Extracorporeal Shock Wave Therapy and the Handstand-Position Radiography for Proximal Humeral Epiphysiolysis in Elite Gymnasts: A Report of Two Cases.

We report two cases of proximal humeral epiphysiolysis in elite gymnasts. Both patients presented with shoulder pain during weight-bearing movements. The patient in case 1, treated with extracorporeal shock wave therapy (ESWT), exhibited rapid bone repair and pain relief, allowing an early return to competition. In the case 2 patient, humeral shortening was identified. Handstand-position radiography revealed compensatory scapular movements, negating the need for surgical intervention. These findings highlight ESWT's potential in promoting bone repair and the utility of handstand-position radiography in assessing humeral length. Both methods provide innovative treatment approaches for proximal humeral epiphysiolysis in gymnasts.

Epiphyseal distraction prior to resection in paediatric bone sarcomas : four decades of experience.

Paediatric bone sarcomas are a dual challenge for orthopaedic surgeons in terms of tumour resection and reconstruction, as it is important to minimize functional and growth problems without compromising survival rates. Cañadell's technique consists of a Type I epiphysiolysis performed using continuous distraction by an external fixator prior to resection. It was designed to achieve a safe margin due to the ability of the physeal cartilage to be a barrier to tumour spread in some situations, avoiding the need for articular reconstruction, and preserving the growth capacity most of the times. Despite initial doubts raised in the scientific community, this technique is now widely used in many countries for the treatment of metaphyseal paediatric bone sarcomas. This annotation highlights the importance of Cañadell's work and reviews the experience of applying it to bone sarcoma patients over the last 40 years.Cite this article: Bone Joint J 2023;105-B(1):11-16.

Delayed Presenting Radial Neck Epiphysiolysis Managed with Open Reduction and Internal Fixation with K Wires: A Case Report and Review of Literature.

Introduction: Radial neck fractures in the pediatric age group account for 1% of all fractures in children. A completely displaced fracture with an angle >30° requires operative intervention. Case Report: An 11-year-old boy with Judet IVb radial neck epiphysiolysis 4 weeks old was managed by open reduction and internal fixation with K-wires. Conclusion: Anatomic reduction must be achieved in radial neck fractures to restore their function. Open reduction and internal fixation with K wires must be considered in patients with >30° angle of inclination, neglected fracture, and failure of closed reduction.

An anatomic and 3D study of the development of the proximal humeral physis.

PURPOSE: During maturation, the ossification centers of the proximal humerus form a characteristic pattern consisting of a metaphyseal peak and corresponding epiphyseal valley. The surface topographies of the metaphyseal peak and epiphyseal valley are not well described and may have variation with age and structural importance to the pathogenesis of proximal humeral epiphysiolysis. METHODS: High-resolution 3-dimensional surface scans of 24 cadaveric proximal humeral epiphyses and metaphyses in specimens aged 3 to 18 years were obtained. Computer modeling software was used to measure the peak height of the metaphysis and maximal depth of the epiphysis relative to a perpendicular line drawn across the proximal humeral physis. RESULTS: The metaphyseal peak had a mean height of 12.7 ± 1.6 mm while the epiphyseal valley had a mean depth of 13.1 ± 2.1 mm, both consistently positioned in the posterolateral quadrant. Both the absolute metaphyseal peak height (R2 = 0.536; p < 0.001) and absolute epiphyseal valley depth (R2 = 0.524; p < 0.001) increase with advancing age. Multiple linear regression analysis demonstrated that normalized metaphyseal peak height + sex (adjusted R2 = 0.408; p < 0.002) correlated more with age than normalized epiphyseal valley depth + sex (adjusted R2 = 0.128; p < 0.091). CONCLUSION: Prominence of the metaphyseal peak and epiphyseal valley both increase with advancing age, with a lower correlation between normalized sizes with age as compared to the absolute sizes, suggesting that these structures stay relatively proportional with growth.

Role of the prophylactic fixation of contralateral unaffected hip in paediatric unilateral slipped capital femoral epiphysis: a systematic review.

