Grape seed extract inhibits apoptosis in growth plate chondrocytes and promotes tibial growth in rats / 中国组织工程研究

BACKGROUND:Grape seed extract has been shown to be effective in inhibiting the growth of androgen-dependent tumors(e.g.,breast cancer),and thus grape seed extract could theoretically inhibit epiphyseal closure induced by estrogen in late adolescence. OBJECTIVE:To screen the effects of grape seed extract on apoptosis of growth plate chondrocytes and epiphyseal closure in rats. METHODS:(1)In vitro experiment:Growth plate chondrocytes from rat large tibia and femur at logarithmic growth stage were obtained and cultured in groups:normal control group,model control group(adding 17β-estradiol to induce apoptosis),positive control group(adding letrozole and 17β-estradiol),grape seed extract group(adding 17β-estradiol and 10 μg/mL grape seed extract),Caspase-9 inhibitor group(adding 17β-estradiol and Caspase-9 inhibitor),Caspase-9 agonist group(adding 17β-estradiol and Caspase-9 agonist).Cell apoptosis was detected by flow cytometry after 48 hours of culture.(2)In vivo experiment:Thirty 3-month-old Sprague-Dawley rats were randomly divided into model control group,positive control group and low-,medium-and high-dose groups,with five rats in each group.All rats were injected subcutaneously with 17β-estradiol(3 times per week)to establish epiphyseal closure models,followed by intragastric administration of letrozole in positive control group and 0.05,0.2 and 0.8 g/kg grape seed extract in low-,medium-and high-dose groups,respectively,once a day until over 2/3 of the epiphyseal plate in the model control group was closed.The length of the tibia was then observed.Another 18 Sprague-Dawley rats were randomly divided into model control group,positive control group,and medium-dose group,with 6 rats in each group,treated as above for 1.5 continuous months.The expression of Caspase-9 protein in rat growth plate cartilage was detected by western blot. RESULTS AND CONCLUSION:(1)In vitro experiment:17β-estradiol could induce apoptosis in growth plate chondrocytes,and letrozole,grape seed extract,and caspase-9 inhibitors could all inhibit apoptosis in growth plate chondrocytes.(2)In vivo experiment:When more than 2/3 of the epiphyseal plate in the model control group was closed,the number of rats with epiphysis closure in the positive control and medium-dose groups was less than that in the model control group(P＜0.05),and the tibial length was longer than that in the model control group(P＜0.05),and the Caspase-9 protein expression in the tibial growth plate was lower than that in the model control group(P＜0.05).To conclude,the appropriate dose of grape seed extract can effectively inhibit the apoptosis of growth plate chondrocytes and delay epiphyseal closure,which has the potential to promote bone growth.

Child Fractures: Are We Getting More Surgical? / Fraturas na criança: Estamos ficando mais cirúrgicos?

Abstract Historically, surgeries on the immature skeleton were reserved for open or articular fractures. In recent years, the improvement in the quality and safety of anesthesia, new imaging equipment, implants designed especially for pediatric fractures, associated with the possibility of shorter hospitalization time and rapid return to social life has demonstrated a new tendency to evaluate and treat fractures in children. The purpose of this update article is to answer the following questions: (1) Are we really turning more surgical in addressing fractures in children? (2) If this is true, is this surgical conduct based on scientific evidence? In fact, in recent decades, the medical literature demonstrates articles that support better evolution of fractures in children with surgical treatment. In the upper limbs, this is very evident in the systematization of the reduction and percutaneous fixation of supracondylar fractures of the humerus and fractures of the forearm bones. In the lower limbs, the same occurs with diaphyseal fractures of the femur and tibia. However, there are gaps in the literature. The available published studies show low scientific evidence. Thus, it can be inferred that, even though the surgical approach is more present, the treatment of pediatric fractures should always be individualized and conducted according to the knowledge and experience of the professional physician, taking into account the presence of technological resources available for the care of the small patient. All possibilities, non-surgical and/or surgical, should be included, always instituting actions based on science and in agreement with the family's wishes.

Resumo Historicamente, as cirurgias no esqueleto imaturo eram reservadas às fraturas expostas ou articulares. Nos últimos anos, a melhora na qualidade e segurança das anestesias, novos equipamentos de imagem, implantes desenhados especialmente para fraturas pediátricas, associados à possibilidade de menor tempo de hospitalização e rápido retorno ao convívio social vêm demonstrando uma nova tendência de avaliar e tratar fraturas na criança. O objetivo deste artigo de atualização é responder às seguintes questões: (1) estamos realmente ficando mais cirúrgicos na abordagem das fraturas em crianças? (2) Caso isto seja verdadeiro, esta conduta cirúrgica está baseada em evidências científicas? De fato, nas últimas décadas, a literatura médica demonstra artigos que suportam melhor evolução das fraturas na criança com o tratamento cirúrgico. Nos membros superiores, isto fica muito evidente na sistematização da redução e fixação percutânea das fraturas supracondilianas do úmero e das fraturas de ossos do antebraço. Nos membros inferiores, o mesmo ocorre com fraturas diafisárias do fêmur e tíbia. No entanto, há lacunas na literatura. Os estudos publicados são geralmente com baixa evidência científica. Assim, pode-se deduzir que, mesmo sendo a abordagem cirúrgica mais presente, o tratamento de fraturas pediátricas deve ser sempre individualizado e conduzido de acordo com o conhecimento e experiência do médico profissional, levando em conta a presença de recursos tecnológicos disponíveis para o atendimento do pequeno paciente. Deve-se incluir todas as possibilidades, não cirúrgicas e/ou cirúrgicas, sempre instituindo ações baseadas na ciência e em concordância com os anseios da família.

