had formed throughout the defects treated with allogenic MSCs. Labelled mesenchymal stem cells/differentiated chondrocytes were detected in the physeal defects based on magnetic resonance imaging and immunofluorescence. The results of this study demonstrated that allogenic mesenchymal stem cells in a new composite hyaluronate/collagen type I/fibrin scaffold repaired iatrogenic defects in the distal femoral physes in rabbits without the use of immunosuppressive therapy. The use of allogenic mesenchymal stem cells for the repair of physeal defects may be an alternative to autologous MSCs transplantation. An allogenic approach would enable mesenchymal stem cells to be isolated from any donor, providing a readily available source of cells for cartilage tissue repair.

Concomitant with increasing participation in youth sports, there is a desire for young athletes to use resistance training to help them achieve peak performance. Recent evidence dispels the myths that weightlifting in children is dangerous as the result of growth plate injury risk and ineffective because children are unable to increase strength or muscle mass. Supervised resistance training currently is recognized to be safe and effective, and it also may reduce injury risk during sports participation in young athletes. In this review, we provide evidence-based guidelines to assist physicians when making recommendations to parents and coaches who wish to administer resistance training to young athletes.

PubMedID: 15928554 Study Design. Experimental study. Objectives. To investigate the effects of pedicle screw insertion on spinal canal and pedicle morphology in immature pigs, and, if transpedicular fixation has an effect, to document whether this occurs because of the inhabitance of the screw inside the growth plate (neurocentral cartilage [NCC]) or because of compression applied across the NCC. Summary of Background Data. Transpedicular fixation has been less commonly applied to the pediatric population, especially because of the risk of damage to the NCC. Methods. Twelve newborn pigs (4-6 weeks of age) were operated on. Left sided pedicles from L1-L5 were studied, while right sides served as controls. Pigs were randomly assigned into 3 groups: (1) pedicles were probed only; (2) screws were inserted; and (3) after screw insertion, a washer and a nut were engaged at the pedicle entry point so that gradual compression across the NCC was achieved. After 4 months, spiral computerized tomography was used to measure the pedicle lengths and size of the halves of the spinal canal. Results. In group 1, the operated hemi-canal area was not statistically different from the nonoperated side (P = 0.159). Pedicle screw insertion either with (P = 0.007) or without (P = 0.005) compression resulted in smaller hemi-canal area and shorter pedicles at the operated side, respectively (P = 0.008, P = 0.021). Approximately 4% to 9% shortening of the pedicle lengths and 20% to 26% narrowing of the hemi-canal areas on the instrumented side occurred with transpedicular instrumentation (groups 2, 3). Conclusion. Even without compression, pedicle screws passing through the NCC in immature pigs disturb spinal canal growth significantly. Clinical relevance for young children should be studied further. © 2005, Lippincott Williams & Wilkins, Inc.

We describe a case of chronic Salter-Harris I injury of the proximal tibial epiphysis. To our knowledge such an injury has not been described in the English language literature. The radiological appearance can mimic chronic infection. The possibility of chronic athletic stress-related change should be considered in such scenarios to avoid a misdiagnosis.

The surgical handling of central cleft hands may involve various procedures to restore acceptable function. Stabilization of the merged cleft is usually achieved through reconstruction of the intermetacarpal ligament. However, no attention has been paid to the agenesis of the metacarpophalangeal collateral ligaments adjacent to the cleft, which is responsible for an excessive laxity of the joint in the frontal plane. We propose an autologous ligamentoplasty aimed at stabilizing the metacarpophalangeal joint while taking into account the specificities of the immature skeleton. A tendon graft is harvested and passed in a figure-of-eight manner around the base of the proximal phalanx and the corresponding metacarpal neck. No transosseous tunnels or bone anchors are used, as these might result in growth plate injury. As the graft does not have any fixed bony attachment, it is free to glide throughout growth, therefore avoiding the occurrence of progressive overtightening.

