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Reporting Two Cases with Reappearance of Growth Plate after Trauma in Ankle Ahmad Shahab
Kosarian1 , Masoud Shayesteh Azar2 , Seyed Mohamad Mehdi Daneshpoor 3 1 Department of
Radiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 2
Department of Orthopedic Surgery, Faculty of Medicine, Mazandaran University of Medical
Sciences, Sari, Iran 3 Resident in Orthopedic Surgery, Student Research Committee, Faculty of
Medicine, Mazandaran University of Medical Sciences, Sari, Iran (Received April 28, 2012 ;
Accepted August 1, 2012)
Abstract Bone growth plates or physis are present at the end of long bones and are
responsible for longitudinal growth. These plates consist of four layers and are lucent in
radiography as a line perpendicular to the longitudinal axis. When the age increases and by
bone maturity these line will be narrower and as longitudinal bone growth stops, the line
disappears. This phenomenon occurs at different ages in different bones of the skeleton but
with complete maturity at the age of 19, all growth plates are closed and sclerosed. Reappearing after closing is uncommon. We introduce two young patients in this study who have
been treated for an ankle cast after trauma. In the control X-ray the re-appearance of growth
plates of tibia and fibula was observed. Subchondral bone resorption is a known phenomenon
that will occur after six to eight weeks immobility in any bone. The lucent line is caused by
imbalance in osteoblast and osteoclast activity and bone absorption. Re-appearing of growth
plates in patients of this study could be due to reversed ossification and bone absorption.
Keywords: Hawkins sign, ankle trauma, growth plate, subchondrel bone resorbtion.
Introduction of 2 cases of recurrence of growth
plate in the ankle following trauma
1 Ahmad Shahab Kawtharian
2 Masoud Shayesteh Azar
3 Sayed Mohammad Mehdi Daneshpour
Bone or pharyngeal growth plates are responsible for the longitudinal growth of long bones,
which consist of 4 layers.
Radiographs show the leucent linearly perpendicular to the longitudinal axis of the bone.
Gradually with increasing age and maturity
The bone of this line of Lucent Barrique disappears as the bone of this line stops growing
longitudinally. This phenomenon is in the bones
It occurs at different ages, but with full skeletal maturity at age 19, all growth plates are
blocked by vasculosis.
They reappear after sclerosis and closure. In this study, two young patients who due to
Trauma treated for ankle sprains Introduced in control radiographs after treatment, plates
Tibial end fibula growth reappeared in them.
Resonant bone resorption (Bone Subchondral) is a well-known phenomenon
Which occurs due to hyperemia and immobility, occurs after 6 to 8 weeks. This Lucent band is
due to imbalance
Osteoblasty and osteoclasts occur in favor of bone resorption and under the cartilage. In other
words, the cause of reappearance
Growth plate in the studied patients can be reversed ossification in the cartilage growth plate
in the past
It was found to cause bone tissue absorption.
Keywords: Hawkins symptom, Ankle trauma, Growth plate, Subcutaneous bone resorption
Searched vertical axis perpendicular to the longitudinal bone line
They are because the cartilage layer absorbs less X-rays
It is calcified compared to bone. Gradually with age
And bony maturity of this line of leucine narrowed with
Inhibition of longitudinal bone growth of this line also disappears (1. (
This phenomenon occurs in different bones at different ages
Created but with full skeletal maturity at age 19 Growth plates (Physis) at the end
There are long bones and it is responsible for their longitudinal growth
The bones are. In fact, longitudinal bone growth
It is a dynamic and active phenomenon that is affected by the cellular process
And is created by the multiplication and differentiation of chondrocytes and this
The pages are its final target organ
One of the 4 layers formed in radiographs
Author: Masoud Shayesteh Azar - Sari: Amir Mazandarani Blvd., Imam Khomeini Medical
Department of Radiology, School of Medicine, Mazandaran University of Medical Sciences
Department of Orthopedics, School of Medicine, Mazandaran University of Medical Sciences
3. Orthopedic Assistant, Student Research Committee, School of Medicine, Mazandaran
University of Medical Sciences
5/11/2012: Approved on 3/23/2012: Reforms for reference on 2/9/2012: Received on
Healed but clear Lucent line in anatomical location
Physis appears at the end of the tibia and fibula, which
The original graphics were not visible (Figure 3).
By age all growth plates become blocked by sclerosis
And their reappearance after sclerosis and enlargement
It is not common. Ankle growth plates normally
Age 15-16 years old, sclerotic and blocked (2.)
The reason for the reappearance of the growth plate can be absorbed
Bony and inverted bone formation on the plate
Cartilage growth that has been done in the past. Trauma or
Treatment of the patient may be one of the causes of the above phenomenon. Existence
Local hyperemia at the site of the fracture can cause
Increase bone resorption (3.