Clinical progress of 3D printing technology in treatment of distal tibial epiphyseal fractures in adolescents / 局解手术学杂志

The distal tibial epiphyseal fractures is a common type of fracture in adolescents.The distal tibia is adjacent to the ankle joint,where the epiphysis is fragile and easily damaged when the fracture occurs,resulting in ischemic necrosis of the epiphysis and impaired bone growth,and the degree of damage and treatment effect directly influence the shape and function of the ankle joint,seriously affect the prognosis and quality of life of adolescents.Therefore,anatomical reduction should be achieved after injury as much as possible to achieve stable fixation.For stable fractures of the distal tibial epiphysis(such as Salter-Harris type Ⅰ or Ⅱ fractures),the conservative treatment can be used;whereas for unstable fractures,especially Salter-Harris type Ⅲ and Ⅳ fractures with a high risk of displacement,surgical treatment is preferred.However,due to the physiological characteristics of the epiphysis of adolescents,the distal tibia grow and develop differently,the individualized treatment plans should be developed according to the situation of adolescents.3D printing technology combined with imaging technologies including CT and MRI can print complex shapes of geometric structures to meet individual needs,and play an important role in the surgical treatment of distal tibial epiphyseal fractures,especially Salter-Harris type Ⅲ and Ⅳ fractures,which can contribute to formulating individualized surgical plans,improving the success rate of surgery,reducing the incidence of long-term complications,and greatly improving the prognosis of adolescents.Based on the literature reports in the past decade,this paper reviews the research progress of the application of 3D printing technology in the diagnosis and treatment of distal tibial epiphyseal fractures in adolescents.

Short-term effectiveness of ultrasound-guided Kirschner wire provocation technique in treatment of Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents / 中国修复重建外科杂志

OBJECTIVE@#To investigate the short-term effectiveness of ultrasound-guided closed reduction by Kirschner wire provocation technique in the treatment of Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents.@*METHODS@#Between May 2019 and May 2022, 41 patients with Salter Harris types Ⅰ and Ⅱ distal tibial epiphyseal fractures were admitted, all of whom had periosteal entrapment on preoperative MRI, and 38 cases (92.7%) were confirmed to have periosteal entrapment by intraoperative ultrasound. There were 24 males and 14 females, the age ranged from 6.8 to 15.7 years, with an average of 10.7 years; and there were 20 cases of Salter Harris type Ⅰ and 18 cases of type Ⅱ. The time from injury to operation was 22-76 hours, with an average of 28.4 hours. The preoperative imaging examination showed excellent alignment in 4 cases, good in 20 cases, and poor in 14 cases. The ultrasound guided Kirschner wire provocation technique for closed reduction and percutaneous Kirschner wire internal fixation were performed. The operation time, intraoperative fluoroscopy frequency, fracture healing time, and complications were recorded. Anteroposterior and lateral X-ray films of the affected ankle joint were taken before operation, at 3 months after operation, and at last follow-up to observe the healing of the fracture, and anteroposterior X-ray films of the whole length of both lower limbs were taken to evaluate the alignment of the force lines of the affected limbs. The range of motion (ROM), visual analogue scale (VAS) score, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were used to evaluate ankle function. The mechanical lateral distal tibia angle (mLDTA) and the anatomic anterior distal tibia angle (aADTA) were measured.@*RESULTS@#The operation time ranged from 17 to 52 minutes, with an average of 22.6 minutes, and the intraoperative fluoroscopy frequency ranged from 3 to 11 times, with an average of 4.2 times. X-ray examination during operation and at 2 days after operation showed that anatomical reduction was achieved. All patients were followed up 10-24 months, with an average of 16.4 months. All fractures healed in 6.1-7.2 weeks, with an average of 6.3 weeks; no fracture displacement occurred, and the patients recovered to their pre-injury level of motion at 6 months after operation. Needle tail irritation occurred in 2 cases at 4 weeks after operation, and they recovered after symptomatic treatment. During the follow-up, there was no serious complication such as incision deep infection, bone nonunion, delayed union, and malunion. At last follow-up, the patients' alignment were all excellent, and the difference was significant when compared with preoperative one ( Z=-7.471, P<0.001). The VAS score, AOFAS ankle-hindfoot score, dorsiflexion-plantar flexion ROM, varus-valgus ROM, mLDTA, and aADTA significantly improved at 3 months after operation and last follow-up when compared with preoperative ones ( P<0.05).@*CONCLUSION@#Ultrasound-guided closed reduction by Kirschner wire provocation technique for treating Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents is minimally invasive and safe.

