PATHOGENESIS AND RADIOLOGICAL FINDINGS IN RARE CASE OF SALTER HARRIS TYPE I DISTAL TIBIAL FRACTURE WITH ASSOCIATED OSTEONECROSIS IN THE PAEDIATRIC POPULATION

Authors

  • Ayesha Ropri SUNY Upstate Medical University
  • Zain Badar SUNY Upstate Medical University
  • Asad Khan SUNY Upstate Medical University
  • Hamza Murtaza SUNY Upstate Medical University
  • Sankarsh Jetty SUNY Upstate Medical University
  • Jason Chu SUNY Upstate Medical University
  • Arthur Yegorov SUNY Upstate Medical University

Abstract

 Salter-Harris type I fractures of the distal tibia are commonly seen in paediatrics and management of such fractures follows an algorithm established in the literature. Despite this, osteonecrosis of the distal tibia can subsequently develop. Osteonecrosis or avascular necrosis is cell death that occurs secondary to trauma, metabolic disturbances, sickle cell disease, or medication side effect. It most frequently affects the femur, talus, or humerus, and rarely the tibia. Radiographs and MRI are pivotal in making a timely diagnosis in order to minimize patient discomfort. To the best of our knowledge, there has only been one previous documented case of osteonecrosis following a Salter Harris Type I distal tibial fracture. Here, we present the second such case.Keywords: Salter Harris Fracture; Osteonecrosis; Distal Tibial Fracture

Author Biographies

Ayesha Ropri, SUNY Upstate Medical University

Medical Student

Zain Badar, SUNY Upstate Medical University

Senior Radiology Resident Doctor

Asad Khan, SUNY Upstate Medical University

Medical Student

Hamza Murtaza, SUNY Upstate Medical University

Medical Student

Sankarsh Jetty, SUNY Upstate Medical University

Medical Student

Jason Chu, SUNY Upstate Medical University

Senior Radiology Resident Doctor

Arthur Yegorov, SUNY Upstate Medical University

Radiology Attending Doctor

References

Assouline-Dayan Y, Chan C, Greenspan A, Shoenfeld Y, Gershwin ME. Pathogenesis and Natural History of Osteonecrosis. Semin Arthritis Rheum 2002;32(2):94–124.

Hofmann S, Kramer J, Plenk H Jr, Leder K, Imhof H, Engel A. Osteonecrosis. Orthopade 1994;23(5):331–41.

Pugely AJ, Nemeth BA, McCarthy JJ, Bennett DL, Noonan KJ. Osteonecrosis of the Distal Tibia Metaphysis After a Salter-Harris I Injury: A Case Report. J Orthop Trauma 2012;26(2):e11–5.

Chakravarty D, Khanna A, Kumar A. Post-traumatic osteonecrosis of distal tibia. Inj Extra 2007;38(8):262–6.

Wuerz TH, Gurd DP. Pediatric physeal ankle fracture. J Am Acad Orthop Surg 2013;21(4):234–44.

Brown JH, Deluca SA. Growth Plate Injuries: Salter-Harris Classification. Am Fam Physician 1992;46(4):1180–4.

Rohmiller MT, Gaynor TP, Pawelek J, Mubarak SJ. Salter-Harris I and II Fractures of the Distal Tibia: Does Mechanism of Injury Relate to Premature Physeal Closure? J Pediatr Orthop 2006;28(3):322–8.

Leary JT, Handling M, Talerico M, Yong L, Bowe JA. Physeal Fractures of the Distal Tibia: Predictive Factors of Premature Physeal Closure and Growth Arrest. J Pediatr Orthop 2009;29(4):356–61.

Filipowska J, Tomaszewki KA, Niedzwiedzki L, Walocha J, Niedzwiedzski, T. The role of vasculature in bone development, regeneration, and proper systemic functioning. Angiogenesis 2016;20(3):291–302.

Maes C, Kobayashi T, Selig MK, Torrekens S, Roth SI, Mackem S, et al. Osteoblast precursors, but not mature osteoblasts, move into developing and fractured bones along with invading blood vessels. Dev Cell 2010;19(2):329–44.

Feng Y, Yang SH, Xiao BJ, Xu WH, Ye SN, Xia T, et al. Decreased in the number and function of circulation endothelial progenitor cells in patients with avascular necrosis of the femoral head. Bone 2010;46(1):32–40.

