The triplane fracture has been described as a fracture of the distal tibial epiphysis occurring across three planes-sagittal, transverse and coronal. The characteristic pattern of fusion of distal tibial epiphysis explains the special configuration of the fragments in the triplane fracture. According to Dias.Tachdjian classification, triplane fracture is classified two part fracture, three part fracture, four part fracture and two part fracture with extension to the medial malleolus. Among four types, two part triplane fracture with extension to the medial malleolus is a relatively rare injury and generally is not treated by closed reduction. Such fractures should have an anatomic reduction and adequate fixation to restore the joint congruity and obtain an anatomic reduction of the growth plate to prevent a future growth deformity. This is usually best accomplished with an open reduction and screw fixation or k-wire fixation. We experienced two part triplane fracture with extension to medial malleolus and check the CT to define the extent of the injury completely. And then we underwent open reduction and screw fixation for the fracture. As a result, we present four cases of two part triplane fracture with extension with review of related literatures.
Congenital Abnormalities ; Epiphyses ; Growth Plate ; Joints

Transforming growth factor-β (TGF-β) is a cytokine that plays an important role in both normal joints and joints affected by osteoarthritis (OA), the most common joint disease. However, the role of this pleiotropic cytokine in a normal healthy joint is very different from its role in an OA joint. In a normal synovial joint, active TGF-β is only present after joint loading and only for a short period. In contrast, permanent and high levels of active TGF-β are detected in OA joints. Due to this difference in levels and exposure period of joint cells to active TGF-β, the function of TGF-β is strikingly different in normal and OA joints. The consequences of this difference in TGF-β levels on joint homeostasis and pathological changes in OA joints are discussed in this review.
Cytokines ; Homeostasis ; Joint Diseases ; Joints* ; Osteoarthritis ; Transforming Growth Factor beta

Unfused olecranon epiphysis has been reported rarely. We found an unfused olecranon tip within joint and a few small spurs on the apposing olecranon fossa and removed it successfully through the arthroscope. We think that it is a part of secondary ossification center of the olecranon and tbat it was separated through the epiphyseal plate by repetitive impaction of the tip of the olecranon into the olecranon fossa during pitching. In conclusion, fusion of the intra-articular part(articular center) of the olecranon epiphysis can not occur by nature. Repetitive extension overload during pitching may cause symptoms, and could be treated with arthroscopic control.
Adult ; Arthroscopes ; Baseball ; Epiphyses ; Growth Plate ; Humans ; Joints ; Olecranon Process

Foot ; Growth Plate ; Hand ; Joints ; Mandible ; Metaplasia ; Osteochondroma

PURPOSE: As the traditional treatment of the Wassel's type I or II of bifid thumb, Bilhaut-Cloquet, has always been the standard method despite several disadvantages such as tearing of the finger nail, injuries of the growth plate, joint instability, and long visible scarring. To overcome these drawbacks, we applied a modified Bilhaut-Cloquet Method. METHODS: The subjects used for the this study were 10 of 20 patients evaluated. The patients underwent modified methods under every type of Wassel's classification. We designed a central wedge Zig-Zag incision and removed the nail and bony tissues in the remaining digit, but not soft tissue if possible, and transferred the ligaments, tendons, and soft tissue to the remaining thumb from the extra digit. We evaluated the patients' lack of extension, the total ROM of the MP and IP joints, the ROM of IP joints, and the lateral deviations of the reconstructed thumb. RESULTS: The results were encouraging, with all patients showing a good functional and aesthetic outcome. CONCLUSION: The modified method proved a very effective procedure in the treatment of bifid thumb in all types, especially types I or II.
Cicatrix ; Classification ; Fingers ; Growth Plate ; Humans ; Joint Instability ; Joints ; Ligaments ; Polydactyly ; Tendons ; Thumb*

OBJECTIVE: To investigate the proliferative and anti-apoptotic effects of TGF-beta and IL-1beta on rheumatoid synovial cells. METHODS: Synovial cells obtained from surgical procedure of the rheumatoid joint were cultured with TFG-beta and IL-1beta The proliferative response of synovial cells was examined by non-radioactive cell proliferation assay. Fas-demiated apoptosis of synovial cells was measured by flow cytometry after addition of anti-Fas antibody. RESULTS: TGF-beta and IL-1betaproliferated synovial cells in a dose-dependent manner. They also made synovial cells resistant to anti-Fas antibody induced apoptosis. CONCLUSION: TGF-beta and IL-1betapromotes synovial cell proliferation possibly through interference with Fas-mediated apoptosis, suggesting their role in synovial hyperplasis in rheumatoid arthritis.
Apoptosis* ; Arthritis, Rheumatoid ; Cell Proliferation ; Flow Cytometry ; Interleukin-1* ; Interleukin-1beta* ; Joints ; Transforming Growth Factor beta*

