Osteoarticular Trauma in the Pediatric Age: Overview — Apophyseal Injuries

Abstract

From the anatomical point of view, apophyses are protuberances on bone (from Greek αποφισις, composed of apo “to bring forth” and physis “to grow”) that make up specialized structures for the attachment of tendons and ligaments. Among children and adolescents, lesions on the apophysis are a common clinical problem related to sporting and recreational activities. This is due to the fact that, between the age of 12 and 16 years, the structure of apophyses makes them vulnerable: the development of their ossification center is not yet complete, and the cartilage, under hormonal influence, loses elasticity and is unable to give firm stability to the osteotendinous junction. Hence, rough application of shear or torsion forces, exercised upon the apophyses by tendons and ligaments, can overcome the threshold of cartilage and bone resistance. This may result in fragmentation or detachment, which consequently impairs function to an extent that can be more or less disabling for the patient. The range of apophyseal injuries is extremely broad and is influenced by the following factors: degree of bone and cartilage maturation (and, therefore, age of the child or adolescent at the time of trauma); anatomical location of the apophysis; and the geometry and degree of the forces applied to the myotendinous system. This pathophysiologic complexity may explain the large number of terms used to define this type of injury, often generating confusion in descriptions of the process itself. Terms range from “apophyseal irritation”, to “traction apophysitis”, “osteochondrosis”, “chronic apophysitis”, “osteochondritis”, and “apophyseal separation”.