The aim of this systematic review is to assess the role of the prophylactic fixation of contralateral unaffected hip in unilateral slipped capital femoral epiphysis (SCFE) in children, focusing on the possible complications of this surgical procedure. A systematic review of medical literature was conducted, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement, to analyse the complications of prophylactic contralateral hip fixation in unilateral paediatric SCFE. We registered the complications reported in the included studies, scoring their severity according to the orthopaedic adaptation of Clavien-Dindo classification. From 1695 studies primarily identified, 14 studies were finally included: 1 prospective cohort study, 4 retrospective case-control studies and 9 retrospective case series, with a total of 811 children diagnosed with unilateral SCFE and treated on the unaffected contralateral hip. Grade IV complications were very rare (0.37%), while the rate of grade III events was 8%. No death was recorded. The most frequent complication was unplanned further surgery (6.29%) that was an epiphyseal refixation, owing to the physiologic growth of the proximal femur, in 42 cases. Cannulated screws fixation showed to have a lower major complication rate than pinning with K-wires, 5.37% vs 17.95%. The prophylactic fixation of contralateral unaffected hip in paediatric unilateral SCFE is a safe procedure. Although a benefit-cost analysis on this topic has not been published yet, considering the low rate of complications, prophylactic hip fixation is a viable option for patients presenting with unilateral SCFE, to prevent the occurrence of severe hip deformity and avoid future invasive surgeries.

[Surgical treatment strategies and their radiological potential for correction of proximal radius fractures in children and adolescents]. / Operative Versorgungsstrategien und deren radiologisches Korrekturpotenzial bei proximalen Radiusfrakturen des Kindes und Jugendlichen.

BACKGROUND AND OBJECTIVE: The isolated proximal radius fracture in children is a quite rare injury. In difference to adults a conservative treatment is often possible. But in case of increasing dislocation the indication for surgery is given. Options for an operative treatment are "closed reduction", "percutaneous reduction", "intramedullary nailing", "open reduction" with and without fixation. Aim of this study is to compare these procedures with each other. STUDY DESIGN AND METHODS: This was a retrospective investigation and 82 patients who underwent surgery after an isolated proximal radius fracture were included. Fracture types were classified according to the AO (working group for osteosynthesis questions)/OTA (Orthopedic Trauma Association) classification. The preoperative and postoperative degrees of axis deviation were compared and were considered to be a measure of the quality of treatment. RESULTS: The lowest degree of axis deviation resulted by open reduction and implantation of K­wires (15,8°) and implantation of headless compression screws (HCS, 16°). Closed reduction without any fixation resulted in 19°, with implantation of an TEN (titan elastic nail) in 20° and the open reduction without any fixation resulted in 21° of axis deviation. No correlation was observed concerning the fracture type and the postoperative axis deviation. CONCLUSION: The study shows that the postoperative result does not depend on the fracture type (according to the AO/OTA classification) but on the surgical procedure. Despite the good radiological results in open reduction and internal fixation this procedure should be reserved for difficult situations in which less invasive surgical procedures fail, to avoid aseptic bone necrosis.

Biology and technology in the surgical treatment of malignant bone tumours in children and adolescents, with a special note on the very young.

PURPOSE: The main challenge in reconstruction after malignant bone tumour resection in young children remains how and when growth-plates can be preserved and which options remain if impossible. METHODS: We describe different strategies to assure best possible long-term function for young children undergoing resection of malignant bone tumours. RESULTS: Different resources are available to treat children with malignant bones tumours: a) preoperative planning simulates scenarios for tumour resection and limb reconstruction, facilitating decision-making for surgical and reconstructive techniques in individual patients; b) allograft reconstruction offers bone-stock preservation for future needs. Most allografts are intact at long-term follow-up, but limb-length inequalities and corrective/revision surgery are common in young patients; c) free vascularized fibula can be used as stand-alone reconstruction, vascularized augmentation of structural allograft or devitalized autograft. Longitudinal growth and joint remodelling potential can be preserved, if transferred with vascularized proximal physis; d) epiphysiolysis before resection with continuous physeal distraction provides safe resection margins and maintains growth-plate and epiphysis; e) 3D printing may facilitate joint salvage by reconstruction with patient-specific instruments. Very short stems can be created for fixation in (epi-)metaphysis, preserving native joints; f) growing endoprosthesis can provide for remaining growth after resection of epi-metaphyseal tumours. At ten-year follow-up, limb survival was 89%, but multiple surgeries are often required; g) rotationplasty and amputation should be considered if limb salvage is impossible and/or would result in decreased function and quality of life. CONCLUSION: Several biological and technological reconstruction options must be merged and used to yield best outcomes when treating young children with malignant bone tumours. LEVEL OF EVIDENCE: Level V Expert opinion.

