The epiphyseal plate (or epiphysial plate, physis, or growth plate) is a hyaline cartilage plate in the metaphysis at each end of a long bone. It is the part of a long bone where new bone growth takes place; that is, the whole bone is alive, with maintenance remodeling throughout its existing bone tissue, but the growth plate is the place where the long bone grows longer (adds length).
Light micrograph of an undecalcified epiphyseal plate that is displaying the hypertrophic zone with its typical chondrocytes, matrix and three zones: maturation (top), degenerative (middle) and provisional calcification (bottom).
The plate is only found in children and adolescents; in adults, who have stopped growing, the plate is replaced by an epiphyseal line. This replacement is known as epiphyseal closure or growth plate fusion. Complete fusion can occur as early as 12 for girls (with the most common being 14-15 years for girls) and as early as 14 for boys (with the most common being 15–17 years for boys).[1][2][3][4][5]
Endochondral ossification is responsible for the initial bone development from cartilage in utero and infants and the longitudinal growth of long bones in the epiphyseal plate. The plate's chondrocytes are under constant division by mitosis. These daughter cells stack facing the epiphysis while the older cells are pushed towards the diaphysis. As the older chondrocytes degenerate, osteoblasts ossify the remains to form new bone. In puberty increasing levels of estrogen, in both females and males, leads to increased apoptosis of chondrocytes in the epiphyseal plate.[6] Depletion of chondrocytes due to apoptosis leads to less ossification and growth slows down and later stops when the entire cartilage have become replaced by bone, leaving only a thin epiphyseal scar which later disappears.[7]
Histologyedit
The growth plate has a very specific morphology in having a zonal arrangement as follows:[8]
Epiphyseal plate zone (from epiphysis to diaphysis)
Description
Zone of reserve
Quiescent chondrocytes are found at the epiphyseal end
Zone of proliferation
Chondrocytes undergo rapid mitosis under influence of growth hormone
Chondrocytes undergo apoptosis. Cartilagenous matrix begins to calcify.
Zone of ossification
Osteoclasts and osteoblasts from the diaphyseal side break down the calcified cartilage and replace with mineralized bone tissue.
Masson Goldner trichrome stain of rabbit epiphysial plate
Clinical significanceedit
Defects in the development and continued division of epiphyseal plates can lead to growth disorders collectively known as osteochondrodysplasia. The most common defect is achondroplasia, where there is a defect in cartilage formation. Achondroplasia is the most common cause of dwarfism or short stature and it also manifests in generalized deformities of bones and joints. However, various other types of osteochondrodysplasias can cause short stature and generalized deformities of bones and joints due to abnormal function of growth plate cartilage cells.[9]Hereditary multiple exostoses is a genetic condition that is caused by growth irregularities of the epiphyseal plates of the long bones of the upper[10] and lower limbs.[11] It usually results in limb deformities and a certain degree of functional limitations.
Salter–Harris fractures are fractures involving epiphyseal plates and hence tend to interfere with growth, height or physiologic functions.[12]
Osgood-Schlatter disease results from stress on the epiphyseal plate in the tibia, leading to excess bone growth and a painful lump at the knee.
There are important clinical implications of the growth plate physiology. For example guided growth surgery, also known as temporary hemiepiphysiodesis is used to achieve correction or straightening of the bone deformities in a variety of pediatric orthopedic disorders such as Blount's disease, rickets, arthrogryposis multiplex congenita and osteochondrodysplasias among others.[13][14][15] This applies to bone and joint deformities in the coronal – medial/lateral – plane or genu varum/genu valgum plane[14] and in the sagittal – anterior/posterior – plane or knee flexion deformity/genu recurvatum plane.[15]
Other animalsedit
John Hunter studied growing chickens. He observed bones grew at the ends and thus demonstrated the existence of the epiphyseal plates. Hunter is considered the "father of the growth plate."[16]
^Crowder, C; Austin, D (September 2005). "Age ranges of epiphyseal fusion in the distal tibia and fibula of contemporary males and females". Journal of Forensic Sciences. 50 (5): 1001–7. doi:10.1520/JFS2004542. PMID 16225203. complete fusion in females occurs as early as 12 years in the distal tibia and fibula. All females demonstrated complete fusion by 18 years with no significant differences between ancestral groups. Complete fusion in males occurs as early as 14 years in both epiphyses. All males demonstrated complete fusion by 19 years
^Barrell, Amanda. "At what age do girls stop growing?". MedicalNewsToday. Retrieved 9 June 2020.