Fractura de la epífisis distal del fémur

Introducción: Las lesiones traumáticas de las epífisis son frecuentes en la edad pediátrica. La articulación de la rodilla es una de las más involucradas, en especial, la epífisis distal del fémur. Objetivo: Actualizar y brindar información sobre las fracturas de la epífisis distal del fémur. Método: La búsqueda y análisis de la información se realizó en un periodo de 61 días (1 de abril al 31 de mayo de 2022) y se emplearon las siguientes palabras: "physeal injuries", "physeal injuries and knee", "physeal fractures around the knee", "distal femoral physeal fracture", a partir de la información obtenida se realizó una revisión bibliográfica de un total de 153 artículos publicados en las bases de datos PubMed, Hinari, SciELO, y Medline, mediante el gestor de búsqueda y gestor de referencias EndNote, de ellos: se utilizaron 34 citas seleccionadas para realizar la revisión, 33 de los últimos cinco años. Desarrollo: Se mencionaron las características anatómicas más importantes relacionadas con el mecanismo de producción. Se hizo referencia a la clasificación de Salter Harris. Se expusieron las principales modalidades de tratamiento tanto conservadoras como quirúrgicas basadas en la clasificación. Con relación a las complicaciones se describieron las más reportadas en la literatura. Conclusiones: Las fracturas de la epífisis distal del fémur son lesiones complejas. Para su mejor entendimiento es importante conocer los mecanismos de producción, así como la clasificación basada en el grado de severidad. La terapéutica tanto conservadora como quirúrgica tiene indicaciones precisas basadas en el desplazamiento y grado de afección de la epífisis.

Introduction: Traumatic injuries of the epiphysis are frequent in the pediatric age groups. The knee joint is one of the most involved, especially, distal femoral epiphysis. Objective: Update and provide information concerning fractures of the distal femoral epiphysis. Method: Search and analysis of information was gathered over a period of 61 days (April 1 to May 31, 2022) and the following words were used as a key: physeal injuries, physeal injuries and knee, physeal fractures aroundtheknee, distal femoral physeal fracture. Based on the information obtained, a bibliographic review was made of a total of 153 articles published in the PubMed, Hinari, SciELO and Medline databases, using the search engine and reference manager EndNote: 34 selected citations were used for the review, 33 of them from the last five years. Development: The most important anatomical characteristics related to the mechanism of production were mentioned. The Salter Harris classification was pointed too. The main treatment modalities, both conservative and surgical, based on the classification, were presented. Regarding complications, the most reported in the literature were described. Conclusions: Fractures of the distal femoral epiphysis are complex injuries. For a better understanding, it is important to know the mechanisms of production, as well as the classification based on the degree of severity. Both conservative and surgical therapeutics have precise indications based on the degree and displacement of epiphysis affection.

Introdução: As lesões traumáticas das epífises são frequentes na idade pediátrica. A articulação do joelho é uma das mais acometidas, principalmente a epífise distal do fêmur. Objetivo: Atualizar e fornecer informações sobre fraturas da epífise distal do fêmur. Método: A busca e análise das informações foi realizada em um período de 61 dias (1º de abril a 31 de maio de 2022) e foram utilizadas as seguintes palavras: "lesões fisárias", "lesões fisárias e joelho", "fraturas fisárias ao redor o joelho", "fratura da fisária distal do fêmur", com base nas informações obtidas, foi realizada uma revisão bibliográfica de um total de 153 artigos publicados nas bases de dados PubMed, Hinari, SciELO e Medline, utilizando o gerenciador de busca e o gerenciador de referências EndNote , das quais: 34 citações selecionadas foram usadas para conduzir a revisão, 33 dos últimos cinco anos. Desenvolvimento: Foram mencionadas as características anatômicas mais importantes relacionadas ao mecanismo de produção. Foi feita referência à classificação de Salter Harris. As principais modalidades de tratamento, tanto conservador quanto cirúrgico com base na classificação, foram expostas. Em relação às complicações, foram descritas as mais relatadas na literatura. Conclusões: As fraturas da epífise distal do fêmur são lesões complexas. Para um melhor entendimento, é importante conhecer os mecanismos de produção, bem como a classificação com base no grau de severidade. Tanto a terapia conservadora quanto a cirúrgica têm indicações precisas baseadas no deslocamento e no grau de acometimento da epífise.