Diagnosis and Management of Little League Shoulder: A Systematic Review.

BACKGROUND: Little League shoulder (LLS) is an overuse injury characterized by throwing-related pain that commonly presents in adolescent male athletes. Investigations into the optimal duration of rest from throwing and protocols for graduated return to sports (RTS) are lacking. PURPOSE: To summarize the current literature with respect to the diagnosis, management, RTS, and return to throwing for LLS. DESIGN: Systematic review; Level of evidence, 4. METHODS: The databases EMBASE, MEDLINE, and PubMed were searched between inception and April 22, 2020. References of retrieved records were reviewed for potentially eligible studies. English-language studies that reported the diagnosis and/or management of LLS in children or adolescents were included. Studies of animals or cadavers, review articles, and non-peer reviewed records were excluded. Data were summarized narratively using descriptive statistics. RESULTS: Overall, 23 studies (21 level 4 studies, 2 level 3 studies) met the criteria for a total of 266 participants with a weighted mean age of 12.8 years (range, 7.4-17 years). Treatment recommendations evolved from prolonged rest and complete cessation of throwing to shorter periods of rest and graduated RTS. Less than half (11/23) of studies reported specific criteria to RTS; 1 case report discussed a coaching strategy to resume throwing, and 1 case report discussed a regimented throwing program. The proportion of participants returning to any sport participation was 94.0% (n = 157/167). The proportion returning to their preinjury level of sport was 92.5% (n = 123/133). Upon RTS, 18.7% (n = 35/187) of participants experienced a recurrence of symptoms. Premature closure of the epiphysis was reported in 1 participant. CONCLUSION: Young athletes with LLS may return to play after a period of rest, and a high proportion return to their preinjury level of sport. Further prospective studies are warranted to develop evidence-based, graduated RTS protocols and to better capture any long-term sequelae of the condition.

Slipped capital femoral epiphysis: an epidemiological Nationwide study in Italy from 2001 to 2015.

BACKGROUND: Slipped capital femoral epiphysis (epiphysiolysis of the femoral head, SCFE) is the most common pediatric hip disease in 10-14 years old children. The most used procedure to correct a stable form of SCFE is in situ pinning. Instead, the proper treatment for unstable forms is controversial. The first purpose of this study was to estimate annual admissions for SCFE in Italian patients from 2001 to 2015, basing on the hospitalization reports. The second aim was to assess the difference between regions regarding SCFE procedures. Lastly, a statistical prediction of the volume of SCFE procedures performed in Italy based on data from 2001 to 2015 was performed. METHODS: Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health regarding the years of this paper. The yearly number of hospital admission for SCFE, the percentage of males and females, the average age, days of hospitalization, primary diagnoses and primary procedures in the whole Italian population were calculated using descriptive statistical analyses. RESULTS: From 2001 to 2015, 4893 hospitalizations for SCFE were recorded in Italy, with a mean incidence of 2.9 (cases/100.000 inhabitants). The majority of patients treated by SCFE were males (70.6%). CONCLUSION: National health statistics for SCFE are attractive for an international audience, as different approaches to screening are reported between countries. These differences allow comparing outcomes internationally. Moreover, sharing national statistics and correlating those to other countries protocols, could be helpful to compare outcomes for different procedures internationally. However, further studies are required to understand the specific reasons for regional variation for SCFE procedures in Italy. LEVEL OF EVIDENCE: III.

