Epiphyseal growth plate fracture-separations: a pathophysiologic approach

The physiologic events in epiphyseal growth plate fracture-separations that lead to growth disorders relate to 1) destruction of the epiphyseal circulation, and 2) communication between the epiphyseal circulation with its osteoprogenitor cells and the metaphyseal circulation with its osteoprogenitor cells, thus forming a bone bridge. A pathophysiologic classification of growth plate injuries based on these criteria is presented. Such injuries are classified currently on a pathoanatomic basis defined by the pathway of breakage as seen radiologically. A review of 1,300 cases from the literature outlines the pathoanatomic types at each epiphysis and their results. By superimposing the pathophysiologic classification on the pathoanatomic classification, such injuries can be considered on the basis of the cellular events that are the main determinants of the end results.