Saphenous vascular periosteal flap in prevention of bone bridge formation after epiphyseal plate injury: An experimental study / 中华显微外科杂志

Objective:To establish a model of epiphyseal plate injury in juvenile rabbits and explore the effect of periosteum flap with saphenous artery on preventing the formation of bone bridge after epiphyseal plate injury.Methods:From July 2017 to January 2018, 30 young New Zealand immature rabbit were randomly grouped into 3 groups (group A, B and C, with 10 rabbits per group). The blood vessels of knee joint were dissected and a periosteum flap with saphenous artery were designed. A model of distal femoral epiphyseal plate injury was established in immature rabbits with a 3.0 mm Kirschner wire on one side of the distal femoral epiphyseal plate as experimental side, and the other side of the distal femoral epiphyseal plate was assigned as control side. The injured epiphysis were prepared and described as follow: in experimental side of group A, a piece of periosteum with the same size as that in group C was resected and discarded. In experimental side of group B, a periosteal flap without vascular pedicle was filled in the injured area. And in experimental side of group C, a periosteum flap with saphenous artery was filled in the injured area. The length and varus angle of femur specimens of length and varus angle of femur specimens wihthin groups were measured at 24 weeks after surgery to evaluate the effect on bone growth in epiphyseal plate injury. The effect of the periosteum flap with saphenous artery on preventing a formation of bone bridge was assessed by section view of decalcified specimens, HE staining and toluidine blue staining. The measured data were expressed as Mean and standard deviation (Mean±SD), and data were compared within and between the groups using one-way analysis of variance (ANOVA). P<0.05 was considered as statistically significant. Results:The femur of experimental side of group A and B showed obvious short with valgus deformity compared with that of control side, and the difference of length and varus angle of femur specimens wihthin groups was statistically significant ( P<0.05). There were no significant differences in the length and valgus angle of the femur between experimental side and its control side in group C ( P>0.05). In experimental side of group A, there were bone bridges in the epiphyseal lesion area, with a clear boundary to the surrounding epiphyseal plate. In experimental side of group B, the periosteum flap in the injured area was absorbed, accompanied by the formation of a few pale white bone tissue, and with a clear boundary to the surrounding epiphyseal plate. In experimental side of group C, the lesion area was filled with milky white cartilage tissue with the same colour as the epiphyseal plate, and with an unclear boundary with the epiphyseal plate. HE stain and toluidine blue staining showed that the injured area of group A was filled with a large number of bone tissue, but no obvious cartilage tissue was observed. In group B, the area of lesion was filled mainly with fibrous tissue, with a small amount of bone tissue. In group C, a large number of hyaline cartilage tissues were formed along the tunnel of the injury area, and closely connected with the normal epiphyseal plate. Conclusion:Filling a periosteum flap with saphenous artery after epiphyseal plate injury can prevent the formation of bone bridge and prevent the affected limb form shortening and angulation.

Advances in tissue engineering treatment of epiphyseal plate injury in children / 中华实用儿科临床杂志

Epiphyseal plate injury in children is very common, which can be caused by fracture, infection, malignant tumors, iatrogenic injury or other causes.Growth arrest and angulation or rotation deformity after epiphyseal plate injury would seriously affect the physical and mental health of children.At present, the success rate of bone bridge resection combined with corresponding material filling is super low.The construction of bioactive epiphyseal cartilage using cartilage tissue engineering technology has become a new research direction for the treatment of epiphyseal plate injury in children.Therefore, this review focuses on the current research on the regeneration of epiphyseal cartilage from the perspective of 3 elements of tissue engineering: seed cells, growth factors, and tissue engineering scaffolds.

Manejo quirúrgico de la duplicación patelar bilateral en displasia epifisiaria múltiple recesiva. Reporte de caso / Surgical management of bilateral duplication of the patella in multiple recessive epiphyseal dysplasia. A case report

Introducción La displasia epifisiaria múltiple (DEM) es una enfermedad poco frecuente y con gran variedad clínica y se caracteriza por deformidades en las articulaciones, dolor, y trastornos de la marcha. La duplicación patelar se asocia con DEM recesiva y consiste en dos segmentos patelares escalonados separados por tejido blando entre ellos. Caso clínico Paciente masculino de 30 años con cuadro clínico de DEM recesiva con duplicación patelar, presenta dolor crónico bilateral de cadera y rodilla, y trastorno de la marcha. Tras el examen físico, se evidenció derrame articular, dificultad para la flexión de las rodillas y un cuerpo libre intra-articular bilateral. Se identificaron dos segmentos patelares, displasia acetabular y de cabeza femoral bilateral con imágenes diagnósticas. El manejo quirúrgico de la duplicación patelar fue resección de los segmentos óseos accesorios, conduciendo a un resultado clínico satisfactorio al año de seguimiento. Discusión Aunque no se realiza el diagnóstico genético de la DEM, nuestro paciente presenta las características fenotípicas y radiológicas de esta entidad. Para la duplicación patelar, se realizó la resección de las patelas accesorias, considerando el alto riesgo de no unión. Sin embargo, existen varios reportes donde unieron los dos segmentos patelares, pero principalmente en niños. Este es el primer reporte publicado sobre el manejo quirúrgico de esta patología en Colombia. La duplicación patelar puede manejarse con éxito mediante la resección de la patela accesoria en adultos. Aunque los hallazgos imagenológicos son muy sugestivos de esta patología, se requiere un adecuado examen físico para evitar un diagnóstico equivoco y tardío.

