Aim: To review the outcome following growth plate arrest in distal femur and proximal tibia of different aetiology in adults. Materials and methods: We have reviewed, retrospectively, eight adult patients with lower leg deformity in the distal femur and proximal tibia, as a sequelae of growth plate arrest of different aetiology. These patients underwent tibial and femoral, correction and lengthening. The total number was 8 patients, there were 6 male and 2 female, with an average age of 22.8 years (17–34.8) The average follow up was 32.9 months (7.9–51.4). Results: Four patients had growth plate arrest following trauma (two patients were involved in road traffic accidents, one had Salter-Harris type V fracture of the proximal tibia and one had sport injury), two patients had iatrogenic growth plate arrest after internal fixation of tibial spine in one patient and after internal fixation of a popliteal muscle rupture in the other, one patient had Osgood Schlater disease, one patient had childhood osteomyelitis and one unknown pathology. The average shortening was 34.8 mm (8–60), the average maximum deformity in any one plane was 19.8 degree (6–40). All the patient underwent corrective surgery and lengthening, five patients had Sheffield Ring Fixator, two had Limb Reconstruction System and one had percutaneous osteotomy on Albizzia nail. The patients who underwent SRF and LRS stayed in the frame for an average 258 days (150–435). The residual leg length discrepancy was 5.5 mm (0–12). There was three grade one complications, three grade two complications, and one patient had grade IV complication following compartment syndrome. Four patients had grade two pin site infection and three patients had grade one. Conclusion: Growth plate arrest of the distal femur and proximal tibia can cause severe deformity and shortening of the lower limb in adult, and this deformity is amenable to correction in the end of growth using different techniques. We used Sheffield ring fixator in complex cases, to address both deformities and lengthening, while other techniques were used in less complex cases

Physeal bar resection for partial growth plate arrest was first described by Langenskjold in 1967. The initial enthusiasm by Peterson (1989) who found that 83% of patients resumed physeal growth was tempered by Birch (1992) who only had 33% success. Poor results were due to failure to resume growth or premature growth arrest. We retrospectively reviewed 21 physeal bar resections performed in 19 children from 1987 to 2003. The average age at surgery was 8.2 years (range 3–12 years). The aetiology of the physeal arrest was : growth plate fracture (8), meningococcal septicaemia (5), osteitis (3; 2 neonatal), dysplasia (3), gunshot (1) and idiopathic (1). The commonest site was the distal femur (12; 5 due to growth plate fracture), followed by the proximal tibia (5; 3 due to meningococcal septicaemia), and the distal tibia (4; 2 due to growth plate fractures). Assessment of the size and location of the bar was with biplanar tomography in 7, MRI in 5 and both in 7. We found equal accuracy with both modalities, but currently prefer MRI. The bar was plotted on an anterior-posterior and lateral map of the growth plate. The average size of the bar was 25% (range 15 to 50%) of the area of the growth plate. Only 3 bars were larger than 30%. Fifteen of the bars were peripheral, 5 linear and 1 central. Results were classified poor if there was no resumption of growth or if premature growth plate arrest occurred, good if there was resumption of growth which continued to maturity or to follow-up, and excellent if the growth exceeded the expected growth. There were 5 (24%) poor results; all failed to resume growth. Three bars exceeded 30% and 2 were due to meningococcal septicaemia. The remaining 16 bars were followed up for a range of 2 to 12 years; 10 to maturity. Four (19%) had an excellent and 12 (57%) had a good result. The authors conclude that physeal bar resection is a worthwhile procedure if the size of the bar is equal to or less than 30% of the area of the growth plate. In growth arrest due to meningococcal septicaemia we only had a 60% success rate

Meningococcal septicaemia from meningococcal infection is a devastating illness affecting children. Advances in medical management have reduced the mortality rate to approximately 15 to 20% and children who survive can develop late orthopaedic sequelae from growth plate arrests with resultant complex deformities. Our aim in this study was to review and analyze the case histories of a series of patients with late orthopaedic sequelae, all treated by the senior author. We describe a treatment strategy to address the multiple deformities that may occur in these patients. Methods & Results Between 1990 and 2009, 12 patients were treated for late orthopaedic sequelae after meningococcal septicaemia by the senior author. There were 8 girls and 4 boys. All patients had lower limb involvement. 1 patient had involvement of the upper limb requiring treatment. Each patient had had a mean of 3 operations (range from 2 to 9). Methods of treatment included a combination of angular deformity correction, limb lengthening and epiphysiodesis. At final follow-up 9 of the 12 patients were skeletally mature. In 9 patients limb length discrepancy in the lower limb was corrected to within 1 cm, with normalization of the lower limb mechanical axis. Conclusion. Meningococcal septicaemia can lead to late orthopaedic sequelae due to growth plate arrests. Central growth plate arrests leads to limb length discrepancy, and partial growth plate arrests leads to an angular deformity. In addition, limb amputations may occur and there may be altered growth of the stump requiring further surgery. In cases of central growth arrest with limb shortening alone, limb equalisation is performed with limb lengthening procedures. In cases of partial growth arrests, angular correction is performed together with ablation of the affected growth plate. We recommend ablation of the affected growth plates at the initial surgery to prevent recurrence of angular deformity. Angular correction can be performed acutely, with a dome or transphyseal osteotomy; or gradually, with application of Ilizarov or Taylor Spatial frames. Severe deformities of the tibial plateau are treated by plateau elevation with bone graft augmentation. With the appropriate strategy deformities can be corrected and further lengthening procedures can be undertaken if necessary. Long-term follow-up of these patients is essential to recognise and treat any recurrence of deformity