^Jarret, Robert R. "Puberty: Tanner Stages – Boys". Pediatric HOUSECALLS. Retrieved 9 June 2020.
^Jarret, Robert R. "Puberty: Tanner Stages – Girls". Pediatric HOUSECALLS. Retrieved 9 June 2020.
^"When do most males' growth plates close?". Zoodoc. Retrieved 9 June 2020.
^Zhong, M; Carney, DH; Boyan, BD; Schwartz, Z (January 2011). "17β-Estradiol regulates rat growth plate chondrocyte apoptosis through a mitochondrial pathway not involving nitric oxide or MAPKs". Endocrinology. 152 (1): 82–92. doi:10.1210/en.2010-0509. PMID 21068162.
^. Archived from the original on 2008-07-09. Retrieved 2008-07-10.
^Ovalle, William K.; Nahirney, Patrick C. (2007). Netter's essential histology : with Student consult online access (1st ed.). Philadelphia, Pa.: Elsevier Saunders. ISBN9781929007868.
^El-Sobky, TamerA; Shawky, RabahM; Sakr, HossamM; Elsayed, SolafM; Elsayed, NermineS; Ragheb, ShaimaaG; Gamal, Radwa (2017). "A systematized approach to radiographic assessment of commonly seen genetic bone diseases in children: A pictorial review". Journal of Musculoskeletal Surgery and Research. 1 (2): 25. doi:10.4103/jmsr.jmsr_28_17. S2CID 79825711.
^E.L.-Sobky, Tamer A.; Samir, Shady; Atiyya, Ahmed Naeem; Mahmoud, Shady; Aly, Ahmad S.; Soliman, Ramy (2018). "Current paediatric orthopaedic practice in hereditary multiple osteochondromas of the forearm: a systematic review". SICOT-J. 4: 10. doi:10.1051/sicotj/2018002. PMC5863686. PMID 29565244.
^Duque Orozco, Maria del Pilar; Abousamra, Oussama; Rogers, Kenneth J.; Thacker, Mihir M. (July 2018). "Radiographic Analysis of the Pediatric Hip Patients With Hereditary Multiple Exostoses (HME)". Journal of Pediatric Orthopaedics. 38 (6): 305–311. doi:10.1097/BPO.0000000000000815. PMID 27328120. S2CID 23800752.
^Mirghasemi, Alireza; Mohamadi, Amin; Ara, Ali Majles; Gabaran, Narges Rahimi; Sadat, Mir Mostafa (November 2009). "Completely displaced S-1/S-2 growth plate fracture in an adolescent: case report and review of literature". Journal of Orthopaedic Trauma. 23 (10): 734–738. doi:10.1097/BOT.0b013e3181a23d8b. ISSN 1531-2291. PMID 19858983. S2CID 6651435.
^Journeau, P (2020). "Update on guided growth concepts around the knee in children". Orthop Traumatol Surg Res. S1877-0568 (19): S171–S180. doi:10.1016/j.otsr.2019.04.025. PMID 31669550.
^ abEL-Sobky, TA; Samir, S; Baraka, MM; Fayyad, TA; Mahran, MA; Aly, AS; Amen, J; Mahmoud, S (1 January 2020). "Growth modulation for knee coronal plane deformities in children with nutritional rickets: A prospective series with treatment algorithm". JAAOS: Global Research and Reviews. 4 (1): e19.00009. doi:10.5435/JAAOSGlobal-D-19-00009. PMC7028784. PMID 32159063.
^ abTrofimova, SI; Buklaev, DS; Petrova, EV; Mulevanova, SA (2016). "Guided growth for correction of knee flexion contracture in patients with arthrogryposis: preliminary results". Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 4 (4): 64–70. doi:10.17816/PTORS4464-70.
Normal bones at GetTheDiagnosis.org, showing the development of epiphyseal plates for different ages and bones.
Wikimedia Commons has media related to Epiphyseal plate.