Background Multiple epiphyseal dysplasia (MED) is a rare disease with a great clinical variation, and is characterised by deformities in the joints, pain, and gait disorders. Duplication of the patella is associated with recessive MED, and consists of two staggered patellar segments separated by soft tissue between them. Clinical case A 30-years-old male patient with a clinical manifestation of recessive MED with duplication of the patella, chronic bilateral hip and knee pain, as well as gait disorder. After the physical examination, joint effusion, difficulty in flexing the knees, and a bilateral intra-articular free body were evident. Two patellar segments, acetabular dysplasia and bilateral femoral head, were identified with diagnostic imaging. The surgical management of duplication of the patella was resection of the accessory bone segments, leading to a satisfactory clinical result at one year of follow-up. Discussion Although the genetic diagnosis of the MED was not made, our patient presented with the phenotypic and radiological characteristics of this disease. For duplication of the patella, the accessory patella resection was performed, considering the high risk of non-union. However, there are several reports where the two patellar segments are joined; but mainly in children. This is the first report published about the surgical management of this pathology in Colombia. Duplication of the patella can be managed successfully by resecting accessory patella in adults. Although the imaging findings are very suggestive of this pathology, an adequate physical examination is required to avoid a false and late diagnosis.

A Case Report Of Blount’s Disease In Physiotherapeutic Perspective

Background: This report on Blount’s disease after evaluation and sessions of exercises has shown the difficulties of obese patient in performing exercises with post surgical weakness. Case Summary: Blount Disease (Tibia Vara) Idiopathic tibia vara, or Blount disease, is the most common pathologic disorder producing a progressive genu varum deformity. It is characterized by abnormal growth of the medial aspect of the proximal tibial epiphysis, resulting in a progressive varus angulation below the knee. Tibia vara can occur at any age in a growing child. It is classified according to the age: infantile (1 to 3 years), juvenile (4 to 10 years), and adolescent (great than 11 years). The infantile group is the most common. The degree of deformity is measured by the distance between the two medial femoral condyles when the patient is lying. Multiple factors such as ethnicity, genetics, and mechanical stress are thought to be contributing elements to this disease. Diagnostic radiography is the method of choice in diagnosing Blount’s disease in children, and common radiographic manifestations include a rounded, dome – like tibial metaphysis with fracturing or change in size of the epiphysis. During the earliest stage of infantile Blount disease, bracing has been utilized in an attempt to correct the varus angle of the proximal tibia. Intervention: When performing osteotomies or with pin insertion, nerves as well as the anterior tibial artery and its recurrent branch, are at risk. With acute correction of the varus deformity, medial-side structures are at risk for stretch injury. Compartment syndrome is a risk particularly with acute correction of tibial deformity. Both through the surgical and/or conservative management, Physical therapy care should be continued to prevent muscle wasting, correct malalignment, strengthening the muscles, promote healing, weight reduction…etc Conclusion: Obesity being one of the prime barrier to overcome and complete the exercises, use of aquatic therapy is favourable. Weakness of muscles have to be checked right from the time condition was diagnosed. Proper bracing and strengthening exercises along with moral support and gaining confidence are key for better prognosis.

T1ρ imaging in diagnosing distal radial epiphyseal plate injury of teenager divers / 中国医学影像技术

Objective: To explore the application value of quantitative T1ρ imaging in distal radial epiphyseal plate injury of teenager divers. Methods: Totally 38 young diving athletes and 25 age-, sex-matched healthy volunteers (control group) underwent bilateral wrist conventional and quantitative T1ρsequence MR scanning. According to conventional MRI, the athletes were divided into epiphyseal plate injury subgroup and no epiphyseal plate injury subgroup. T1ρ values of distal radial epiphyseal plate different of opposite the boat phrenology area, opposite the month phrenology area and the lateral area were separately measured on T1ρ pseudo-color pictures. T1ρ values of distal radial epiphyseal plate were analyzed among groups and different ROI in same groups. Results: T1ρvalue of distal radial epiphyseal plate in epiphyseal plate injury subgroup and no epiphyseal plate injury subgroup were lower than that in control group (both P0.05). Conclusion: Quantitative T1ρimaging helps to discover changes of internal ultrastructure and cell molecular level in distal radial epiphyseal plate injury of the diver.