Distal tibial physeal fractures are the second most common growth plate injury and the most common cause of growth arrest and deformity. This study assesses the accuracy of pre-operative planning for placement of the screws in these fractures using either standard radiographs or CT scans. We studied 62 consecutive physeal fractures over a period of four years. An outline of a single cut of the CT scan was used for each patient. An ideal position for the screw was determined as being perpendicular to and at the midpoint of the fracture. The difference in entry point and direction of the screw between the ideal and the observers’ assessments were compared using the paired Student’s t-test. There was a statistically significant improvement (p < 0.0001) in the accuracy of the point of insertion and the direction of the screw on the pre-operative plan when CT scans were used rather than plain radiographs. We would, therefore, recommend that CT scans are routinely used in the pre-operative assessment and treatment of distal tibial physeal fractures.

We present an atypical case with a rare combination of Maisonneuve and triplane fracture A Maisonneuve injury can present with external rotation of foot in the absence of signs and symptoms of a proximal injury. Pre-operative CT scans of the growth plate injury facilitates planning open reduction and internal fixation; it is vital to check the syndesmotic stability by intra-operative imaging. This rare combination of fracture pattern illustrates the need for awareness of the dual pathology and to provide adequate stability to prevent chronic ankle pain.

In this report, we review the Salter-Harris classification of pediatric fractures, including its histologic basis in the biomechanics of bone growth, and present a case of ankle injury. The case describes a unique subtype of pediatric growth plate injury, the Tillaux fracture, whose treatment is then discussed.

Purpose. To evaluate pediatric growth plate injuries with conventional radiographs and magnetic resonance imaging (MRI). To review potential clinical impact of MRI on subsequent patient management and outcome. Methods. Fourteen patients with known or suspected growth plate injury were studied. Each patient underwent imaging by conventional radiography and MRI within 2 weeks of injury. Findings on conventional radiographs and on MR images were compared and then correlated with subsequent management and outcome at a mean of 12 months. Results. Direct visualization of cartilage afforded by MRI improved evaluation of growth plate injury in each case. MRI changed Salter Harris classification or staging in 2 of 9 patients with fractures visualized on conventional radiographs, allowed the detection of radiographically occult fractures in 5 of 14 cases, and resulted in a physical change in management in 5 of the 14 patients studied. Conclusion. MRI has an important role in the evaluation of acute pediatric growth plate injury, particularly when diagnostic uncertainty persists following the evaluation of conventional radiographs. MRI allows detection of occult fractures, may alter Salter Harris staging, and in the reported study it frequently resulted in a change in patient management.

Growth plate injuries often result in undesirable bony repair causing bone growth defects, for which the underlying mechanisms are unclear. Whilst the key importance of pro-angiogenic vascular endothelial growth factor (VEGF) is well-known in bone development and fracture repair, its role during growth plate bony repair remains unexplored. Using a rat tibial growth plate injury repair model with anti-VEGF antibody, Bevacizumab, as a single i.p. injection (2.5 mg/kg) after injury, this study examined the roles of VEGF-driven angiogenesis during growth plate bony repair. Histology analyses observed isolectin-B4-positive endothelial cells and blood vessel-like structures within the injury site on days 6 and 14, with anti-VEGF treatment significantly decreasing blood-vessel-like structures within the injury site (PPPPRunx2expression at the injury site following treatment. Furthermore, growth plate injury-induced reduced tibial lengthening was more pronounced in anti-VEGF-treated injured rats on day 60, consistent with the observation of a significantly increased height of the hypertrophic zone adjacent to the growth plate injury site (P

This paper is one of 4 papers in a thematic review section on Recent Research on the Growth Plate: Regulation, Injury and Regeneration. The guest editor for this section was Cory Xian, University of South Australia, Adelaide, Australia. C Xian was not involved in the handling of this paper, on which they are listed as an author. Injuries to the growth plate cartilage often lead to bony repair, resulting in bone growth defects such as limb length discrepancy and angulation deformity in children. Currently utilised corrective surgeries are highly invasive and limited in their effectiveness, and there are no known biological therapies to induce cartilage regeneration and prevent the undesirable bony repair. In the last 2 decades, studies have investigated the cellular and molecular events that lead to bony repair at the injured growth plate including the identification of the four phases of injury repair responses (inflammatory, fibrogenic, osteogenic and remodelling), the important role of inflammatory cytokine tumour necrosis factor alpha in regulating downstream repair responses, the role of chemotactic and mitogenic platelet-derived growth factor in the fibrogenic response, the involvement and roles of bone morphogenic protein and Wnt/B-catenin signalling pathways, as well as vascular endothelial growth factor-based angiogenesis during the osteogenic response. These new findings could potentially lead to identification of new targets for developing a future biological therapy. In addition, recent advances in cartilage tissue engineering highlight the promising potential for utilising multipotent mesenchymal stem cells (MSCs) for inducing regeneration of injured growth plate cartilage. This review aims to summarise current understanding of the mechanisms for growth plate injury repair and discuss some progress, potential and challenges of MSC-based therapies to induce growth plate cartilage regeneration in combination with chemotactic and chondrogenic growth factors and supporting scaffolds. Refereed/Peer-reviewed

