Treatment of physeal plate growth arrest: A systematic review of literature

Abstract

Distal ends of long bones of children have epiphysis and physis (growth plate). The physis is the weakest point in the child skeleton which is a cartilaginous structure of different thickness depending on age and location. The physis is divided into four zones: resting, proliferative, hypertrophic and zone of provisional calcification. The physis is weaker than bone in torsion, shear and bending predisposing the child to injury through this weak area.

There are several ways of physeal injury; the most common cause is traumatic injury. Other causes are: infection, radiation, disuse, tumors, arterial insufficiency, burns, frostbite, chronic stress, and iatrogenic injury which may cause interruption of physeal growth.

The most obvious and catastrophic complication of physeal injury is arrest of physeal growth. Complete growth arrest may result in limb length discrepancy, while partial growth arrest may cause progressive angular or rotational deformities.

Assessment of complications of growth arrest either partial or complete can be done by examination and investigation. Limb length discrepancy can be assessed by: Moseley straight line graph, estimation technique, multiplier method and Anderson Green tables by the help of X- ray and CT radiography. Angular deformities can be assessed by long film x-ray to assess the type of deformity either varus or valgus and to measure its magnitude. Also rotational deformities