Multiple Epiphyseal Dysplasia: Uncommon Diagnosis in a Patient with Swelling over Pinna

Multiple Epiphyseal Disorder (MED) is a congenital birth disorder presenting with abnormalities of bone and cartilage and is of two types – dominant and recessive. Nearly 50% of individuals with recessive multiple epiphyseal dysplasia (rMED) are born with at least one abnormal feature, including clubfoot, cleft palate, clinodactyly, or ear swelling. A case report of 6-year-old male child with left ear swelling and deafness is presented to highlight the need for maintaining a high index of suspicion for this disorder. A missed or delayed diagnosis of this diagnosis may lead to an erroneous treatment plan

Application of 3-D printing technology in the diagnosis and treatment of proximal epiphyseal fracture of tibia in adolescents / 实用医学杂志

Objective To investigate the feasibility of 3-D printing technology in the application of proxi-mal tibial epiphyseal injury fracture surgery for teenagers. Methods Clinical materials of the 8 patients with proxi-mal tibial epiphyseal injury fracture who were admitted to our hospital from January 2014 to March 2016 were retro-spectively analyzed. CT data of all patients was collected before the surgery and was used for fracture 3-D recon-struction with Minics software to print out the 1:1 physical model. Meanwhile,surgical simulation was carried out on the 3-D model to design the internal fixation scheme,and all intraoperative operations were implemented in line with the preoperative planning. Postoperative brace immobilization and the early-stage function exercise were taken and growth situation of the affected limbs and fracture healing were observed and recorded. In line with the modified Hohl and Luck knee score standards,knee functional score was taken 12 months after the surgery. Results All pa-tients received postoperative follow-up service for 12 to 18 months,with the average of 15.3 months. All patients were bony union,with the excellent knee score rate of 100%. The full-length axis of two limbs was compared be-tween the postoperative reexamination and no premature skeleton closure. Pronation and supination of the knee,un-stable joints and other complications were investigated. No obvious differences were found among the activity of the affected limbs and 12-month growth length after the surgery and that of the uninjured side. Conclusions 3-D printing technology is a strong clinical guidance to the treatment of proximal tibial epiphyseal injury fracture surgery for teenagers.

Arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with double heads compressive cannulated screw fixation in adolescents / 中国修复重建外科杂志

Objective: To discuss the effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture in adolescents by using double heads compressive cannulated screw fixation. Methods: Twenty-four patients with ACL tibial eminence avulsion fractures were treated by arthroscopic reduction and internal fixation with double heads compressive cannulated screw fixation between June 2014 and June 2017. There were 15 males and 9 females with an average age of 12.3 years (range, 5-18 years). The body mass index was 19.3-26.4 kg/m 2 (mean, 23.3 kg/m 2). The injury causes included traffic accident injury in 10 cases, sports injury in 8 cases, and falling injury in 6 cases. According to the Meyers-McKeever classification, there were 19 cases of type Ⅱ and 5 cases of type Ⅲa. All patients’ drawer test and pivot shift test were positive. The interval between injury and operation was 3-14 days (mean, 6.2 days). During the follow-up period, the fracture healing condition of patients were determined by X-ray examination; Lysholm score, International Knee literature Committee (IKDC) score, and Tegner score were used to evaluate the knee function. Results: Primary healing of incision was obtained in all patients after operation. All the 24 patients were followed up 6-32 months (mean, 16.4 months). At 6 weeks after operation, 3 patients had difficulty in knee flexion. After the release of the knee joint by manipulation, the knee joint function recovered normally at 6 months after operation. At last follow-up, the X-ray films showed that all the fractures healed and no epiphyseal dysplasia, knee joint deformity, or leg length discrepancy occurred. The Lysholm score, IKDC score, and Tegner score were improved from preoperative 44.3±5.4, 43.7±4.4, and 3.0±1.3 to postoperative 93.1±4.3, 94.6±3.3, and 8.1±1.2, the differences were all significant ( t=25.152, P=0.000; t=28.634, P=0.000; t=13.226, P=0.000). Conclusion: The arthroscopic reduction and internal fixation with double heads compressive cannulated screw in treatment of ACL tibial avulsion fracture (Meyers-McKeever type Ⅱ and Ⅲ) in adolescents has so many advantages, such as minimal trauma, simple operation, firm fixation, little effect on the epiphyseal plate, and has a good joint function recovery.

Rótula bicapa bilateral / Rotule à double couche bilatérale / Bilateral Double-Layered Patella

Se presenta un escolar masculino de 12 años de edad, talla de 155 cm y 45 kg de peso que es traído a consulta externa de Ortopedia y Traumatología por presentar discreto aumento de volumen doloroso en ambas rodillas, profundo, en cara posterior de la rótula al movilizarla y al presionar sobre ella (en flexión y en extensión). Aumenta al subir y bajar escaleras. Signo de la butaca positivo y sensación de crepitación o chasquido. Se realizan estudios imaginológicos que conjuntamente con el cuadro clínico permiten llegar al diagnóstico(AU)