Providers treating pediatric injuries must understand the properties of the pediatric skeleton and be sensitive to the psychological and social expectations of patients and their families. Immediate needs must be addressed, and the long-term prognosis must be explained. Detailed understanding of fracture mechanism and fracture patterns is essential for diagnosis and treatment. The provider must remain vigilant for changes in the osseous and soft tissue structures during treatment. Failure to recognize signs of growth interruption and changes in position may lead to functional abnormalities. This article presents an overview of pediatric growth plate injury management.

The growth plate at the end of long bones is the cartilaginous organ responsible for longitudinal bone growth in children. Trauma to the growth plate, i.e. fractures, can severely impair longitudinal bone growth, leading to growth disorders due to destruction of the epiphyseal circulation and formation of a bone bridge. From the clinical experience it is known that in some patients this bone bridge eventually disappears during the growth process. However, the molecular mechanisms involved in bone bridge formation and dissolution have not been clarified yet. The aim of this study was to investigate the spatial and temporal protein level of molecules potentially involved in these processes, i.e. RANKL, OPG, DKK-1, Coll 10, BMP-2 and IL-6, in an experimental rat model using an immunohistochemical approach. The results from our study suggest that bone bridge formation might be an early event starting immediately after growth plate injury and involving several pro-osteoblastic molecules, i.e. IL-6, BMP-2 as well as OPG and Coll X. In the late studied time points 3- and 9-month post-injury expression of anti-osteoblastic proteins, i.e. DKK1 and RANKL, was increased. This indicates that bone bridge dissolution might be a late event and potentially linked to Wnt signaling inhibition and RANK/RANKL signaling activation.

AB Purpose: The treatment of anterior cruciate ligament (ACL) tears in children is controversial because of the potential injury to the growth plate resulting from traditional transphyseal surgery. Some authors recommend Tanner staging as a method to determine the patient's maturity to decide between physeal-sparing or transphyseal surgery. This study examines the accuracy and interobserver and intraobserver reliabilities of Tanner staging performed by orthopedic surgeons. Methods: Twenty-eight photographs representing Tanner stages 1-5 were obtained from a pediatric endocrinologist. Four sports medicine orthopedic surgeons received a tutorial on Tanner staging and independently graded the photographs twice, with a 1-month interval between grading exams. The endocrinologist's grade was considered correct. Intraobserver and interobserver reliabilities were determined. Results: The overall average correct scores were as follows: 53% correct Tanner stages on exam 1 and 59% correct on exam 2. The average results for specific Tanner stages were as follows: Tanner stage 1 = 62% correct on exam 1, 83% on exam 2; Tanner stage 2 = 60%/65%; Tanner stage 3 = 60%/46%; Tanner stage 4 = 45%/55%; and Tanner stage 5 = 50%/45%. Per examiner, correct grading was as follows: examiner 1 = 39% on exam 1 and 35% on exam 2; examiner 2 = 67%/82%; examiner 3 = 50%/42%; and examiner 4 = 67%/75%. When comparing the grading between exams 1 and 2, examiner 1 changed five answers from correct to incorrect; four answers from incorrect to correct; and two answers from incorrect to a different incorrect choice; examiner 2, three/seven/zero; examiner 3, six/four/one; and examiner 4, two/four/zero. Conclusions: Preoperative Tanner staging performed by orthopedic surgeons is unreliable with large intraobserver and interobserver variabilities. Therefore, relying on Tanner staging as a method to guide decision making for surgery in skeletally immature patients with ACL tears may lead to inadvertent growth plate injury.

