By Hamlet A. Peterson

This ebook records the entire methods a progress plate will be broken, except fracture. This harm could be inflicted by means of a large choice of insults, such a lot of that are unusual occurrences. all of them, notwithstanding, have comparable features: common roentgenographs on the time of insult and untimely entire or partial arrest famous weeks, months, or years later. due to this hold up, the arrest is frequently no longer suspected or regarded early. The ensuing bone deformity and relative shortening often pass undetected till corrective surgical procedure is required. This publication emphasises etiology, analysis, and remedy of those injuries.

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Ischemia of the physis can occur with or without involvement of the 30 [105]. ” [100] Hind leg immobilization of 2½ month old rats retarded longitudinal growth by 2 weeks [102]. Growth resumed, but did not catch up. The combination of the frog position and cast immobilization may therefore produce marked diminution of blood flow to the lower extremities. Traction of the femur may produce arterial spasm [99], which could also be a factor in some cases of DDH. There is a strong correlation between the initial degree of vascular insufficiency and subsequent radiographic changes such as a crescent-shaped epiphysis, medial bowing of the femoral neck (a shorter and more concave curve between the lesser trochanter and femoral head [the lateral portion of Shenton’s line]) and premature physeal closure [103].

2 Vascular Anatomy of the Physis 5 a Fig. 4 Widening of the physis due to ischemia of the metaphyseal arteries of the proximal tibia. This 12 year 0 month old boy was kicked by another soccer player on the right knee just medial to the tibial tubercle and inferior to the joint line. There was immediate pain and he was carried from the field. (a) Roentgenographs were reported normal and a diagnosis of “sprain” of the knee was made. A knee immobilizer was applied and crutches given. Four days later an orthopedist noted swelling and tenderness well localized medial to the tibial tubercle.

The eventual surgical physeal arrests on the right leg prevented the discrepancy from increasing. Since all tibial physes were then closed, the ultimate discrepancy without surgical closure on the right cannot be determined. The value of presenting this case is to (1) document the possibility of physeal closure of both the proximal and distal tibial physis, but without that of the distal femur, and (2) to emphasize the need for close follow-up 20 c e Fig. 3 Vascular Deficiency Due to Reduced Quantity f g Fig.

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