Blurring and widening of the margins of the physis. Osteopenia with resorption of trabeculae.
Deficient ossification of the zone of provisional calcification. Etiology is vitamin D deficiency, either acquired or congenital (malabsorption, failure of conversion to active form of vitamin D, renal osteodystrophy, etc.).
Widening of the physis of the proximal femur.
Early sign of Legg-Calvé-Perthes disease may be widening of physis with intact epiphysis.
Epiphyseal fracture and slipped capital femoral epiphysis
Although the physis is typically narrowed, widening of the physis may occur in association with slippage of the epiphysis.
Slipped capital femoral epiphysis
The epiphysis is separated and sometimes displaced from the metaphysis.
Distal humerus in infants and young children. Although the physis is typically narrowed in slipped capital femoral epiphysis, widening of the physis may occur in association with slippage of the epiphysis.
Several different types, some with known genetic deficiencies in either parathyroid hormone or collagen function.
Fig. 5.60, p. 535
Usually focal bone bridge (bar) with limb-length discrepancy ± angular deformity.
Frank destruction or local ischemia results in bridging after fracture or infection. Recruitment of osteoprogenitor cells via blood vessels that cross the physis may promote bone bridge formation. MRI may help quantify amount of bone bridge and direct treatment.
Advanced bone age
Normal architecture and mineralization.
All growth plates are affected similarly. A child’s current height and bone age can be used to predict adult height.
DD: prolonged elevation of sex steroid levels (precocious puberty or congenital adrenal hyperplasia), premature adrenarche, obesity from a young age, lipodystrophy, genetic overgrowth syndromes (Sotos, Beckwith-Wiedemann, and Marshall-Smith syndromes).