Abstract
The cartilaginous primary physis, or growth plate, at the end of long bones in children allows for longitudinal bone growth. A variety of insults to the physis can lead to physeal bridge formation, which in turn can lead to limb-shortening and angular deformities. This paper begins with a description of the causes, risk factors and mechanisms by which bridges form. Then it reviews the use of imaging in the diagnosis and characterization of bridges and in the evaluation of treatment and post-treatment complications. It is important for radiologists taking care of children to be aware of the indirect and direct imaging findings of physeal bridges to aid in their diagnosis, to be able to characterize bridges as part of preoperative planning, and to know the imaging finding of post-resection complications.
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References
Khoshhal KI, Kiefer GN (2005) Physeal bridge resection. J Am Acad Orthop Surg 13:47–58
Ecklund K, Jaramillo D (2001) Imaging of growth disturbance in children. Radiol Clin N Am 39:823–841
Jawetz ST, Shah PH, Potter HG (2015) Imaging of physeal injury: overuse. Sports Health 7:142–153
Nguyen JC, Markhardt BK, Merrow AC, Dwek JR (2017) Imaging of pediatric growth plate. Radiographics 37:1791–1812
Jaimes C, Chauvin NA, Delgado J, Jaramillo D (2014) MR imaging of normal epiphyseal development and common epiphyseal disorders. Radiographics 34:449–471
Oestreich AE (2008) Enchondral growth: physes and acrophyses. In: Growth of the pediatric skeleton a primer for radiologists. Springer-Verlag, Berlin, pp 7–11
Laor T, Jaramillo D (2009) MR imaging insights into skeletal maturation: what is normal? Radiology 250:28–38
Jaramillo D, Dormans JP, Delgado J et al (2017) Hematogenous osteomyelitis in infants and children: imaging of a changing disease 1. Radiology 283:629–643
Trueta J, Morgan JD (1960) The vascular contribution to osteogenesis. I. Studies by the injection method. J Bone Joint Surg Br 42:97–109
Vu TH, Shipley JM, Bergers G et al (1998) MMP-9/gelatinase B is a key regulator of growth plate angiogenesis and apoptosis of hypertrophic chondrocytes. Cell 93:411–422
Jaramillo D, Laor T, Zaleske DJ (1993) Indirect trauma to the growth plate: results of MR imaging after epiphyseal and metaphyseal injury in rabbits. Radiology 187:171–178
Abzug JM, Little K, Kozin SH (2014) Physeal arrest of the distal radius. J Am Acad Orthop Surg 22:381–389
Leary JT, Handling M, Talerico M et al (2009) Physeal fractures of the distal tibia: predictive factors of premature physeal closure and growth arrest. J Pediatr Orthop 29:356–361
Kraus R, Kaiser M (2008) Growth disturbances of the distal tibia after physeal separation — what do we know, what do we believe we know? A review of current literature. Eur J Pediatr Surg 18:295–299
Ecklund K, Jaramillo D (2002) Patterns of premature physeal arrest: MR imaging of 111 children. AJR Am J Roentgenol 178:967–972
Jaramillo D, Kammen BF, Shapiro F (2000) Cartilaginous path of physeal fracture-separations: evaluation with MR imaging — an experimental study with histologic correlation in rabbits. Radiology 215:504–511
Stephen RF, Benson MKD, Nade S (2012) Misconceptions about childhood acute osteomyelitis. J Child Orthop 6:353–356
Speers DJ, Nade SM (1985) Ultrastructural studies of adherence of Staphylococcus aureus in experimental acute hematogenous osteomyelitis. Infect Immun 49:443–446
Gilbertson-Dahdal D, Wright JE, Krupinski E et al (2014) Transphyseal involvement of pyogenic osteomyelitis is considerably more common than classically taught. AJR Am J Roentgenol 203:190–195
Saltzman MD, King EC (2007) Central physeal arrests as a manifestation of hypervitaminosis a. J Pediatr Orthop 27:351–353
Steineck A, Mackenzie JD (2016) Premature physeal closure following 13-cis-retinoic acid and prolonged fenretinide administration in neuroblastoma. Pediatr Blood Cancer 63:2050–2053
Lawson JP, McGuire J (1987) The spectrum of skeletal changes associated with long-term administration of 13-cis-retinoic acid. Skelet Radiol 16:91–97
Skyttä E, Savolainen A, Kautiainen H et al (2003) Treatment of leg length discrepancy with temporary epiphyseal stapling in children with juvenile idiopathic arthritis during 1957–99. J Pediatr Orthop 23:378–380
Khanna G, Sato TS, Ferguson P (2009) Imaging of chronic recurrent multifocal osteomyelitis. Radiographics 29:1159–1177
Golant A, Nord RM, Paksima N, Posner MA (2008) Cold exposure injuries to the extremities. J Am Acad Orthop Surg 16:704–715
Kraus R, Wessel L (2010) The treatment of upper limb fractures in children and adolescents. Dtsch Arztebl Int 107:903–910
Cerezal L, Pin F, Abascal F (2004) Imaging findings in ulnar-sided wrist. Magn Reson Imaging Clin N Am 12:281–299
Gogna P, Gaba S, Mukhopadhyay R, Rohilla R (2017) Neglected epiphyseal injuries of the distal end of the radius with ulnar impaction: analysis of distal osteotomy of both bones using a dorsal midline approach. J Orthop Traumatol 18:31–36
Ali S, Kaplan S, Kaufman T et al (2015) Madelung deformity and Madelung-type deformities: a review of the clinical and radiological characteristics. Pediatr Radiol 45:1856–1863
Zebala LP, Manske PR, Goldfarb CA (2007) Madelung’s deformity: a spectrum of presentation. J Hand Surg Am 32:1393–1401
Zbojniewicz AM, Laor T (2011) Focal periphyseal edema (FOPE) zone on MRI of the adolescent knee: a potentially painful manifestation of physiologic physeal fusion? AJR Am J Roentgenol 197:998–1004
Yuan BJ, Stans AA, Larson DR, Peterson HA (2019) Excision of physeal bars of the distal femur, proximal and distal tibia followed to maturity. J Pediatr Orthop 39:e422–e429
Craig JG, Cody DD, Van Holsbeeck M (2004) The distal femoral and proximal tibial growth plates: MR imaging, three-dimensional modeling and estimation of area and volume. Skelet Radiol 33:337–344
Sailhan F, Chotel F, Guibal AL et al (2004) Three-dimensional MR imaging in the assessment of physeal growth arrest. Eur Radiol 14:1600–1608
Mäkelä EA, Vainionpää S, Vihtonen K et al (1988) The effect of trauma to the lower femoral epiphyseal plate. An experimental study in rabbits. J Bone Joint Surg Br 70:187–191
Lee SU, Lee JY, Joo SY et al (2016) Transplantation of a scaffold-free cartilage tissue analogue for the treatment of physeal cartilage injury of the proximal tibia in rabbits. Yonsei Med J 57:441–448
Li W, Xu R, Huang J et al (2017) Treatment of rabbit growth plate injuries with oriented ECM scaffold and autologous BMSCs. Sci Rep 7:1–11
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Dr. Meyers is an author and editor for Amirsys/Elsevier and receives royalties.
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Meyers, A.B. Physeal bridges: causes, diagnosis, characterization and post-treatment imaging. Pediatr Radiol 49, 1595–1609 (2019). https://doi.org/10.1007/s00247-019-04461-x
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DOI: https://doi.org/10.1007/s00247-019-04461-x