Abstract
This paper investigates the relation between metaphyseal zone fragility and growth rate. It is concluded that there are two sites of weakness, the hypertrophic zone of the plate and the metaphysis. From a study of the age incidence of traumatic plate fractures compared with that of shaft fractures, it is deduced that fragility of both zones is a non-linear function of growth rate. It is concluded that this correlation explains the occurrence and age incidence of a range of diseases in which plate fractures occur in shear, and of central Schmorl's node which is a metaphyseal fracture in compression. The mechanism of plate fragility appears to be an increase in thickness of the hypertrophic zone from any cause, including rickets as well as increased growth. No evidence is found to implicate endocrine imbalance as a necessary factor in the normal transient fragility of the growth spurt.
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References
Adams, P.C., Strand, R.D., Bresnan, M.J., Lucky, A.W.: Kinky hair syndrome; serial study of radiological findings with emphasis on the similarity to the battered child syndrome. Radiology 112, 401 (1974)
Alexander, C.J.: The etiology of femoral epiphyseal slipping. J. Bone Jt Surg. 48B, 299 (1966)
Alexander, C.J.: The etiology of juvenile spondylarthritis. Clin. Radiol. 21, 178 (1970)
Andren, L., Borgstrom, R.E.: Seasonal variation of epiphysiolysis of the hip and possibility of causal factor. Acta orthop. scand. 28, 22 (1959)
Appleton, A.B.: Postural deformities and bone growth. Lancet 1934 I, 451
Arkin, A.M., Katz, J.F.: Effects of pressure on epiphyseal growth. J. Bone Jt Surg. 38 A, 1056 (1956)
Astley, R.: Multiple metaphyseal fractures in small children. Brit. J. Radiol. 26, 311, 577 (1953)
Berry, J.M.: Fracture of the tuberosity of the ischium due to muscular action. J. Amer. med. Ass. 59, 1450 (1912)
Billing, L., Severin, E.: Slipping epiphysis of the hip. Acta radiol. (Suppl.) 174 (1959)
Bourne, G.H.: The Biochemistry and Physiology of Bone. Vol. 2., 2 nd. Ed. pp 162, 289 London: Academic Press 1972
Brashear, H.R.: Epiphyseal fractures with a microscopic study of the healing process in rats. J. Bone Jt Surg 41 A, 1055 (1972)
Buffon (1777). Quoted by Thompson, D.W. [52]
Burrows, H.J.: Slipped upper femoral epiphysis. J. Bone Jt Surg. 39B, 641 (1957)
Caffey, J.: Multiple fractures in long bones of infants suffering from chronic subdural haematoma. Amer. Roentgenol. 56, 163 (1946)
Caffey, J.: Some traumatic lesions in growing bones other than fractures and dislocations. Brit. J. Radiol. 30, 225, 353 (1957)
Caffey, J.: Pediatric X-ray Diagnosis. Vol. 2, 6th Ed., pp. 1135, 1142, 1144. Chicago: Year Book Medical Publishers 1972
Clark, Sir W.E. Le Gros: The Tissues of the Body. 4th Ed., p. 136. London. Oxford University Press 1958
Coventry, M.B., Ghormley, R.K., Kernohan, J.W.: Intervertebral disc: its microscopic anatomy and pathology. J. Bone Jt Surg 27, 460 (1945)
Crilly, R.G.: Longitudinal overgrowth of the chicken radius. J. Anat. 112, 11 (1972)
Davidson, E.A.: (1964) Quoted by Little, K. [30]
Ehrenborg, G., Engfeldt, B.: Histological changes in the Osgood-Schlatter lesion. Acta chir. scand. 121, 328 (1961)
Fairbank, Sir Thomas: An Atlas of General Affections of the Skeleton. p. xix Edinburgh: Livinstone 1951
Fergusson, A.B., Howarth, M.B.: Slipping of the upper femoral epiphysis. J. Amer. med. Ass. 97, 1867 (1931)
Hass, S.L.: The localisation of the growing point in the epiphyseal cartilage plate of bones. Amer. J. Orthop. Surg. 15, 563 (1917)
