Skip to main content

Advertisement

Log in

Physeal bridges: causes, diagnosis, characterization and post-treatment imaging

  • Musculoskeletal imaging
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15

Similar content being viewed by others

References

  1. Khoshhal KI, Kiefer GN (2005) Physeal bridge resection. J Am Acad Orthop Surg 13:47–58

    Article  Google Scholar 

  2. Ecklund K, Jaramillo D (2001) Imaging of growth disturbance in children. Radiol Clin N Am 39:823–841

    Article  CAS  Google Scholar 

  3. Jawetz ST, Shah PH, Potter HG (2015) Imaging of physeal injury: overuse. Sports Health 7:142–153

    Article  Google Scholar 

  4. Nguyen JC, Markhardt BK, Merrow AC, Dwek JR (2017) Imaging of pediatric growth plate. Radiographics 37:1791–1812

    Article  Google Scholar 

  5. Jaimes C, Chauvin NA, Delgado J, Jaramillo D (2014) MR imaging of normal epiphyseal development and common epiphyseal disorders. Radiographics 34:449–471

    Article  Google Scholar 

  6. Oestreich AE (2008) Enchondral growth: physes and acrophyses. In: Growth of the pediatric skeleton a primer for radiologists. Springer-Verlag, Berlin, pp 7–11

    Google Scholar 

  7. Laor T, Jaramillo D (2009) MR imaging insights into skeletal maturation: what is normal? Radiology 250:28–38

    Article  Google Scholar 

  8. 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

    Article  Google Scholar 

  9. Trueta J, Morgan JD (1960) The vascular contribution to osteogenesis. I. Studies by the injection method. J Bone Joint Surg Br 42:97–109

    Article  Google Scholar 

  10. 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

    Article  CAS  Google Scholar 

  11. 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

    Article  CAS  Google Scholar 

  12. Abzug JM, Little K, Kozin SH (2014) Physeal arrest of the distal radius. J Am Acad Orthop Surg 22:381–389

    Article  Google Scholar 

  13. 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

    Article  Google Scholar 

  14. 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

    Article  CAS  Google Scholar 

  15. Ecklund K, Jaramillo D (2002) Patterns of premature physeal arrest: MR imaging of 111 children. AJR Am J Roentgenol 178:967–972

    Article  Google Scholar 

  16. 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

    Article  CAS  Google Scholar 

  17. Stephen RF, Benson MKD, Nade S (2012) Misconceptions about childhood acute osteomyelitis. J Child Orthop 6:353–356

    Article  Google Scholar 

  18. Speers DJ, Nade SM (1985) Ultrastructural studies of adherence of Staphylococcus aureus in experimental acute hematogenous osteomyelitis. Infect Immun 49:443–446

    CAS  PubMed  PubMed Central  Google Scholar 

  19. 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

    Article  Google Scholar 

  20. Saltzman MD, King EC (2007) Central physeal arrests as a manifestation of hypervitaminosis a. J Pediatr Orthop 27:351–353

    Article  Google Scholar 

  21. 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

    Article  CAS  Google Scholar 

  22. 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

    Article  CAS  Google Scholar 

  23. 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

    PubMed  Google Scholar 

  24. Khanna G, Sato TS, Ferguson P (2009) Imaging of chronic recurrent multifocal osteomyelitis. Radiographics 29:1159–1177

    Article  Google Scholar 

  25. Golant A, Nord RM, Paksima N, Posner MA (2008) Cold exposure injuries to the extremities. J Am Acad Orthop Surg 16:704–715

    Article  Google Scholar 

  26. Kraus R, Wessel L (2010) The treatment of upper limb fractures in children and adolescents. Dtsch Arztebl Int 107:903–910

    PubMed  PubMed Central  Google Scholar 

  27. Cerezal L, Pin F, Abascal F (2004) Imaging findings in ulnar-sided wrist. Magn Reson Imaging Clin N Am 12:281–299

    Article  Google Scholar 

  28. 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

    Article  Google Scholar 

  29. 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

    Article  Google Scholar 

  30. Zebala LP, Manske PR, Goldfarb CA (2007) Madelung’s deformity: a spectrum of presentation. J Hand Surg Am 32:1393–1401

    Article  Google Scholar 

  31. 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

    Article  Google Scholar 

  32. 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

    Article  Google Scholar 

  33. 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

    Article  Google Scholar 

  34. 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

    Article  Google Scholar 

  35. 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

    Article  Google Scholar 

  36. 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

    Article  Google Scholar 

  37. 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

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Arthur B. Meyers.

Ethics declarations

Conflicts of interest

Dr. Meyers is an author and editor for Amirsys/Elsevier and receives royalties.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-019-04461-x

Keywords

Navigation