[Preoperative CT showed that a bone bridge (red arrow) appeared on the medial epiphyseal plate of Lele’s proximal tibia, leading to growth arrest]
Wen Jie’s deputy chief physician found that Lele had a limp gait of the right lower limb, and the right knee joint The left leg is straight and the right leg is bent. The legs look like an inverted letter "D". The length of both lower limbs is unequal, and the right lower limb is about 2 cm shorter than the left lower limb.
CT examination of the right knee joint showed that a bone bridge was formed on the medial side of the proximal tibia of the right knee.
Wenjie told Lele's parents that the reason why children can grow taller and have longer legs is because there is a special structure at both ends of each bone - epiphysis .
The epiphysis is a unique structure of children's bones. There is also an actively growing cartilage area between the epiphysis and metaphysis, called the epiphyseal plate or growth plate, which has the function of horizontal and vertical growth.
The epiphyseal plate is like a small river, running between the epiphysis and metaphysis. Once the epiphyseal plate is damaged, a bony connection will appear between the metaphysis and epiphysis, like a bridge across the small river, that is, a bone bridge.
Bone bridges can prevent the bones in the corresponding areas from continuing to grow, while the bones in the surrounding areas without bone bridges continue to grow, causing joint deformities, leading to limb shortening, severe deformity and/or angulation, affecting the growth and development of children.
[Lele’s left lower limb is straight, and the knee joint of the right lower limb is bent from the tibia (calf), and both lower limbs look like an inverted letter “D”]
Lele’s right knee is varus and her right lower limb is shortened. This is because It is caused by the restriction of transverse and longitudinal growth of the proximal tibia due to the bone bridge of the epiphyseal plate in the right proximal tibia. Why does bone bridge appear in
? Wen Jie further explained: fractures, infections, tumors, radiation, etc. may cause epiphyseal plate damage, and because the cartilage area where the epiphyseal plate is located is not visible on X-ray films, early diagnosis after injury is difficult, and the rate of misdiagnosis and missed diagnosis is extremely high.
Therefore, early diagnosis and appropriate treatment are key.
[The doctor excavated the bone bridge through the bone tunnel (red) on the inner side of the proximal right tibia and filled it with fat bone grafting. He performed a temporary growth block on the outer side and allowed the outer side of the tibia to grow "wait" while the inner side grew to correct the varus of the right knee. Deformity】
After the doctor inquired about the medical history in detail and conducted relevant examinations, he could basically rule out the possibility of Lele's tumor, radiation, etc. Wenjie speculated that his right leg may have suffered vertical violent trauma six months to one year ago, similar to improper jumping or The injury to the epiphyseal plate of the proximal tibia was not detected in time due to a violent impact when landing from a high place.
As a result, the left leg grew normally, but the right leg slowly grew and bent, so the legs looked like a "D" shape.
html On June 24, Chief Physician Xiao Sheng, Deputy Chief Physician Wen Jie, and Chief Physician Zeng Ming of Pediatric Orthopedics performed minimally invasive surgery to dig out a "small tunnel" in the bone with the assistance of arthroscopy to treat Lele. " right proximal tibial epiphyseal bone bridge excavation and fat filling + right proximal tibial lateral epiphyseal block " was performed.The operation went smoothly and the child recovered well after the operation and was discharged from the hospital on June 29.
[Hunan Provincial People's Hospital Pediatric Orthopedic Surgeon Checks Lele's Postoperative Recovery]
Wenjie emphasized that children are not smaller versions of adults. Due to the particularity of children's epiphyseal and epiphyseal plate injuries, they are complicated by malunion caused by epiphyseal synostosis. , not only hinders the appearance, but most importantly affects joint function, which is not conducive to children's physical and mental health.
As the summer vacation approaches, he reminds parents: Once their children suffer from trauma, they should go to a regular children's orthopedics department to reduce missed diagnosis and misdiagnosis due to the lack of X-ray visualization of cartilage, epiphyseal plates, etc., and to avoid sequelae caused by fractures in children.
(Editor Rainbow.)
Hunan Medical Chat Special Author: Hunan Provincial People's Hospital Li Fanling Zhang Siqi
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