Growth Plate Physeal Longitudinal Growth May Actually Overcome Bone Bridges, New Evidence Showing LSJL May Work

Me: In one of my most recent posts I had questioned the validity of the LSJL method based on the fact that in most papers and studies, if there is any bone that connects the two bone areas the growth plates was supposed to connect to, that would lead to a contraint not allowing the growth plate to ever stretch again. Growth was stunted because I thought the bone was too hard to ever be broken by just the pushing of the cartilage.

However I was going through PubMed today when this very short paper caught my eye. It appears that if bone bridges are formed, it might be possible in some rare cases that the growth potential of the physis (aka growth plate) is able to “break the already transformed osseous bridge” (aka bone bridge). This seems to show that the theory behind LSJL may be valid in the idea that chondrocytes which can lead to possible cartilage may theoretically have enough loading strength to even push bone apart thus stretching the long bone longitudinally. 

Update: Since publishing the first edition of this post, I happened to find a 2nd article on PubMed that shows that bone bridges can spontaneous go away leading to regular cartilage growth. The 2nd study is found below the first one. It seems to suggest that in only rare occasional cases that bone can give way to cartilage. 

From source link HERE

J Pediatr Orthop B. 2012 Jul;21(4):369-72. doi: 10.1097/BPB.0b013e328347a42d.

Spontaneous correction of partial physeal arrest: report of a case and review of the literature.

Gkiokas A, Brilakis E.

Source

1st Orthopaedic Department, General Children’s Hospital, ‘P. & A. Kyriakou’, Athens, Greece.

Abstract

This study describes the rare phenomenon of partial physeal arrest spontaneous correction. It concerns a case of a 3.5-year-old girl who suffered from a Salter-Harris IV fracture of the distal tibial epiphysis, which was managed conservatively. After fracture healing an osseous bridge was formed at the medial part of the physis, leading to a varus deformity. The parents refused the operation, but 6 years later, both the ankle’s deformity and the shortening of the extremity had been spontaneously corrected. It seems that the growth potential of the physis healthy portion is able to break the already transformed osseous bridge.

PMID: 21597386      [PubMed – indexed for MEDLINE]

From source link HERE
Acta Chir Orthop Traumatol Cech. 2008 Dec;75(6):471-3.

[Osseous bridge after physeal-injury to the distal tibia with spontaneous resolution].

[Article in Slovak]
Trnka J, Sýkora L, Bibza J.

Source

Klinika detskej chirurgie DFNsP a LFUK, Bratislava. trnka@dfnsp.sk

Abstract

The risk of osseous bridge development after certain types of physeal injury is well established. Once formed, the bridge continues to grow and results in a progressive deformity. The authors present an unusual case of a five-year-old girl who had a Salter-Harris Type-IV fracture of the distal tibial epiphyseal plate, with subsequent osseous bridge formation and deformity development. The bridge resolved spontaneously in 16 months, and joint mechanical axis alignment was gradually restored with normal growth of the distal tibia. Key words: physis, paediatric fractures, bony bridge, growth arrest.

PMID: 19150006  [PubMed – indexed for MEDLINE]

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