We present a 12-year-old male schoolchild, 155 cm in height and weighing 45 kg, who is brought to the outpatient clinic of Orthopedics and Traumatology for presenting a discreet increase in painful volume in both knees. His pain is deep in the posterior face of the patella, when mobilizing and pressing (in flexion and extension). It increases when going up and down stairs. The sign of the armchair is positive and there is a crackling or clicking sensation. Imaging studies and the clinical exam endorsed diagnosis(AU)

Un écolier âgé de 12 ans, avec 155 cm de taille et 45 kg de poids, vu en consultation externe d'orthopédie et traumatologie pour légère augmentation du volume des deux genoux, avec douleur profonde si mobilité ou pression (en flexion et extension) au côté postérieur de la rotule, est présenté. La douleur augmente à la montée-descente des escaliers. Le signe du cinéma est positif, et il y a aussi une sensation de crépitation ou claquement. On fait des études d'imagerie permettant, conjointement avec l'examen clinique, de faire un diagnostic(AU)

Displasia epifisaria con falanges en forma de ángel: Caso clínico / Angel-shaped phalango-epiphyseal dysplasia: Case report

Se describe una patología de aparición poco frecuente y esporádica que se caracteriza por deformidad en cuello de cisne en las manos, artrosis de cadera en la adultez, retardo en la edad ósea y malformaciones de las falanges medias, en forma de ángel. El paciente es un niño de 4 años de edad que sufrió un traumatismo de mano, por lo cual se le realizó una radiografía donde se observaron falanges con forma de ángel. A partir de este hallazgo, se obtuvieron otras radiografías y se diagnosticó una displasia epifisaria con falanges en forma de ángel. A raíz de este diagnóstico en el niño y de consultas con el Servicio de Genética, se diagnosticó el mismo síndrome en la madre.

We describe a rare and sporadic condition, characterized by swan neck deformity in hands, hip osteoarthritis in adulthood and malformations of the middle phalanges with an angel shape. The patient is a 4 year old boy who suffered hand trauma and on x-ray examination he was diagnosed with angel-shaped phalango-epiphyseal dysplasia. Based on this diagnosis, his mother, who suffered from constant pain in her hips and lower limbs, was diagnosed with this syndrome as well.

A Neglected Markedly Displaced Medial Epicondyle Fracture with Simultaneous Ulnar Nerve Palsy in an Adolescent

Humeral medial epicondyle fractures constitute around 15% of pediatric elbow fractures. Up to 60% occur in association with elbow dislocations. Knowledge of potential imaging pitfalls when examining acute elbow fractures in children contributes significantly to accurate diagnosis. Nevertheless, management of missed pediatric medial epicondyle fractures has rarely been reported. We present an 11-year-old boy with a neglected and severely displaced medial epicondyle fracture with concurrent ulnar nerve palsy. We performed neural decompression, fragment excision, and muscular and capsuloligamentous reconstruction of the medial elbow. This study demonstrates that the surgical outcome of a late presenting fracture can be satisfactory in terms of function and neural recovery. It also underscores the importance of careful interpretation of elbow imaging including normal anatomic variants.

Treatment of Late-Onset Legg-Calve-Perthes Disease by Arthrodiastasis

BACKGROUND: To evaluate the efficacy of arthrodiastasis for Legg-Calve-Perthes disease. METHODS: Arthrodiastasis was conducted using external fixator devices (Orthofix) in 7 patients at least 8 years of age with a diagnosis of Legg-Calve-Perthes disease. The average follow-up was 80 months (range, 32 to 149 months), and their average age was 9.1 years (range, 8 to 12 years). The results of treatment were evaluated by measuring the degree of hip pain and the range of motion of the hip at 6 months after the operation and comparing the values with preoperative measurements. Radiological recovery was evaluated by the epiphyseal index and compared with the preoperative values. At the final follow-up, clinical and radiological results were evaluated using the Iowa hip score and the Stulberg classification. RESULTS: On the clinical evaluation performed at 6 months after arthrodiastasis, the degree of pain decreased by 1.8 points on average, and the average flexion, internal rotation, and abduction increased by 35°, 16°, and 11°, respectively. Based on radiological findings, the epiphyseal index showed a remarkable increase of 6.6 on average (from 19 preoperatively to 26 postoperatively). At the final follow-up, the average Iowa hip score improved from 65 points preoperatively to 84 points. There were 1 Stulberg class I hip, 2 Stulberg class II hips, 3 Stulberg class III hips, 1 Stulberg class IV hip, and no Stulberg class V hip. CONCLUSIONS: We conclude that arthrodiastasis using an external fixator can be a relatively promising surgical procedure for the treatment of late-onset Legg-Calve-Perthes disease.