PURPOSE: To find out the process of bone remodelling and risk factors in birth-associated femoral fracture. MATERIALS AND METHOD: We evaluated the four femoral fractures in three neonates about the obstetric and family history, and measured the angulation at the fracture site and the angle between the proximal and distal epiphysis of the femur on the radiographies taken at regular intervals. RESULTS: The incidence of birth-associated femoral fracture was 0.06%. In two cases, fracture angulation and interepiphyseal angle had been decreased. However the angular deformity was worsened in two cases, but the interepiphyseal angle had been decreased regardless to the change of fracture angulation. So the alignment of epiphyseal plate came to normal alignment of joint surface. CONCLUSION: The underlying disorder should be searched, because of its rarity. The physeal reorientation that makes joint alignment near normal irrespective of amount of angular deformity is assumed as the predominant mechanism in remodelling process of the angular deformity.
Congenital Abnormalities* ; Epiphyses ; Femoral Fractures ; Femur ; Growth Plate ; Humans ; Incidence ; Infant, Newborn ; Joints ; Risk Factors

Forty-nine children between the ages of 2 and 10 years, treated conservatively for fomoral shaft fracture, were studied clinically and radiographically to access the complications and related factors. They had an average follow-up of 48.8months(range, 12 to 77months). 35 percent of the patients had significant associated injuries. Leg length discrepancies of 10mm to 20mm are observed in 5 cases(10%) of the patients. The average overlap of bone ends at union was 6.5mm. The average growth acceleration was 8.8mm regardless of sex, age, upper limb dominance, fracture site or shape, but was promoted by overriding of the fracture ends at union, There were 16 cases(32%) of excessive angular deformity of 10° to 25° after union. However all deformities were remodelled enough to give normal alignment of the joint surface. The growth plate played on important role in the remodelling process.
Acceleration ; Child ; Congenital Abnormalities ; Follow-Up Studies ; Growth Plate ; Humans ; Joints ; Leg ; Upper Extremity

Congenital anomalies of the hand were reviewed, which were treated at Seoul National University Hospital from 1973 to 1982. The Conclusions are as follows. 1. Polydactyly is the most common congenital anomaly of the hand in this series. The next common congenital hand anomalies are trigger digit, syndactyly in that order. 2. Better results had been obtained with early reconstructive surgery within one year after birth. 3. Authors propose a new classification of polydactyly. In Joint type (type 1), the extradigit has its own epiphysis in its origin,and in Epiphyseal plate type (type 2) the extradigit do not have its own epiphyseal plate and seems to be derived from the physis of the more developed adjacent digit. We observed 22 cases of joint type and 10 cases of epiphyseal plate type. 4. 6 cases of macrodactyly had been observed. The complicated reconstructive surgery such as Tsuge and Barsky operation resulted in digital necrosis. So more simple and effective operation such as symphalangization would be attempted.
Classification ; Epiphyses ; Growth Plate ; Hand ; Joints ; Necrosis ; Parturition ; Polydactyly ; Seoul ; Syndactyly ; Trigger Finger Disorder

PURPOSE: The purpose of this study was to analyze of the MR findings of the pyogenic osteomyelitis involving the epiphyses of the long bones in childhood. MATERIALS AND METHODS: Eleven childen with pyogenic osteomyelitis involving the epiphyses of the long bones were evaluated by MRI. A diagnosis of pyogenic osteomyelitis was established by biopsy and culture in eight cases and during follow-up after antibiotic treatment in three. We analyzed the involved bone, initial location, pattern, degree of growth plate involvement, degree of epiphyseal involvement, surrounding change and plain radiographic findings. RESULTS: The involved bones were the proximal femur in four cases, distal femur in two, proximal tibia in two, distal tibia in one, distal fibula in one and proximal humerus in one. The initial site of the lesion was the metaphysis in ten cases and epiphysis in one. The lesion pattern was the Brodie's abscess in six cases and osteomyelitis in five. The degree of growth plate involvement was 16-20% in five case and 5% or less in four ; the degree of epiphyseal involvement was 5% or less in four cases, 6-10% in four and 11-15% in two. All cases showed low or intermediate signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and contrast enhancement. Joint effusion adjacent to the lesion was detected in five cases. Radiographic findings of the involved epiphysis were normal in six cases, but indicated osteolytic lesion in four cases and sclerosis in one. CONCLUSION: Pyogenic osteomyelitis involving the epiphyses of the long bones in childhood usually developed from metaphyseal osteomyelitis and was combined with destruction of the growth plate.
Abscess ; Biopsy ; Diagnosis ; Epiphyses* ; Femur ; Fibula ; Follow-Up Studies ; Growth Plate ; Humerus ; Joints ; Magnetic Resonance Imaging ; Osteomyelitis* ; Sclerosis ; Tibia