Epifisiolisis distal del fémur en un recién nacido / Distal epiphysiolysis of the femur in a newborn

La separación por fractura de la epífisis del fémur distal es una lesión relativamente poco frecuente en los recién nacidos, pero se ha documentado como una complicación del parto distócico. La mayoría de los casos ocurren a nivel distal del húmero y, de manera excepcional, afectan al fémur. La epifisiolisis distal del fémur casi no está descrita en la literatura. Se localizan normalmente en el tercio superior del fémur por un movimiento de torsión de este en los partos en posición podálica e incluso en cesáreas distócicas. El diagnóstico diferencial al inicio de la exploración suele ser con artritis séptica del recién nacido. A partir de un paciente de 3 días de vida que se presenta a su control posterior al alta con tumefacción en una de sus rodillas, se plantea este difícil e infrecuente diagnóstic

Fracture separation of the epiphysis from the distal femur is a relatively rare lesion in newborns, but it has been documented as a difficult complication of labor. Most of the cases occur at the distal humeral level and exceptionally affect the femur. Epiphysiolysis of the distal femur is practically not described. They are normally located in the upper third of the femur due to a twisting movement of the femur in breech deliveries and even in difficult caesarean sections. The differential diagnosis at the beginning of the examination is usually with septic arthritis of the newborn. This difficult and infrequent diagnosis arises from a 3-day-old baby who presents for his post-discharge check-up with swelling in one of his knees.

[Distal epiphysiolysis of the femur in a newborn]. / Epifisiolisis distal del fémur en un recién nacido.

Fracture separation of the epiphysis from the distal femur is a elatively rare lesion in newborns, but it has been documented as a difficult complication of labor. Most of the cases occur at the distal humeral level and exceptionally affect the femur. Epiphysiolysis of the distal femur is practically not described. They are normally located in the upper third of the femur due to a twisting movement of the femur in breech deliveries and even in difficult caesarean sections. The differential diagnosis at the beginning of the examination is usually with septic arthritis of the newborn. This difficult and infrequent diagnosis arises from a 3-day-old baby who presents for his post-discharge check-up with swelling in one of his knees.

La separación por fractura de la epífisis del fémur distal es una lesión relativamente poco frecuente en los recién nacidos, pero se ha documentado como una complicación del parto distócico. La mayoría de los casos ocurren a nivel distal del húmero y, de manera excepcional, afectan al fémur. La epifisiolisis distal del fémur casi no está descrita en la literatura. Se localizan normalmente en el tercio superior del fémur por un movimiento de torsión de este en los partos en posición podálica e incluso en cesáreas distócicas. El diagnóstico diferencial al inicio de la exploración suele ser con artritis séptica del recién nacido. A partir de un paciente de 3 días de vida que se presenta a su control posterior al alta con tumefacción en una de sus rodillas, se plantea este difícil e infrecuente diagnóstico.

Hip arthroscopy following slipped capital femoral epiphysis fixation: chondral damage and labral tears findings.

PURPOSE: This study investigated the association between chondrolabral damage and time to arthroscopic surgery for slipped capital femoral epiphysis (SCFE). METHODS: This was a descriptive retrospective study that enrolled patients with SCFE who underwent hip arthroscopy for femoral osteochondroplasty after SCFE fixation. SCFE type, time from SCFE symptom onset or slip fixation surgery to hip arthroscopy and intraarticular arthroscopic findings were recorded. Acetabular chondrolabral damage was evaluated according to the Konan and Outerbridge classification systems. Nested analysis of variance and the chi-squared test were used for statistical analyses. RESULTS: We analyzed 22 cases of SCFE in 17 patients (five bilateral). The mean age at the time of hip arthroscopy was 13.6 years-old (8-20), and mean time from SCFE fixation to arthroscopy was 25.1 months (3 weeks to 8 years). Labral frying was present in 20 cases, labral tears in 16 and acetabular chondral damage in 17. The most frequent lesion was type 3 (41%) (Konan classification). Two cases had a grade III and 1 had a grade II acetabular chondral lesion (Outerbridge classification). Positive associations were observed between time from SCFE to hip arthroscopy and hip intraarticular lesions evaluated using Konan (p = 0.004) and Outerbridge (p = 0.000) classification systems. There was no association between SCFE severity (chi-squared = 0.315), stability (chi-squared = 0.558) or temporality (chi-squared = 0.145) type and hip intraarticular lesions. CONCLUSION: A longer time from SCFE symptom onset and fixation to hip arthroscopy is associated with greater acetabular chondrolabral damage. LEVEL OF EVIDENCE: IV.

