Growth Plate, Premature Physeal Closure



Growth Plate, Premature Physeal Closure


B. J. Manaster, MD, PhD, FACR



DIFFERENTIAL DIAGNOSIS


Common



  • Fracture


Less Common



  • Osteomyelitis


  • Septic Joint


  • Iatrogenic (Surgical)


  • Juvenile Idiopathic Arthritis (JIA)


  • Ollier/Maffucci Syndrome (Mimic)


  • Radiation-Induced Growth Deformities


  • Thermal Injury


Rare but Important



  • Complications of Vitamin A


  • Hemophilia: MSK Complications


  • Meningococcemia


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Number/distribution of physes is diagnostic


Helpful Clues for Common Diagnoses



  • Fracture



    • Hyperemia in metadiaphyseal fracture may result in early fusion of physis


    • Salter injury (usually 3, 4, or 5) may result in focal early bony bridging


Helpful Clues for Less Common Diagnoses



  • Osteomyelitis



    • Usually located in metaphysis in child



      • Occasionally, process will cross physis to involve epiphysis → early fusion


    • Hyperemia from chronic infection may result in early fusion of entire physis


  • Septic Joint



    • Early fusion: Chronic hyperemia or direct extension to physis if intracapsular (hip)


  • Iatrogenic (Surgical)



    • Epiphysiodesis performed for angular deformity or short contralateral limb


  • Juvenile Idiopathic Arthritis (JIA)



    • Chronic hyperemia at involved joints has 2 growth-related consequences



      • Epiphyseal/metaphyseal overgrowth


      • Early fusion of physis → short limb


    • Knee > elbow > ankle, not symmetric


  • Ollier/Maffucci Syndrome (Mimic)



    • Short, broad, abnormally tubulated metaphyses; often chondroid matrix


  • Radiation-Induced Growth Deformities



    • Vasculitis from radiation puts physis at risk


    • Nonviable physis → fusion and hypoplasia


    • Watch for port-like distribution


  • Thermal Injury



    • Vessels supplying physes at risk, particularly in hands or feet



      • → short, stubby fingers in adults


    • Burn: Contractures and calcification


    • Frostbite: Abnormality spares thumb


Helpful Clues for Rare Diagnoses

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Aug 10, 2016 | Posted by in PEDIATRICS | Comments Off on Growth Plate, Premature Physeal Closure

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