0:00

Here we have a series of radiographs

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and MR in an unfortunate boy who,

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at the age of two years, had a very bad

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injury to his epiphyseal cartilage.

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Here are the initial

0:14

radiographs that we saw.

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Actually, the injury happened before this,

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but these are the earliest films that we have.

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At this point, the child is two years of age.

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This is the normal frontal

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projection, uh, on the left side.

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And this is the abnormal

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projection on the right side.

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As you can notice, the epiphyseal

0:36

cartilage here has just disappeared.

0:39

You can sort of make a hint of

0:41

something soft tissue right over here.

0:44

And I suspect that this is what is

0:46

remaining of cartilage of the epiphysis.

0:49

If the border of it is sort of inferiorly

0:52

located, uh, there's a gap between the bony

0:55

structure here and the cartilaginous margin

0:58

over here, but that's just my suspicion.

1:00

I can't be sure looking

1:01

at this plain radiograph.

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For a normal comparison, that's what a normal

1:05

epiphysis of a two-year-old should look like.

1:08

It should be nice and symmetric.

1:10

So definitely, we're missing a

1:11

chunk of the lateral epiphysis.

1:14

Now we're getting another radiograph from

1:16

when the child is three years of age.

1:18

I'm going to bring up the normal left

1:21

side and the abnormal right side.

1:23

You can see now the disordered formation

1:27

of these ossification centers.

1:28

Because the cartilage has been injured,

1:31

there's been compromise of the vascular

1:34

system, disorganization of the vascular system.

1:36

Remember from the earlier vignettes,

1:38

we know that vessels are needed to

1:40

cause cartilage to form into bone.

1:43

So this tells me vessels are still there, but

1:44

they're not getting there in the right amount or

1:46

in the right distribution, uh, or what have you.

1:49

So we have these sort of rests

1:51

of cartilage here and here.

1:54

And there may be loose bodies, we don't know.

1:56

So this is one year later.

1:58

Again, the normal developing

1:59

epiphysis on the contralateral side is

2:02

beautifully shown on this radiograph.

2:04

Uh, you're welcome to look

2:05

at the lateral views also.

2:06

Um, you have access to it

2:08

through your PAC system.

2:09

But I'm just showing you the salient

2:11

images for the sake of timing.

2:14

Now, I'm going to show you what happened to

2:15

this child all the way up to 12 years of age.

2:19

First, I want to bring up a leg length study.

2:22

I'm going to bring this up as a one-on-one.

2:25

And just an overview.

2:26

Notice that there is a bowing deformity

2:29

of that midshaft of that right femur.

2:31

The right femur's overall length also appears

2:34

to be a little shorter than the left femur.

2:37

Notice the lateral condyle has actually

2:40

formed pretty well, but it's definitely

2:42

shorter or smaller than the medial condyle.

2:45

So all of that results in an overall

2:48

decreased length of the right lower extremity.

2:51

Remember we talked about injuries to the

2:53

cartilage and physis eventually will manifest

2:57

later as leg length discrepancy or deformities

3:00

in alignments such as varus or valgus problems.

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Now, finally, I want to show you what

3:06

the MR looks like at 12 years of age.

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I think for that, the best sequence

3:11

that I can show you, there are several

3:13

great sequences, but I really like our

3:15

sagittal depths, which is over here.

3:17

I'm going to zoom up for that just a little bit.

3:20

And I'm going to bring up a coronal.

3:24

This is our space.

3:26

This is a 3D acquired isovolumetric

3:29

proton density sequence.

3:32

I'm going to zoom up on that also a little bit.

3:34

So let's look at the sagittal views.

3:36

Here are the areas of cartilage, uh,

3:39

that are forming rests of cartilage.

3:41

I think this, these little pieces of bone

3:44

that are formed in the cartilage are actually

3:46

contained within a bigger cartilaginous on log

3:49

that's not separate from your main epiphysis.

3:53

Thanks.

3:53

Because of the devastating injury, they have

3:55

formed their own ossification centers and never

3:58

quite fused with the main ossification center.

4:01

You can also see lines of fracture

4:03

over here where you have injury.

4:06

There's, there's injury to the physis.

4:09

You have physial bar.

4:10

You know, where the growth plate

4:12

was not injured, we still have

4:13

a nice trilaminar appearance.

4:15

The coronal view here shows you that

4:17

there are actually some loose bodies in

4:19

the joint, which is best depicted here.

4:22

And this image right over here.

4:24

So, and I think you can also appreciate

4:26

the fact that this condyle, the

4:28

medial condyle, has a different shape

4:31

and size than the lateral condyle.

4:34

Because there is a synergy between the size

4:37

of the meniscus and the size of the condyles,

4:39

the ipsilateral meniscus is also enlarged

4:43

and bigger than the contralateral side.

4:45

Similar, if you remember, to

4:47

what we saw on Blount's disease.

4:49

When there is an injury to the The epiphysis,

4:52

it manifests as changes in your meniscus also.