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Postnatal epiphyseal development: the distal tibia and fibula.
1Shriners Hospital for Crippled Children, University of South Florida College of Medicine, Tampa 33612-9499.
Journal of Pediatric Orthopedics
|May 1, 1990
Summary
The distal tibial and fibular physes change from transverse to undulated structures as the child grows. Understanding these normal developmental changes is crucial to avoid misinterpreting them as injuries.
Area of Science:
- Orthopedics
- Pediatric Radiology
- Anatomy
Background:
- The distal tibial and fibular physes undergo significant morphological changes during skeletal maturation.
- These changes include the development of undulations and peripheral lappet formation.
- Poland's hump, an anteromedial undulation of the tibial physis, is a normal finding that can be mistaken for injury.
Purpose of the Study:
- To describe the normal developmental anatomy of the distal tibial and fibular physes.
- To differentiate normal physeal development from traumatic injuries in pediatric patients.
- To elucidate the sequence of ossification and epiphyseodesis in the distal tibia.
Main Methods:
- Descriptive anatomical study based on radiographic and imaging findings.
- Analysis of physeal morphology and ossification patterns throughout childhood and adolescence.
- Correlation of developmental changes with known fracture patterns.
Main Results:
- The distal tibial physis transitions from a transverse to an undulated structure with peripheral lappets, starting anteromedially (Poland's hump).
- The tibial secondary ossification center appears centrally, extends medially, and reaches the malleolar tip in adolescence, with potential accessory ossification.
- Physiologic closure of the tibial physis begins medially and progresses laterally, influencing fracture patterns like the Tillaux fracture.
- The distal fibular physis also develops undulations and lappets, typically aligning with the tibial articular surface by the first year, with enchondromalike extensions into the metaphysis.
Conclusions:
- Normal developmental changes in the distal tibial and fibular physes can mimic traumatic injuries.
- Recognition of these normal morphologic variations, including Poland's hump and accessory ossification, is essential for accurate diagnosis in pediatric patients.
- Understanding the sequence of physeal closure is critical for interpreting distal tibia and fibula fractures.