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 Summary 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 Introduction 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 Center 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 (6,5) 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
