Growth and Bone Development in the Horse: When Is a Horse Skeletally Mature?

Within the lay literature, and social media in particular, there is often debate about the age at which a horse should be started and introduced to racing or sport. To optimize the welfare and longevity of horses in racing and sport, it is important to match exercise with musculoskeletal development and the ability of the musculoskeletal system to respond to loading. The justification for not exercising horses at a certain age is often in contrast to the scientific literature and framed, with incorrect generalizations, with human growth. This review provides a relative comparison of the growth and development of the horse to the descriptors used to define growth and development in humans. Measures of physeal closure and somatic growth demonstrate that the horse completes the equivalent of rapid infant growth by weaning (4–6 months old). At approximately 11 months old, the horse completes the equivalent of the childhood phase of growth and enters puberty. At 2 years old, the horse has achieved most measures of maturity used within the human literature, including the plateauing of vertical height, closure of growth plates, and adult ratios of back length:wither height and limb length:wither height. These data support the hypothesis that the horse evolved to be a precocious cursorial grazer and is capable of athletic activity, and use in sport, relatively early in life.

Ankle fractures in children

Ankle fractures are common in children, and they have specific implications in that patient population due to frequent involvement of the physis in a bone that has growth potential and unique biomechanical properties. Characteristic patterns are typically evident in relation to the state of osseous development of the segment, and to an extent these are age-dependent. In a specific type known as transitional fractures – which occur in children who are progressing to a mature skeleton –a partial physeal closure is evident, which produces multiplanar fracture patterns. Computed tomography should be routine in injuries with joint involvement, both to assess the level of displacement and to facilitate informed surgical planning. The therapeutic objectives should be to achieve an adequate functional axis of the ankle without articular gaps, and to protect the physis in order to avoid growth alterations. Conservative management can be utilized for non-displaced fractures in conjunction with strict radiological monitoring, but surgery should be considered for fractures involving substantial physeal or joint displacement, in order to achieve the therapeutic goals. Cite this article: EFORT Open Rev 2021;6:593-606. DOI: 10.1302/2058-5241.6.200042

Premature Physeal Closure after a Non-Displaced Physeal Fracture of Distal Fibula

Premature physeal closure (PPC) may lead to clinically significant progressive angular deformity or leg length discrepancy. Many variables seem to play a role in determining which injuries result in PPC. A 8- year-old boy sustained a non-displaced physeal fracture of distal tibia and fibula. He showed no signs of PPC at 7 months post-injury. Seven years later, his ankle became painful. He had developed PPC of distal fibula causing angular ankle deformity, which was treated successfully by corrective osteotomy. To our knowledge, this is the first reported case of a non-displaced fracture of the distal fibula leading to PPC several years after the initial injury, which in our understanding was impossible to predict.

Traumatic physeal fractures in cats: a review of 36 cases (2010–2020)

Objectives The aim of this study was to describe the demography, aetiology, location and classification of physeal fractures in cats, and to describe their management and outcomes. Methods Clinical records and radiographs of cats referred for management of physeal fractures were retrospectively reviewed. Fractures of the proximal femoral physis were excluded. Descriptive statistics were used to describe signalment, cause of injury, presence of concurrent injuries, fracture description, treatment modality, complications, follow-up, physeal closure, implant removal and outcome. Results Thirty-four cats with 36 fractures were included, of which 17 affected the distal femur, 11 the distal tibia and fibula, five the distal radius and ulna, two the proximal tibia and one the distal humerus. Salter–Harris classification was type I in 14, type II in 16, type III in two and type IV in four fractures. Thirty-four fractures were treated with primary fixation, and the most common method was crossed Kirschner wires (24/34 fractures). Complications were observed in 14 fractures, of which 12 were minor. At radiographic follow-up, physeal closure was reported in 23 fractures, of which 15 were considered premature. Implant removal was performed in three fractures. Outcome was good in 28, fair in four and poor in two fractures. Conclusions and relevance Fracture of the distal femoral physis was the most common physeal fracture seen. Cats presenting with physeal fractures may be skeletally immature or mature with delayed physeal closure. The rate of physeal closure after fracture repair was relatively high but without apparent impact. The frequency of implant removal was very low, indicating that despite having a physeal fracture repair, most cats did not require a second procedure to remove implants. Overall, internal fixation provided a good outcome in most fractures.

Open Reduction and Internal Fixation for Displaced Salter-Harris type II Fractures of the Distal Tibia: A Retrospective Study of Eighty-Five Cases in Children

Background: The treatment for displaced Salter-Harris Ⅱ distal tibia fractures remains controversial. The purpose of this study was to evaluate the rate of premature physeal closure (PPC) and to identify the risk factors treated by open reduction and internal fixation.Methods: We reviewed the charts and radiographs of patients with Salter-Harris Ⅱ fractures of the distal tibia with displacement >3mm between 2012 and 2019. Open reduction and internal fixation was performed for all patients. Patients were followed up for a minimum of 4 months. Contralateral ankle radiograph or CT scans were obtained if there was any evidence of premature physeal closure. Any angular deformity or shortening of the involved leg was documented.Results: A total of 85 patients with a mean age of 12.3years were included in the study. The mean initial displacement was 8.5 mm. All patients but one were treated within seven days after injury and the mean interval was 3.7 days. SER injuries occurred in 65 patients (76.5%), PER in 17 (20.0%), and SPF in three (3.5%). The rate of PPC was 29.4% and two patients with PPC had varus deformities. The rate of PPC was significantly greater in patients with associated fibular fracture as compared with those with intact fibular (P=0.005). Patient age, gender, injured side, mechanism of injury (only SER vs PER), amount of initial displacement, interval from injury to surgery, or energy of injury did not affect the rate of PPC significantly. Conclusions: PPC is a common complication for displaced S-H Ⅱ distal tibia physeal fractures. We suggest that open reduction internal fixation is an effective choice to reduce the risk of PPC. The presence of concomitant fibula fracture was associated with PPC.

EVALUATION OF PEDIATRIC INTRACAPSULAR NECK OF FEMUR FRACTURE FIXATION WITH MOORE'S PINS

Paediatric femoral neck fractures are uncommon injuries and are usually caused by high-energy trauma. Low-energy trauma can result in pathological neck fractures and stress fractures of the neck, due to repetitive activity. Surgical options can vary based on age, Delbet classification and displacement of the fracture. Treatment for displaced fractures is by closed or open reduction and Moore’s fixation. Fixation should be supplemented by spica cast immobilization in younger children. The high rate of complications occurs due to the vascular anatomy of the hip and proximal femur. Avascular necrosis, coxa vara, premature physeal closure, and non-union are the most common and these often result in poor outcome.