OKOJ

OKOJ, Volume 6, No. 8


Diagnosis and Management of Physeal Injuries

Knowledge of the macroscopic and microscopic anatomy of the growth plate is essential for successful management of physeal injuries. Damage to any area of the physis can lead to significant abnormalities of physeal growth and long bone development. In general, there are a number of standard rules or guidelines that should be followed in the management of physeal fractures. Nondisplaced or minimally displaced type I and type II injuries usually can be managed effectively with closed manipulative reduction and appropriate casting or splinting. Surgical treatment with either percutaneous or open fixation is indicated for fractures that extend to the joint surface (type III and type IV fractures) because intra-articular discontinuity can lead to early degenerative arthritis, and physeal discontinuity can result in disruption of longitudinal bone growth.

    • Keywords:
    • physeal injury

    • physis fracture

    • epiphyseal plate fracture

    • epiphyseal plate injury

    • growth plate fracture

    • growth plate injury

    • Salter-Harris classification

    • physeal arrest

    • Subspecialty:
    • Pediatric Orthopaedics

Pigmented Villonodular Synovitis

Pigmented villonodular synovitis (PVNS) is a benign intra-articular disease characterized by variable degrees of proliferative synovitis and hemosiderin deposition. The condition typically presents with a mono-articular synovial process that usually affects the adult knee during middle age, although it has been observed in the hip, ankle, shoulder, elbow, and spine. The classically described form of the disease primarily affects joints. Because bursae and tendon sheaths may also be affected by a condition that has histologic similarities to PVNS, controversy exists as to whether these similar conditions are variants of the disease or separate clinical entities. MRI is extremely valuable in narrowing the differential diagnosis and defining the extent of the disease. This article focuses mainly on traditional intra-articular PVNS and the benefits of surgical excision.

    • Keywords:
    • localized PVNS

    • nodular PVNS

    • diffuse PVNS

    • intra-articular joint disease

    • monoarticular synovial process

    • arthritis

    • fibrohistiocytic proliferation

    • hemosiderin

    • multi-nucleated giant cells

    • fibrosis

    • sarcoma

    • hemarthrosis

    • synovectomy

    • arthroscopy

    • total joint arthroplasty

    • Subspecialty:
    • Musculoskeletal Oncology

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