Introduction and Aims: To determine the optimum management of growth arrests secondary to meningococcal septicaemia. Method: A retrospective study of 28 children treated in children’s hospitals in the UK for long bone deformities caused by growth plate arrests secondary to meningococcal septicaemia. Results: 28 children (age range four to eight years) with growth arrests of the long bones following meningococcal septicaemia were treated for their bony deformities (a limb length discrepancy or a progressive angular deformity of the upper or lower limb) using the Ilizarov technique. Resection of bony blocks was ineffective in preventing progressive deformities. Limb length discrepancies were treated satisfactorily with equalisation of limb lengths. Angular deformities required ablation of the remaining part of the affected growth plate in order to prevent recurrence. Distal tibial deformities were treated satisfactorily with a transepiphyseal osteotomy. In the upper limb lengthening of either the radius or ulna restored alignment to the wrist. One patient with a growth arrest affecting a tibial amputation stump underwent satisfactory stump realignment and lengthening. Limb lengthening will need to be repeated in younger children, as the deformity will recur with growth until skeletal maturity. Conclusion: The Ilizarov technique enables satisfactory treatment of growth deformities secondary to meningococcal septicaemia. With peripheral growth plate arrests causing an angular deformity the remaining open growth plate needs to be ablated to prevent recurrence of the angular deformity. Any recurrence will then be a shortening only, which can be treated by further lengthening if required

Summary Statement. The implantation of scaffold-free CTE from suspension culture into growth-plate defects resulted in a significant reduction in growth arrest of the rabbit tibia. Introduction. In childhood and adolescence, the growth plate injury can cause partial premature arrest of growth plate, which can make problems such as leg length discrepancy and angular deformity. Bone bridge resection and variable implantation materials such as fat, bone wax, silastic and craniopalst has been investigated. However, those procedures may show limitations including the control of bone growth and long term safety of implant materials in vivo. As an alternative, homogeneous or heterogeneous cartilage cells and stem cell transplants have been tried. In this method, scaffold for cell transplantation is needed. But, so far the most suitable scaffold has not been established. Recently, some authors generated a cartilage tissue equivalent (CTE) using a suspension culture with biophysical properties similar to native hyaline cartilage. Therefore we are able to transplant the CTE without scaffold to the physeal defect. The purpose of this study was to investigated the effects of a transplantation of a vitro-generated scaffold-free tissue-engineered cartilage tissue equivalent (CTE) using a suspension chondrocyte culture in a rabbit growth arrest model. Material and Method. Cartilage tissue equivalent culture. The CTE was generated by the suspension culture of chondrocytes (2 × 10. 7. /well/1 mL) which was isolated from articular cartilage of 5 weeks New Zealand white rabbit on a 24-well plate (2.4 cm. 2. /well) treated with poly HEMA (nunc, Roskide, Denmark) for up to 8 and 16 weeks. (2)Partial growth arrest animal model. An experimental model for growth arrest was created by excising the growth plate at the proximal medial side of tibia with the 4 mm in diameter and 4 mm in depth from 6-week-old New Zealand white rabbits. Two experimental groups were set to evaluate CTE implantation; group I, no implantation as controls; group II, implantation of CTE. (3) Evaluation of effect of the transplantation of CTE. Serial plain radiographs were performed at one week. The medial proximal tibial angle (MPTA) was measured for assessing the degree of angular deformity. Histologic examination using HE stain, Alcian bule and immunohistochemistry was done at 4 and 8 weeks after surgery. Results. Radiographic results: In group I, all damaged growth plates were arrested and angular deformities appeared 4 weeks later. In groups II, angular deformities were much less than in the control group. Histologic result: In group I, bone bridge formation was shown at the damaged growth plate at 4 weeks after surgery. In group II, regeneration of growth plates was recognised at 4 and 8 week after surgery. However, the thickness of regenerated growth plate at 8 weeks specimen was thinner than that of 4 weeks specimen. Discussion and Conclusion. The implantation of scaffold-free CTE from suspension culture into growth-plate defects resulted in a significant reduction in growth arrest of the rabbit tibia