An unusual injury of pediatric both forearm fractures: Distraction epiphysiolysis: A case report.

INTRODUCTION AND IMPORTANCE: Pediatric both forearm fractures are one of the common traumas we encounter in clinical practice. We aimed to show a complication not shown in the literature, its possible cause and management of this complication in the surgery of these fractures. CASE PRESENTATION: 9 years old girl applied to emergency orthopedics unit after fall. Both forearm fracture was appeared after X-ray. Due to reduction loss in the control X-ray of the first week, closed reduction and intramedullary K wire were planned. The prebent K-wire was tried to be sent as intramedullary. While attempting to advance the K-wire, loss of intramedullary resistance was felt. When controlled with fluoroscopy, type 1 epiphysiolysis was observed in the distal radius. Open anatomical reduction was performed on distal radius epiphysis. Two K wires were placed so that crossed the physis line. In 2-year follow-up, there was no length discrepancy or limitation of movement between the left and right radius. CLINICAL DISCUSSION: Intramedullary fixation is first choice for surgery in pediatric both forearm fractures. There are 2 opinions for K-wire entering point: proximal and distal of physis. The biggest concern about transphyseal transmission of the K wire is that this conduction may cause physeal damage or arrest. However, physeal damage or arrest could not be shown in the literature. On the other hand, transphyseal application provides convenience in terms of surgical applicability. CONCLUSION: In our opinion, it will be more appropriate and safe to send the K wire transphyseal over the styloid for pediatric population have both forearm fractures.

Capital femoral physeal dysplasia in cats submited to ostectomy of the femoral head and neck / Displasia femoral capital em felinos submetidos a ostectomia da cabeça e colo femoral

ABSTRACT: This report described pathological fracture of the femoral head (physeal dysplasia) in four male cats (three mixed breed and one Bengal), with an average age of 16 months, treated by an ostectomy of the femoral head and neck. Three cats were neutered and one entire. All presented with mild intermittent lameness in the pelvic limbs. Displacement of the femoral epiphysis and resorption of the femoral neck were present and excision of the femoral head and remaining neck was performed in all cases. Hstological examination showed mild foci of compaction and trabecular fibrosis with deposition of fibrous connective tissue, permeated by granulation tissues, consistent with the original diagosis. Limb function improved in all patients from 2 to 4 weeks postoperatively. Diagnosis of physeal dysplasia is challenging and treatment is different from acute traumatic fractures. Femoral head and neck excision was considered a good alternative in these patients.

RESUMO: Este trabalho descreve a fratura patológica da cabeça do femur (displasia fiseal) em quatro machos (três raças mistas e um Bengal), com idade média de 16 meses, que foram tratados com ostectomia da cabeça e colo femorais. Três gatos eram castrados e um inteiro. Todos apresentaram leve claudicação intermitente nos membros pélvicos. O deslocamento da epífise femoral e a reabsorção do colo femoral estavam presentes, a excisão da cabeça e colo femoral foi realizada em todos os casos. O exame histológico mostrou focos de compacteção e fibrose trabecular com deposição de tecido conjuntivo fibroso, permeado por tecidos de granulação, consistentes com o suposto diagnóstico. A função dos membros melhorou em todos os paciente entre dois a quatro semanas pós-operatório. O diagnóstico da displasia fiseal pe desafiador e o tratamento é diferente das fraturas traumáticas agudas. A excisão de cabeça e colo femoral é considerada uma boa alternativa nesses pacientes.

Management of an Open Distal Radius Epiphysiolysis in a 14-year-old Male: A Case Report.

INTRODUCTION: Open fractures in children are uncommon and usually the result of a high-energy trauma. Open distal radius fractures are even more uncommon. In our clinic, we managed a pediatric open fracture separation of the distal radius due to hyper extension and axial load, with low-energy movement of the wrist. To the best of our knowledge, no other similar case or case series is published in literature. CASE REPORT: Our case involved a 14-year-old male who had been pushing a heavy object during a basketball match. The patient presented at our emergency department with metaphysis of the distal radius protruding through a transverse volar laceration in the wrist. The patient was immediately taken to the operating room and underwent debridement and internal stabilization of the fractures. The wrist was observed for 18 months and no complication occurred. CONCLUSION: Through this case report, we present an unusual type of injury that has never been described before; also, we show that the principles of treatment that stand for open fracture in adult patients can be used for children as well.

