Imaging of Pediatric Growth Plate Disturbances

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Abstract
The authors review the normal anatomy and function of the primary growth plate complex (composed of the growth plate, epiphysis, and metaphysis), examine the imaging findings and pathophysiology commonly associated with injury to each of these components (including bone bridge, differential longitudinal growth, and growth plate widening), and discuss the roles of imaging and goals of treatment. The growth plates, or physes, are visible on virtually all images obtained in skeletally immature children. The proper function of these growth plates depends on an intricate balance between chondrocyte proliferation, which requires nourishment from the epiphyseal vessels, and chondrocyte death, which requires the integrity of the metaphyseal vessels. Therefore, injury to the growth plate (ie, direct insult) or vascular compromise on either side of the growth plate (ie, indirect insult) can cause growth plate dysfunction. Direct growth plate insults occur most commonly with Salter-Harris fractures, and injuries that allow the transphyseal communication of vessels are at a higher risk for subsequent transphyseal bone bridge formation. Indirect insults lead to different sequelae that are based on whether the epiphyseal blood supply or metaphyseal blood supply is compromised. Epiphyseal osteonecrosis can result in slowed longitudinal bone growth, with possible growth plate closure, and is often accompanied b...

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