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Growth arrest lines and intra-epiphyseal silhouettes: a case series.

Kennedy JW, Irwin GJ, Huntley JS - BMC Res Notes (2014)

Bottom Line: Growth arrest lines can develop within the skeleton after physiological stress or trauma.They are usually evident on radiographs as transverse lines in the metaphyses and have been used in fields from palaeontology to orthopaedics.Case 1 describes a 9-year-old who suffered a knee hyperflexion injury requiring anterior cruciate ligament and posterior cruciate ligament reattachments.

View Article: PubMed Central - HTML - PubMed

Affiliation: Glasgow University/Orthopaedic Department, Royal Hospital for Sick Children, Glasgow, Yorkhill G3 8SJ, UK. james.huntley@glasgow.ac.uk.

ABSTRACT

Background: Growth arrest lines can develop within the skeleton after physiological stress or trauma. They are usually evident on radiographs as transverse lines in the metaphyses and have been used in fields from palaeontology to orthopaedics. This report consists of three cases, two of which describe growth arrest lines in an intra-epiphyseal site hitherto rarely documented, and a third demonstrating their clinical application.

Case presentation: Case 1 describes a 9-year-old who suffered a knee hyperflexion injury requiring anterior cruciate ligament and posterior cruciate ligament reattachments. She subsequently developed a marked distal femoral intra-epiphyseal arrest silhouette, as well as metaphyseal arrest lines in the femur, tibia and fibula. Case 2 describes an 8-year-old who sustained a tibial spine fracture and underwent open reduction and internal fixation. Subsequent imaging shows a further example of femoral intra-epiphyseal arrest silhouette as well as tibia and fibula metaphyseal arrest lines. Case 3 describes a 10-year-old who sustained a distal tibia fracture which was managed with open reduction and internal fixation. Subsequently the metaphyseal growth arrest line was parallel to the physis, suggesting no growth arrest (a danger with such a fracture).

Conclusion: This case series describes two examples of rarely described intra-epiphyseal growth arrest silhouettes and demonstrates the usefulness of arrest lines when assessing for growth plate damage.

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Anteroposterior (A) and lateral (B) radiographs taken four months after knee injury and operative reattachment of the anterior and posterior cruciate ligaments. Arrows indicate early metaphyseal arrest lines in the femur and tibia.
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Figure 1: Anteroposterior (A) and lateral (B) radiographs taken four months after knee injury and operative reattachment of the anterior and posterior cruciate ligaments. Arrows indicate early metaphyseal arrest lines in the femur and tibia.

Mentions: A 9-year-old girl suffered a left knee hyperflexion injury, resulting in avulsions of her anterior and posterior cruciate ligaments (ACL/PCL). This was managed with ACL/PCL reattachments via an anterior arthrotomy. Post-operative radiographs (Figures 1 and2) show conventional metaphyseal femoral, fibular and tibial growth arrest lines, but also an intra-epiphyseal distal femoral epiphyseal ‘arrest silhouette’ (Figure 2C).


Growth arrest lines and intra-epiphyseal silhouettes: a case series.

Kennedy JW, Irwin GJ, Huntley JS - BMC Res Notes (2014)

Anteroposterior (A) and lateral (B) radiographs taken four months after knee injury and operative reattachment of the anterior and posterior cruciate ligaments. Arrows indicate early metaphyseal arrest lines in the femur and tibia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3927262&req=5

Figure 1: Anteroposterior (A) and lateral (B) radiographs taken four months after knee injury and operative reattachment of the anterior and posterior cruciate ligaments. Arrows indicate early metaphyseal arrest lines in the femur and tibia.
Mentions: A 9-year-old girl suffered a left knee hyperflexion injury, resulting in avulsions of her anterior and posterior cruciate ligaments (ACL/PCL). This was managed with ACL/PCL reattachments via an anterior arthrotomy. Post-operative radiographs (Figures 1 and2) show conventional metaphyseal femoral, fibular and tibial growth arrest lines, but also an intra-epiphyseal distal femoral epiphyseal ‘arrest silhouette’ (Figure 2C).

Bottom Line: Growth arrest lines can develop within the skeleton after physiological stress or trauma.They are usually evident on radiographs as transverse lines in the metaphyses and have been used in fields from palaeontology to orthopaedics.Case 1 describes a 9-year-old who suffered a knee hyperflexion injury requiring anterior cruciate ligament and posterior cruciate ligament reattachments.

View Article: PubMed Central - HTML - PubMed

Affiliation: Glasgow University/Orthopaedic Department, Royal Hospital for Sick Children, Glasgow, Yorkhill G3 8SJ, UK. james.huntley@glasgow.ac.uk.

ABSTRACT

Background: Growth arrest lines can develop within the skeleton after physiological stress or trauma. They are usually evident on radiographs as transverse lines in the metaphyses and have been used in fields from palaeontology to orthopaedics. This report consists of three cases, two of which describe growth arrest lines in an intra-epiphyseal site hitherto rarely documented, and a third demonstrating their clinical application.

Case presentation: Case 1 describes a 9-year-old who suffered a knee hyperflexion injury requiring anterior cruciate ligament and posterior cruciate ligament reattachments. She subsequently developed a marked distal femoral intra-epiphyseal arrest silhouette, as well as metaphyseal arrest lines in the femur, tibia and fibula. Case 2 describes an 8-year-old who sustained a tibial spine fracture and underwent open reduction and internal fixation. Subsequent imaging shows a further example of femoral intra-epiphyseal arrest silhouette as well as tibia and fibula metaphyseal arrest lines. Case 3 describes a 10-year-old who sustained a distal tibia fracture which was managed with open reduction and internal fixation. Subsequently the metaphyseal growth arrest line was parallel to the physis, suggesting no growth arrest (a danger with such a fracture).

Conclusion: This case series describes two examples of rarely described intra-epiphyseal growth arrest silhouettes and demonstrates the usefulness of arrest lines when assessing for growth plate damage.

Show MeSH
Related in: MedlinePlus