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Case Reports: Treatment of Traumatic Triradiate Cartilage Epiphysiodesis: What is the Role of Bridge Resection?

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Clinical Orthopaedics and Related Research®

Abstract

Background

Acetabular fractures are rare in children and can be complicated by premature fusion of the triradiate cartilage resulting in secondary acetabular dysplasia. Early recognition and treatment of a physeal bar in this location can be difficult. The purpose of this case report was to investigate whether early intervention could restore acetabular growth and prevent secondary acetabular dysplasia as measured on plain radiographs.

Case Description

We report a series of three patients (3, 4, and 5 years old) who underwent physeal bridge resection and methylmethacrylate or fat interposition through an extended Pfannenstiel approach. The mean followup was 6 years. After resection of the osseous bridge the physis initially remained open with evident acetabular growth in all three patients. In one patient, the bridge reformed 6 years after the procedure. All patients had a slight increase in the thickness of the acetabular wall relative to the contralateral side but no radiographic evidence of acetabular dysplasia.

Literature Review

To our knowledge, there are only two reports of physeal arrest resection of triradiate cartilage with one successful result.

Clinical Relevance

Posttraumatic, partial physeal arrest of the triradiate cartilage may be treated with resection of the bone bridge resection through an extended Pfannenstiel approach. The potential benefits of this treatment must be weighed against the risks.

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Fig. 1A–E
Fig. 2A–C
Fig. 3A–D

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Authors and Affiliations

  1. Université Pierre et Marie Curie, Paris, France

    Alina Badina MD, Raphael Vialle MD, PhD, Frank Fitoussi MD, PhD & Jean Paul Damsin MD, PhD

  2. Hôpital Armand Trousseau, Service de Chirurgie Pédiatrique, 26 avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France

    Alina Badina MD, Raphael Vialle MD, PhD, Frank Fitoussi MD, PhD & Jean Paul Damsin MD, PhD

Authors
  1. Alina Badina MD
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  2. Raphael Vialle MD, PhD
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  3. Frank Fitoussi MD, PhD
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  4. Jean Paul Damsin MD, PhD
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Corresponding author

Correspondence to Alina Badina MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the reporting of this case report, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Hôpital Armand Trousseau, Paris, France.

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Badina, A., Vialle, R., Fitoussi, F. et al. Case Reports: Treatment of Traumatic Triradiate Cartilage Epiphysiodesis: What is the Role of Bridge Resection?. Clin Orthop Relat Res 471, 3701–3705 (2013). https://doi.org/10.1007/s11999-013-3054-z

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  • DOI: https://doi.org/10.1007/s11999-013-3054-z

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