Background Conventional radiography has limitations in the detection of physeal fractures before the closure of the physis occurs. Fracture detection may be improved by using magnetic resonance imaging (MRI). Purpose To evaluate the usefulness of MRI for the detection of occult fractures involving the physis when radiography results are negative. Material and Methods In this prospective study, 24 children (age range, 3–15 years; mean age, 10.7 years) received MRI if they met the following criteria: acute joint trauma, swelling and tenderness around the joint, limitations in bearing weight, an open physis, and negative radiography results for fractures. Fractures revealed by the MRI were classified according to the Salter-Harris classification system. Joint effusion, bone marrow edema, and periosteal alterations were graded on a three-point scale. The non-parametric Wilcoxon test and Fisher's exact test were used for the statistical evaluation. Results From a total of 24 MR data-sets, 23 were evaluated (one patient was excluded due to poor MR image quality). Elbow injuries were present in 10 patients (43.5%), distal tibia injuries in 10 patients (43.5%), and distal femur injuries in three patients (13%). MRI results excluded physeal fractures in 15 (65.2%) of the 23 children. An occult physeal fracture was detected with MRI in eight (34.8%) patients; of these, five (21.7%) had fractures of the elbow, two (8.7%) had fractures of the distal tibia, and one (4.3%) had a fracture of the distal femur. All of the patients with fractures and 11 of the 15 patients without fractures demonstrated bone marrow edema. Conclusion The frequency of occult fracture, as detected by MRI, was 34.8%. Thus, MRI is a useful additional imaging method for the detection of occult fractures when radiography is negative.

A growth plate injury can lead to a total or partial epiphysiodesis. In the first case, a leg length discrepancy will occur, due to the growth arrest of the injured plate. The anticipation of the discrepancy at skeletal maturity is achieved with the Green and Anderson data, either with the arithmetic method, the growth remaining charts, or the Moseley straight line graph. In case of a partial excentric epiphysiodesis, the future growth will lead to a progressive angular deformity, and the prognosis can be approached with the Bowen graph. If the injury is located at the metaphyseal area, a temporary overgrowth can be observed, due to a delay in maturation of the ossification front. The growth velocity returns to a normal value usually after one or two years, but the final prognosis is difficult to establish. Finally, the growth plate acts as a remodelling factor for some metaphyseal and diaphyseal malunions. The potential of remodelling depends on the age of the child, the proximity of the malunion to the plate, and the plane of the deformity. A good knowledge of these rules can help to determine the tolerance levels of incomplete reductions of children's fractures.

Injuries to the growth plate remain a significant clinical challenge. The need to better understand mechanisms of growth disruption following transphyseal injuries and evaluate new therapeutic approaches to growth restoration motivates development of a well characterized model of growth plate injury. The goals of this study were to develop a growth plate defect model in the rat and to use microcomputed tomography (micro-CT) imaging to detect and quantify associated changes in growth plate morphology and mineralization over time following injury and in response to treatment. Three-dimensional images of the growth plate were created from micro-CT scans and used to quantify the volume of mineralized tissue within the defect site. Growth plate thickness and volume as well as the degree of growth plate fusion were also measured from the reconstructed 3D images. Growth deficiency was then quantified as a function of time post-injury from whole limb micro-CT scans. Finally, this model was used to determine the ability of an injectable in situ gelling hydrogel to prevent formation of a bony bridge within the defect and the subsequent effect on limb length deficiency and changes to growth plate morphology. Growth plate injury resulted in significant shortening of the defect limb by day 28 and significant thinning and fusion of the surrounding growth plate up to day 112. Limb length reduction was correlated with changes in the growth plate volume and average thickness at day 56. Injection of an in situ gelling agarose into the defect resulted in a reduction of limb length discrepancy as well as a thicker growth plate on average compared to empty defect controls. These results establish a novel method of characterizing changes in whole bone and growth plate morphology due to a growth plate injury and indicate that treatment with agarose hydrogel reduces limb length discrepancy but is not sufficient to regenerate growth plate tissue or fully restore growth function.