December 15, 2023
epiphyseal, plate, this, article, uses, anatomical, terminology, epiphyseal, plate, epiphysial, plate, physis, growth, plate, hyaline, cartilage, plate, metaphysis, each, long, bone, part, long, bone, where, bone, growth, takes, place, that, whole, bone, alive. This article uses anatomical terminology The epiphyseal plate or epiphysial plate physis or growth plate is a hyaline cartilage plate in the metaphysis at each end of a long bone It is the part of a long bone where new bone growth takes place that is the whole bone is alive with maintenance remodeling throughout its existing bone tissue but the growth plate is the place where the long bone grows longer adds length Epiphyseal plateRadiogram of distal tibia left and fibula right showing two epiphyseal platesLight micrograph of an undecalcified epiphyseal plate that is displaying the hypertrophic zone with its typical chondrocytes matrix and three zones maturation top degenerative middle and provisional calcification bottom DetailsIdentifiersLatinlamina epiphysialisMeSHD006132TA98A02 0 00 020TA2395FMA75427Anatomical terminology edit on Wikidata The plate is only found in children and adolescents in adults who have stopped growing the plate is replaced by an epiphyseal line This replacement is known as epiphyseal closure or growth plate fusion Complete fusion can occur as early as 12 for girls with the most common being 14 15 years for girls and as early as 14 for boys with the most common being 15 17 years for boys 1 2 3 4 5 Contents 1 Structure 1 1 Development 1 2 Histology 2 Clinical significance 3 Other animals 4 See also 5 References 6 External linksStructure editDevelopment edit Endochondral ossification is responsible for the initial bone development from cartilage in utero and infants and the longitudinal growth of long bones in the epiphyseal plate The plate s chondrocytes are under constant division by mitosis These daughter cells stack facing the epiphysis while the older cells are pushed towards the diaphysis As the older chondrocytes degenerate osteoblasts ossify the remains to form new bone In puberty increasing levels of estrogen in both females and males leads to increased apoptosis of chondrocytes in the epiphyseal plate 6 Depletion of chondrocytes due to apoptosis leads to less ossification and growth slows down and later stops when the entire cartilage have become replaced by bone leaving only a thin epiphyseal scar which later disappears 7 Histology edit The growth plate has a very specific morphology in having a zonal arrangement as follows 8 Epiphyseal plate zone from epiphysis to diaphysis DescriptionZone of reserve Quiescent chondrocytes are found at the epiphyseal endZone of proliferation Chondrocytes undergo rapid mitosis under influence of growth hormoneZone of maturation and hypertrophy Chondrocytes stop mitosis and begin to hypertrophy by accumulating glycogen lipids and alkaline phosphataseZone of calcification Chondrocytes undergo apoptosis Cartilagenous matrix begins to calcify Zone of ossification Osteoclasts and osteoblasts from the diaphyseal side break down the calcified cartilage and replace with mineralized bone tissue nbsp Masson Goldner trichrome stain of rabbit epiphysial plateClinical significance editDefects in the development and continued division of epiphyseal plates can lead to growth disorders collectively known as osteochondrodysplasia The most common defect is achondroplasia where there is a defect in cartilage formation Achondroplasia is the most common cause of dwarfism or short stature and it also manifests in generalized deformities of bones and joints However various other types of osteochondrodysplasias can cause short stature and generalized deformities of bones and joints due to abnormal function of growth plate cartilage cells 9 Hereditary multiple exostoses is a genetic condition that is caused by growth irregularities of the epiphyseal plates of the long bones of the upper 10 and lower limbs 11 It usually results in limb deformities and a certain degree of functional limitations Salter Harris fractures are fractures involving epiphyseal plates and hence tend to interfere with growth height or physiologic functions 12 Osgood Schlatter disease results from stress on the epiphyseal plate in the tibia leading to excess bone growth and a painful lump at the knee There are important clinical implications of the growth plate physiology For example guided growth surgery also known as temporary