Epifisiólisis femoral proximal, una entidad desapercibida en atención primaria / Proximal Femoral Epiphysiolysis, an Unnoticed Entity in the Primary Care / Epifisiólise próxima! do fémur: uma entidade desapercebida em atenção primária

Resumen: La epifisiólisis femoral proximal o deslizamiento capital femoral es un trastorno de la cadera que se caracteriza por un desplazamiento de la epífisis sobre la metáfisis a través de la fisis (cartílago de crecimiento), quedando la epífisis posterior e inferior. Es una entidad relativamente frecuente en atención primaria y prehospitalaria que genera dolor y limitación de cadera; sin embargo, por su sintomatología vaga es usualmente infradiagnosticada o es diagnosticada tardíamente generando consecuencias a largo plazo. Si se tienen en cuenta los factores de riesgo asociados a una adecuada exploración física y el uso imágenes diagnósticas se lograría hacer un diagnóstico oportuno y una disminución de la tasa de complicaciones.

Abstract: Proximal femoral epiphysiolysis or slipped capital femoral is a hip disorder characterized by a displacement of the epiphysis over the metaphysis through the physis (growth plate), leaving the epiphysis in a posterior and inferior position. It is a relatively frequent entity in primary and prehospital care that generates hip pain and limitation. However, due to its vague symptoms, it is usually underdiagnosed or diagnosed late, generating long-term consequences. If the risk factors associated to an adequate physical examination and the use of diagnostic images are taken into account, a timely diagnosis and a reduction in the rate of complications would be achieved.

Resumo: A epifisiólise proximal do fêmur ou escorregamento epifisário proximal do fêmur é um transtorno do quadril que é caracterizado por um deslocamento da epífise sobre a metáfise por meio da fise (placa de crescimento), ficando a epífise posterior e inferior. É uma entidade relativamente frequente em atenção primária e pré-hospitalar que gera dor e limitação do quadril; contudo, por sua sintomatologia vaga, é usualmente subdiagnosticada ou é diagnosticada tardiamente, o que leva a consequências em longo prazo. Se os fatores de risco associados com uma adequada exploração física e com o uso de imagens diagnósticas forem considerados, é possível realizar um diagnóstico oportuno e diminuir a taxa de complicações.

[Osteonecrosis of the femoral head complicating prophylactic screw fixation for upper femoral epiphyolysis: case report and literature review]. / Ostéonécrose de la tête fémorale compliquant un vissage préventif d'une épiphysiolyse fémorale supérieure: cas clinique et revue de la littérature.

The therapeutic approach for the treatment of children with radiologically "normal" hip presenting with epiphysiolysis of the contralateral upper femur is controversial. We here report the case of a 12-year-old boy with osteonecrosis of radiologically "normal" and asymptomatic left femoral head prophylactically fixed due to acute femoral epiphysiolysis of the contralateral hip. Eight months after first surgery, the patient developed symptoms of avascular osteonecrosis of the femoral head. Specific criteria to be used in evaluating the most effective treatment between preventive screw or simple close monitoring exist. Despite these criteria, the risk of osteonecrosis in the "healthy" hip is not zero.

Epifisiólisis de clavícula medial tipo Salter 1 con desplazamiento posterior agudo en el esqueleto inmaduro / Salter 1 medial collarbone epiphysiolysis with acute posterior displacement in the immature skeleton

Resumen: La epifisiólisis esternoclavicular es una lesión rara, siendo la variante posterior aún menos frecuente. Su presentación clínica puede ser sutil o puede comprometer estructuras mediastinales, ya sea inicialmente o durante la evolución, lo que constituye un cuadro grave y potencialmente fatal. Este reporte de caso documenta una disociación esternoclavicular en un paciente con esqueleto inmaduro, dada por una lesión fisaria tipo Salter y Harris 1, la que se trató quirúrgicamente mediante reducción abierta y fijación interna con lazadas en ocho transóseas con sutura no reabsorbible. Con un seguimiento de 10 meses y resultados excelentes. Esta técnica parece ser una buena opción para el tratamiento de luxación esternoclavicular en el paciente esquemáticamente inmaduro, recuperando la función y evitando complicaciones.