Clinical features and treatment strategy of ankle supination fractures in children / 中华创伤骨科杂志

Objective To analyze the clinical characteristics and treatment strategy of ankle supination fracture in children.Methods From January 2012 through July 2014,89 children were treated at our department for ankle fracture caused by supination sprain according to their medical history,physical examination,X-ray films and CT three-dimensional reconstruction of the ankle.Appropriate protocols were applied on the basis of Lauge-Hansen classification,type and displacement of their fractures.Of them,52 belonged to the supination-adduction type (the extramalleolus fracture was of Odgen type Ⅶ in 51 children whose epiphyseal plate of distal fibula had not been closed),35 to the supination-extorsion type (32 cases had tri-plane fracture and 3 Tillaux fracture),and the remaining 2 did not fit the Lauge-Hansen classification.Surgical treatment was applied in 32 cases and conservative treatment in 57 ones.Results All the children received outpatient follow-up from 12 to 24 months(mean,18 months).No bone nonunion,osteoarthritis,or fracture malunion was found.The American Orthopaedic Foot & Ankle Society scores averaged 92 points (range,from 88 to 100 points) at the last follow-ups.Conclusions In children whose epiphyseal plate is nearly closed,supination-adduction sprain likely causes an extramalleolus fracture of Salter-Harris type Ⅰ or type Ⅱ,but in children whose epiphyseal plate is unclosed,an epiphyseal fracture of Odgen type Ⅶ is inclined to happen.A Tillaux fracture or tri-plane fracture at the level of distal tibiofibular syndesmosis results often from supination-extorsion sprain in children.For fractures involving epiphysis or epiphyseal plate,anatomical reduction and proper fixation are critical to functional recovery and reducing complications.

SURGICAL TREATMENT OF Seymour FRACTURES IN CHILDREN AND ADOLESCENTS / 中国修复重建外科杂志

OBJECTIVE: To discuss the treatment method and effectiveness of Seymour fracture in children and adolescents. METHODS: Between January 2013 and November 2015, 26 children and adolescents with Seymour fractures were treated. There were 18 males and 8 females, aged from 1 year and 1 month to 17 years (median, 8.2 years). The injury causes included crush in 14 cases, bruise in 10 cases, and puncture in 2 cases. The thumb was involved in 2 cases, index finger in 1 case, middle finger in 12 cases, ring finger in 6 cases, and little finger in 5 cases. The time from injury to operation was 1-15 hours (mean, 3.2 hours). The patients underwent debridement, nail removal, nail matrix repair, closed reduction and osteosynthesis with Kirschner wires, and splinting in emergency. Kirschner wires and splints were removed at 4 weeks after surgery, and functional exercises were done. RESULTS: All wounds healed by first intention without infection. The follow-up duration was 2-24 months (mean, 12.3 months). The fracture healing was obtained at 1-2 months (mean, 1.4 months) on X-ray film, and no complications of nonunion, malunion, re-displacement, premature epiphyseal closure, or no growth of the nails occurred. Nail deformity developed in 1 case and no re-operation was given. At last follow-up, 1 patient had 10° extension limitation of the distal interphalangeal joint, but the flexion was normal. The motion range of distal interphalangeal joint was 0-75°, showing no significant difference when compared with that of contralateral side (0-78°). CONCLUSIONS: The effectiveness for treating Seymour fracture is satisfactory by debridement, nail removal, nail matrix repair, closed reduction and osteosynthesis with Kirschner wires, and splinting in emergency.

The Possible Protective Role of Magnesium on Ciprofloxacin Induced Chondrotoxicity on the Epiphyseal Plate Growth of Juvenile Albino Rat: A Histological and Morphometric Study.

Background: Ciprofloxacin is one of the most effective antibiotics used in the treatment of many infectious diseases in adults, but it has undesirable toxic effects on the growing cartilage. The present study was designed to detect the toxic effect of ciprofloxacin on growing cartilage in the immature albino rats and the possible protective role of magnesium in prevention of such toxicity. Methods: Seventy rats were used in the current study. They were divided into five groups Group I: control group, group II: ciprofloxacin treated group, group III: magnesium given before ciprofloxacin, group IV: ciprofloxacin with magnesium and group V: magnesium given after ciprofloxacin). The region of the knee joint was prepared and stained with hematoxylin and eosin stain for light microscopic examination. Morphometric studies were also done using the image analyzer. Results: ciprofloxacin treated group revealed different changes in the tibial epiphyseal growth plate of juvenile rats in the form of decreased thickness, loss of chondrocytes, karryorrhexis, pyknotic nuclei, interlacunar hemorrhage, irregularity in the columns and myxomatous degeneration. Partial improvement was observed in the group treated with magnesium before ciprofloxacin and in the group treated with magnesium concurrently with ciprofloxacin, meanwhile no improvement was detected in the group treated with magnesium given after ciprofloxacin. Conclusion: The present study concluded that the use of ciprofloxacin in juvenile rats caused epiphyseal plate growth retardation; accordingly the use of this drug in pediatrics should be restricted to carefully selected indications. Owing to its protective role in reducing such chondrotoxic effects, the use of magnesium before (in chronic cases like cystic fibrosis of the lung) and concomitantly with ciprofloxacin is highly recommended.