In addition to plastering and immobilization as well
Factors in the development of local focal osteoporosis
Immobility and absorption of bone mineral are known
In this study, two young patients due to
Trauma treated for ankle sprains
We introduce that in the initial radiographs of both patients
Only bone and tissue injuries were present and
Their growth plates have been radiologically developed
It was not seen but in control radiography after treatment,
The growth plates of the end of the tibia and fibula reappeared.
Case report
Case 1: An 18-year-old student following an accident
He referred on 6/4/89. In the examination of pain and swelling of the wrist
The right foot was seen. Other skeletal injuries
‫ن رـيسـيد‬. The patient was considered normal and abnormal
It was not clear in the limbs. In post-trauma radiography
Spiral fracture of the lower fibula with swelling
The soft tissue of the ankle was seen. The appearance of Tibia and Talus was normal
The joint did not show any problems (Figure 1).
Closed growth plates are located one by one
The line of fine sclerosis was noticeable. For the patient
Plastering was performed (Figure 2) (after 78 days)
The plaster opened. In distal fibula fracture radiography
At that time, a trace of the growth plate of the tibia
Could not be seen. In radiographic control after 45 days
There is a union fracture in the plaster and a line
Clear Lucent at the site of the bone growth plate in the tibia and
Fibula has appeared (Figure 7). Soft tissue swelling
Brief Existence of Dardoli's Bone Injury
No one else is seen. Then after 11-12 weeks
Lucent lines gradually sclerosed and faded again.
Lytic or destructive changes in other readings
Not observed and in control after 7-8 weeks of this line
Lucent gradually sclerosed and disappeared.
Case 2: Mr. 27-year-old student in history
22/8/89 Following the twisting of the right ankle, refer to
Appeared. In the examination of soft tissue swelling and tenderness on the ankle
Internally observed. Patient from vascular development
The problem was not obvious. In the graph of the first day
(Pictures No. 4 and 5) Fracture of the inner ankle tip
Tibia was observed with soft tissue swelling. ‫شكسـتگی‬
The patient was treated with a pin the day after the trauma
The patient was cast (Figure 6).
Discussion of subarachnoid bone resorption
(Bone Subchondral Resorption)
Is in any bone that due to hyperemia and
It becomes immobile, it occurs after 6 to 8 weeks.
In the past, Hawkins Leland was a phenomenon of attraction
The bone beneath the cartilage is described in its talus
have given. Subchondral absorption in the talus bone 6
It can be seen up to 8 weeks after the fracture
According to Hawkins, it is a good sign to determine in advance
It is an advertisement for treatment because this symptom is a sign of blood clotting
It is enough in that place and the risk of avascular necrosis
Rejects but absorbs cartilage in the review of articles
Indicated on the growth page by Hawkins or others
Has not been (9. (
In referred patients, it is possible to appear
Re-growth plates due to suction of cartilage
He knew that not only under the terminal cartilage but also in
It also forms under the cartilage of the growth plate. Both
The patients were young and had a long period of puberty
Radiological closure of their growth plate had not occurred.
It seems that this radiological sign does not necessarily mean
Complete disappearance of cartilage tissue in bone tissue
And hyperemia and more osteoclast activity in this tissue
The small cartilage that remains in the pharynx is also
The end cartilage of the bone causes more local absorption and
Create Lucent lines. Obviously after
Treatment and return of mechanical load of dismemberment and cessation
Osteoclast activity gradually reversed all of these processes
After a period of bone mineralization in place
It returns to normal.
Lucent band due to disturbance of osteoblastic balance and
Osteoclasts in favor of bone resorption and under cartilage
It is created (7.) Of course, the creation of this sign requires existence
Arterial circulation is sufficient and healthy in the bone. ‫بـه‬
Another phrase in these patients is osteoporosis on the page
Inverted cartilage growth in the past and tissue
Bone is absorbed. The reason for this can be found in
Know the trauma or treatment of the patient. Existence of local hyperemia in
The fracture site can increase bone resorption
And porosity of cortical bone tissue in that area
In addition, plastering reduces the load.
The mechanics of the limb and its immobility (disuse) and so on
The matter as a recognized factor in creating
Focal osteoporosis is an acceptable site of immobilization (4. (
Immobility also rapidly absorbs bone minerals
Occurs because immobility causes activity to increase
Osteoclasts and decreased osteoblast activity
On the other hand, other readings are similar to other textures.
They are nourished by blood vessels that need to be woven.
By their endothelial cells as vasoactive substances
It secretes prostaglandins and at a time of immobility
This regulatory system regulates bone circulation.
It can also reduce (8.) The above factors are totally effective.
Known phenomenon of osteoporosis due to plastering
Disuse osteoporosis