[Periosteal tethering of growth plates in long bones (focal fibrocartilaginous dysplasia)].
OBJECTIVE
Another three cases of periosteal tethers (focal fibrocartilaginous dysplasia) are reported. Until now only 54 children affected by this entity were described. Analysis of these three cases concerning clinical appearance, x-ray deformity, preoperative and histologic findings and the end-results of the own method of surgical treatment was undertaken to categorise the proper diagnosis.


METHODS
The studied group involved distal posteromedial femoral lesion (Boy aged 11 months, Epiphysis-diaphysis angle 68 degrees, femoro-tibial angle 27 degrees). Another case with proximal tibial lesion on the lateral side (Boy aged 18 months, Epiphysis-diaphysis angle 75 degrees, femoro-tibial angle 18 degrees). Third case with proximal tibial lesion, localised typically medially (Boy aged 17 months, Epiphysis-diaphysis angle 70 degrees, femoro-tibial angle 19 degrees).


METHODS
All three cases were routinely followed for short time, before surgical correction was performed. AP and lateral x-rays were undertaken. Surgical correction involved curretage of the lesion and a half-circumferential excision of the periost between the lesion and the physis. Short-term immobilisation followed. In no case an osteotomy was needful.


RESULTS
Limited surgical approach consisting of curretage and periost excision resulted in slow but full correction of the long bone angulation. In the distal femoral lesion the normal value of limb axis was achieved in 9 years, in proximal and lateral tibial lesion in 7 years and in proximal and medial tibial lesion in 3 years. Persisting shortening of the limb length was found only in femoral lesion involving 10 millimetres. Histologic findings comprised areas of dense fibrous tissue, of fibrocartilage and of sclerotic bone. Bacterial cultivation was negative.


CONCLUSIONS
It seems, that there is almost no difference between clinical, x-ray and preoperative findings of periosteal tethers and focal fibrocartilaginous dysplasia. A real fibrous band between the cortical lesion and the physis was not found in this study, however the periost was roughened and adhered firmly to the bone. Limited surgical exposure consisting of curretage and half-circumferential excision of periost quaranteed in all three cases full correction of the former deformity.


CONCLUSIONS
Osteotomy is not an absolutely necessary surgical solution in these cases.
Poul
J
J
Klinika dĕtské chirurgie, ortopedie a traumatologie, Dĕtská nemocnice, FN, Brno. jpoul@med.muni.cz
Straka
M
M
D002648:Child; D002675:Child, Preschool; D006132:Growth Plate / Q000473:pathology; D006801:Humans; D007223:Infant; D007719:Knee Joint / Q000000981:diagnostic imaging; D008297:Male; D010009:Osteochondrodysplasias / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010521:Periosteum / Q000473:pathology; D011859:Radiography