hemiepiphysiodesis is used to achieve correction or straightening of the bone deformities in a variety of pediatric orthopedic disorders such as Blount s disease rickets arthrogryposis multiplex congenita and osteochondrodysplasias among others 13 14 15 This applies to bone and joint deformities in the coronal medial lateral plane or genu varum genu valgum plane 14 and in the sagittal anterior posterior plane or knee flexion deformity genu recurvatum plane 15 Other animals editJohn Hunter studied growing chickens He observed bones grew at the ends and thus demonstrated the existence of the epiphyseal plates Hunter is considered the father of the growth plate 16 See also editHuman development biology Salter Harris fractureReferences edit Crowder C Austin D September 2005 Age ranges of epiphyseal fusion in the distal tibia and fibula of contemporary males and females Journal of Forensic Sciences 50 5 1001 7 doi 10 1520 JFS2004542 PMID 16225203 complete fusion in females occurs as early as 12 years in the distal tibia and fibula All females demonstrated complete fusion by 18 years with no significant differences between ancestral groups Complete fusion in males occurs as early as 14 years in both epiphyses All males demonstrated complete fusion by 19 years Barrell Amanda At what age do girls stop growing MedicalNewsToday Retrieved 9 June 2020 Jarret Robert R Puberty Tanner Stages Boys Pediatric HOUSECALLS Retrieved 9 June 2020 Jarret Robert R Puberty Tanner Stages Girls Pediatric HOUSECALLS Retrieved 9 June 2020 When do most males growth plates close Zoodoc Retrieved 9 June 2020 Zhong M Carney DH Boyan BD Schwartz Z January 2011 17b Estradiol regulates rat growth plate chondrocyte apoptosis through a mitochondrial pathway not involving nitric oxide or MAPKs Endocrinology 152 1 82 92 doi 10 1210 en 2010 0509 PMID 21068162 Skeletal System Bone Development and Growth Archived from the original on 2008 07 09 Retrieved 2008 07 10 Ovalle William K Nahirney Patrick C 2007 Netter s essential histology with Student consult online access 1st ed Philadelphia Pa Elsevier Saunders ISBN 9781929007868 El Sobky TamerA Shawky RabahM Sakr HossamM Elsayed SolafM Elsayed NermineS Ragheb ShaimaaG Gamal Radwa 2017 A systematized approach to radiographic assessment of commonly seen genetic bone diseases in children A pictorial review Journal of Musculoskeletal Surgery and Research 1 2 25 doi 10 4103 jmsr jmsr 28 17 S2CID 79825711 E L Sobky Tamer A Samir Shady Atiyya Ahmed Naeem Mahmoud Shady Aly Ahmad S Soliman Ramy 2018 Current paediatric orthopaedic practice in hereditary multiple osteochondromas of the forearm a systematic review SICOT J 4 10 doi 10 1051 sicotj 2018002 PMC 5863686 PMID 29565244 Duque Orozco Maria del Pilar Abousamra Oussama Rogers Kenneth J Thacker Mihir M July 2018 Radiographic Analysis of the Pediatric Hip Patients With Hereditary Multiple Exostoses HME Journal of Pediatric Orthopaedics 38 6 305 311 doi 10 1097 BPO 0000000000000815 PMID 27328120 S2CID 23800752 Mirghasemi Alireza Mohamadi Amin Ara Ali Majles Gabaran Narges Rahimi Sadat Mir Mostafa November 2009 Completely displaced S 1 S 2 growth plate fracture in an adolescent case report and review of literature Journal of Orthopaedic Trauma 23 10 734 738 doi 10 1097 BOT 0b013e3181a23d8b ISSN 1531 2291 PMID 19858983 S2CID 6651435 Journeau P 2020 Update on guided growth concepts around the knee in children Orthop Traumatol Surg Res S1877 0568 19 S171 S180 doi 10 1016 j otsr 2019 04 025 PMID 31669550 a b EL Sobky TA Samir S Baraka MM Fayyad TA Mahran MA Aly AS Amen J Mahmoud S 1 January 2020 Growth modulation for knee coronal plane deformities in children with nutritional rickets A prospective series with treatment algorithm JAAOS Global Research and Reviews 4 1 e19 00009 doi 10 5435 JAAOSGlobal D 19 00009 PMC 7028784 PMID 32159063 a b Trofimova SI Buklaev DS Petrova EV Mulevanova SA 2016 Guided growth for correction of knee flexion contracture in patients with arthrogryposis preliminary results Pediatric Traumatology Orthopaedics and Reconstructive Surgery 4 4 64 70 doi 10 17816 PTORS4464 70 Growth Plate Physeal Fractures EMedicine com Retrieved 2008 01 15 External links editNormal bones at GetTheDiagnosis org showing the development of epiphyseal plates for different ages and bones nbsp Wikimedia Commons has media related to Epiphyseal plate Retrieved from https en wikipedia org w index php title Epiphyseal plate amp oldid 1188090759, wikipedia, wiki, book, books, library,
