[Natural course following fractures during the growth years].
"Spontaneous" correction of axial deformities after trauma is shown, as well as the limiting factors of such remodelling by growth. The prognosis of all sorts of post-traumatic growth disturbances is discussed. After any fracture during growth, stimulation of the function of one or more growth plates can be anticipated. The outcome is dependent on the age of the patient at the time of the accident: an overgrowth with lengthening will take place in the patient under 10 years of age; early closure of the plate with shortening will occur in patients more than 10 years. Post-traumatic leg length discrepancies do not show remodelling during further growth. Partial stimulation has clinical importance in the proximal tibia where it leads to a unilateral genu valgum. If the patient is young enough, the joint will grow away from this deformity, whereas the proximal and distal epiphysis of the tibia will grow again into the correct position for the weight-bearing forces. The most important growth disturbance is premature partial closure of a growth plate, which leads to increasing axial deformity and shortening. If there is a small osseous bridge between the metaphysis and epiphysis, "spontaneous" bursting of this bridge is possible. If there is a large bridge resection, osteotomy may also be necessary. In both cases--"spontaneous bursting" and resection--a late recurrence of such a bridge during puberty--years after the accident--is possible. It is described as late weakening of the growth forces in the former traumatized area of the growth plate.
von Laer
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Traumatologische Abteilung des Kinderspitals, Basel.
D001846:Bone Development; D016723:Bone Remodeling; D002648:Child; D002675:Child, Preschool; D005260:Female; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D006128:Growth; D006801:Humans; D007223:Infant; D016916:Joint Deformities, Acquired / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D011859:Radiography
Spontanverläufe nach Frakturen im Wachstumsalter.