BACKGROUND: After any physeal injury, the primary concern is the possibility of some pattern of growth alteration, particularly transphyseal bridging that may cause lasting deformities and impact subsequent patient care. Small areas of physeal bridging, however, may be associated with continued growth, rather than impairment. METHODS: Seven patients with small central physeal bridges of the distal femur were identified. Demographic data and imaging studies were reviewed. RESULTS: Radiography identified small, relatively centrally located transphyseal osseous bridging that was associated with a linear (longitudinal) region of osseous density extending from the physeal bridge proximally into the metaphysis. This linear striation disappeared at the metaphyseal/diaphyseal gradation, an area of progression proximally from metaphysis to diaphysis. Only 1 patient had a significant leg length inequality. Magnetic resonance imaging confirmed the intrametaphyseal linear sclerotic bone and its disappearance with diaphyseal remodeling. CONCLUSIONS: Small, central transphyseal osseous bridges may form after radiologically confirmed acute physeal injury. Normal physiological (hydrostatic) growth forces can be sufficient to overcome such limited central bridging and allow continued, essentially normal, longitudinal growth. LEVEL OF EVIDENCE: Level IV (retrospective case series); anatomic study.
BACKGROUND: After any physeal injury, the primary concern is the possibility of some pattern of growth alteration, particularly transphyseal bridging that may cause lasting deformities and impact subsequent patient care. Small areas of physeal bridging, however, may be associated with continued growth, rather than impairment. METHODS: Seven patients with small central physeal bridges of the distal femur were identified. Demographic data and imaging studies were reviewed. RESULTS: Radiography identified small, relatively centrally located transphyseal osseous bridging that was associated with a linear (longitudinal) region of osseous density extending from the physeal bridge proximally into the metaphysis. This linear striation disappeared at the metaphyseal/diaphyseal gradation, an area of progression proximally from metaphysis to diaphysis. Only 1 patient had a significant leg length inequality. Magnetic resonance imaging confirmed the intrametaphyseal linear sclerotic bone and its disappearance with diaphyseal remodeling. CONCLUSIONS: Small, central transphyseal osseous bridges may form after radiologically confirmed acute physeal injury. Normal physiological (hydrostatic) growth forces can be sufficient to overcome such limited central bridging and allow continued, essentially normal, longitudinal growth. LEVEL OF EVIDENCE: Level IV (retrospective case series); anatomic study.
Authors: Bernhard Neumayer; Eva Amerstorfer; Clemens Diwoky; Richard A Lindtner; Elisabeth Wadl; Eva Scheurer; Annelie-Martina Weinberg; Rudolf Stollberger Journal: MAGMA Date: 2017-03-30 Impact factor: 2.310