Menck J, Bertram C, Lierse W. Sectorial angioarchitecture of the human tibia. Acta Anat (Basel) 1992;143(1):67–73.

McLeod JM, Ng A, Kruse DL, Stone PA. Nontraumatic Osteonecrosis of the Distal Tibia: A Case Presentation and Review of Literature. J Foot Ankle Surg 2017;56(1):158–66.

Babu N, Schuberth JM. Partial avascular necrosis after talar neck fracture. Foot Ankle Int 2010;31(9):777–80.

Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg 1995;77(1):34–41.

Basener CJ, Mehlman CT, DiPasquale TG. Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis. J Orthop Trauma 2009;23(9):663–7.

Mubarak SJ, Kim JR, Edmonds EW, Pring ME, Bastrom TP. Classification of proximal tibial fractures in children. J Child Orthop 2009;3(3):191–7.

Shi DP, Zhu SC, Li Y, Zheng J. Epiphyseal and physeal injury: comparison of conventional radiography and magnetic resonance imaging. Clin Imaging 2009;33(5):379–83.

Arkader A, Warner WC Jr, Horn BD, Shaw RN, Wells L. Predicting the outcome of physeal fractures of the distal femur. J Pediatr Orthop 2007;27(6):703–8.

Schnetzler KA, Hoernschemeyer D. The pediatric triplane ankle fracture. J Am Acad Orthop Surg 2007;15(12):738–47.

Ilharreborde B, Raquillet C, Morel E, Fitoussi F, Bensahel H, Pennecot GF, et al. Long-term prognosis of Salter-Harris type 2 injuries of the distal femoral physis. J Pediatr Orthop B 2006;15(6):433–8.

Craig JG, Cody DD, Van Holsbeeck M. The distal femoral and proximal tibial growth plates: MR imaging, three-dimensional modeling and estimation of area and volume. Skeletal Radiol 2004;33(6):337–44.

Swischuk LE, Hernandez JA. Frequently missed fractures in children (value of comparative views). Emerg Radiol 2004;11(1):22–8.

Barmada A, Gaynor T, Mubarak SJ. Premature physeal closure following distal tibia physeal fractures: a new radiographic predictor. J Pediatr Orthop 2003;23(6):733–9.

Ecklund K, Jaramillo D. Patterns of premature physeal arrest: MR imaging of 111 children. AJR Am J Roentgenol 2002;178(4):967–72.

Koury SI, Stone CK, Harrell G, La Charite DD. Recognition and management of Tillaux fractures in adolescents. Pediatr Emerg Care 1999;15(1):37–9.

Carey J, Spence L, Blickman H, Eustace S. MRI of pediatric growth plate injury: correlation with plain film radiographs and clinical outcome. Skeletal Radiol 1998;27(5):250–5.

Rodgers WB, Schwend RM, Jaramillo D, Kasser JR, Emans JB. Chronic physeal fractures in myelodysplasia: magnetic resonance analysis, histologic description, treatment, and outcome. J Pediatr Orthop 1997;17(5):615–21.

Shih C, Chang CY, Penn IW, Tiu CM, Chag T, Wu JJ. Chronically stressed wrists in adolescent gymnasts: MR imaging appearance. Radiology 1995;195(3):855–9.

Bartolotta RJ, MuCullion JC, Belfi LM, Hentel KD. Mueller-Weiss syndrome: imaging and implications. Clin Imaging 2014;38(6):895–8.

Issa K, Baziri Q, Kapadia BH, Lamm BM, Jones LC, Mont MA. Clinical characteristics of early-stage osteonecrosis of the ankle and treatment outcomes. J Bone Joint Surg Am 2014;96(9):e73.

Buchan CA, Pearce DH, Lau J, White LM. Imaging of postoperative avascular necrosis of the ankle and foot. Semin Musculoskelet Radiol 2012;16(3):192–204.

Pearce DH, Mongiardi CN, Fornasier VL, Daniels TR. Avascular necrosis of the talus: a pictorial essay. Radiographics 2005;25(2):399–410.

Toussirot E, Jeunet L, Michel F, Kantelip B, Wendling D. Avascular necrosis of the hallucal sesamoids update with reference to two case-reports. Joint Bone Spine 2003;70(4):307–9.

Published

2018-09-16