Hansman, C.: Appearance and fusion of ossification centres in the human skeleton. Amer. J. Roentgenol. 88, 476 (1962)
Harris, W.B.: Endocrine basis for slipping of upper femoral epiphysis. J. Bone Jt Surg. 32B, 5 (1950)
Hiller, H.G.: Battered or not? A reappraisal of metaphyseal fragility. Amer. J. Roentgenol. 114, 241 (1972)
Keyes, D.C., Compere, E.L.: Normal and pathological physiology of the nucleus pulposus. J. Bone Jt Surg. 14, 897 (1932)
Little, K.: Bone behaviour. p. 35. London: Academic Press 1973
Lufti, A.M.: The germinal zone of the growth cartilage at the upper ends of the tibia and fibula in Gallus Domesticus. J. Anat. 106, 565 (1970)
McCann, P.: The incidence and value of radiological signs in scurvy. Brit. J. Radiol. 35, 683 (1962)
MacGowan, T.J.B.A.: Adolescent kyphosis. Lancet 1944 I, 211
McKenzie, A., Court Brown, W.M., Doll, R., Sissons, H.A.: Mortality from primary tumours of bone in England and Wales. Brit. Med. J. 1, 1782 (1961)
Mineiro, J.D.: Coluna vertebral humana. Lisboa: Thesis 1965
Murray, R.O.: The aetiology of primary osteoarthritis of the hip. Brit. J. Radiol. 38, 810 (1965)
New Zealand Department of Health. Special Report Series 38. Wellington: Government Printer 1971
Park, E.A., Guild, H.G., Jackson, D., Bond, M.: Recognition of scurvy with especial reference to early x-ray changes. Arch. Dis. Child. 10, 265 (1935)
Paul, L.W., Juhl, J.H.: Essentials of Roentgen Interpretation. p. 74. London: Cassell & Co. 1959
Phillips, H.J.: The vascularisation of scorbutic bone. J. Anat. 108, 347 (1971)
Salter, R.B., Harris, W.B.: Injuries involving the epiphyseal plate. J. Bone Jt Surg. 45A, 587 (1963)
Salter, R.B.: The Growth Plate and its Disorders. Ed. M. Rang. p. 132, 134. London: E.S. Livingstone 1969
Silverman, F.N.: Roentgen manifestations of unrecognised skeletal trauma in infants. Amer. J. Roentgenol. 69, 413 (1953)
Silverman, F.N.: Modern trends in Radiology. 3rd Series, p. 192. London: Butterworth 1960
Smith, S.M., Hanson, R.: 134 battered children with a medical and psychological study. Brit. Med. J. 1974 III, 666
Snedecor, S.T., Knapp, R.E., Wilson, H.B.: Traumatic ossifying periostitis of newborn. Surg. Gynec. Obstet. 61, 385 (1935)
Snedecor, S.T., Wilson, H.B.: Some obstetrical injuries to long bones. J. Bone Jt Surg. 31A, 378 (1949)
Stayton, C.A.: Ischial epiphysiolysis. Amer. J. Roentgenol. 76, 1161 (1956)
Tanner, J.M.: Grwoth at Adolescence. 2nd Ed., Pp. 2, 5, 9, 12, 26, 110. Oxford: Blackwell Scientific Publications 1962
Tapp, E.: Tetrocycline labelling methods of measuring the growth of bones in the rat. J. Bone Jt Surg. 48B, 517 (1966)
Taylor, J.R.: Persistence of the notochordal canal in the vertebrae. J. Anat. 111, 211 (1972)
Thompson, D.W.: On Growth and Form. Vol. 1, 2nd Ed., Pp. 107, 90, 100, 233. London: Cambridge University Press 1959
Trueta, J., Amato, V.P.: The vascular contribution to osteogenesis. J. Bone Jt Surg. 42B, 571 (1960)
Uhry, E.: Osgood Schlatter's disease.Arch. Surg. 48, 406 (1944)
Vickers, A.A.: Letter. Brit. Med. J. 1964 I, 60
Woolley, P.V., Evans, W.A.: Significance of skeletal lesions in infants resembling those of traumatic origin. J. Amer. med. Ass. 158, 539 (1955)
Weston, W.J.: Metaphyseal fractures in infancy. J. Bone Jt Surg. 39B, 694 (1957)
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Alexander, C.J. Effect of growth rate on the strength of the growth plate-shaft junction. Skeletal Radiol. 1, 67–76 (1976). https://doi.org/10.1007/BF00347411
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DOI: https://doi.org/10.1007/BF00347411