Abstract: Sternoclavicular epiphysiolysis is a rare lesion, the posterior variant being even less common. Its clinical presentation may be subtle, or it may compromise mediastinal structures, either initially or during evolution, which is a serious and potentially fatal picture. This case report documents sternoclavicular dissociation in a patient with an immature skeleton, given by a Salter and Harris 1-type injury, which was surgically treated by open reduction and internal fixation with transosseous configuration with non-reabsorbable suture. With a 10-month follow-up and excellent results. This technique seems to be a good option for the treatment of sternoclavicular dislocation in the schematically immature patient, regaining function and avoiding complications.

[Salter 1 medial collarbone epiphysiolysis with acute posterior displacement in the immature skeleton]. / Epifisiólisis de clavícula medial tipo Salter 1 con desplazamiento posterior agudo en el esqueleto inmaduro.

Sternoclavicular epiphysiolysis is a rare lesion, the posterior variant being even less common. Its clinical presentation may be subtle, or it may compromise mediastinal structures, either initially or during evolution, which is a serious and potentially fatal picture. This case report documents sternoclavicular dissociation in a patient with an immature skeleton, given by a Salter and Harris 1-type injury, which was surgically treated by open reduction and internal fixation with transosseous configuration with non-reabsorbable suture. With a 10-month follow-up and excellent results. This technique seems to be a good option for the treatment of sternoclavicular dislocation in the schematically immature patient, regaining function and avoiding complications.

La epifisiólisis esternoclavicular es una lesión rara, siendo la variante posterior aún menos frecuente. Su presentación clínica puede ser sutil o puede comprometer estructuras mediastinales, ya sea inicialmente o durante la evolución, lo que constituye un cuadro grave y potencialmente fatal. Este reporte de caso documenta una disociación esternoclavicular en un paciente con esqueleto inmaduro, dada por una lesión fisaria tipo Salter y Harris 1, la que se trató quirúrgicamente mediante reducción abierta y fijación interna con lazadas en ocho transóseas con sutura no reabsorbible. Con un seguimiento de 10 meses y resultados excelentes. Esta técnica parece ser una buena opción para el tratamiento de luxación esternoclavicular en el paciente esquemáticamente inmaduro, recuperando la función y evitando complicaciones.

Mechanism and predisposing factors for proximal tibial epiphysiolysis in adolescents during sports activities.

BACKGROUND: Proximal tibial epiphysiolysis (PTE) can have debilitating consequences for young athletes. The mechanism and predisposing factors for this lesion have yet to be determined. To find a common denominator and a biomechanical explanation for PTE, we were using a retrospective analysis of 15 cases in combination with a systematic review of literature. METHODS: A retrospective review of medical charts was performed to identify all PTE between 2003 and 2012. Records were screened for patient age and gender, sports activity, mechanism of injury, and treatment protocols. Additionally, a literature review (MEDLINE/PubMed database, the Cochrane Library, online search engines) was conducted. RESULTS: Medical charts of 14 adolescents (15 Salter-Harris I and II fractures) were analyzed. The literature review revealed additional 75 fractures. The predominant mechanisms were landing from a jump, takeoff for a jump, stop and go movements, and eccentric muscle contraction with the knee in flexion. The main sports-activities implicated in these injuries were basketball. CONCLUSIONS: Landing from a jump with a decreased knee and hip flexion movement increases tensile forces on the proximal tibia epiphysis. During physiological epiphysiodesis, the growth plate displays an increased vulnerability and such increased tensile forces can lead to a growth plate failure. Neuromuscular fatigue can alter coordination and proprioceptive accuracy during landing from a vertical jump and thus perturbs sagittal shock absorption. In our opinion, trainers should instruct young athletes in techniques that help avoiding uncontrolled high impact landings. LEVEL OF EVIDENCE: Level IV.