Love S M, Ganey T, Ogden J A
Shriners Hospital for Crippled Children, University of South Florida College of Medicine, Tampa 33612-9499.
J Pediatr Orthop. 1990 May-Jun;10(3):298-305. doi: 10.1097/01241398-199005000-00002.
At birth, the distal tibial physis is a transverse structure. However, as the tibia enlarges diametrically and the epiphyseal ossification center matures, the physis becomes increasingly undulated, with peripheral lappet formation. The anteromedial area is the first to develop undulation (Poland's hump). This should not be misinterpreted as an injury or premature epiphyseodesis subsequent to trauma. The tibial secondary ossification center forms within the central epiphysis. The medial margin is irregular and may have peripheral foci of ossification. Between the ages of 7 and 8 years, this secondary center extends into the medial malleolus, reaching the distal tip during adolescence. The malleolar tip may develop accessory ossification. Physiologic epiphyseodesis begins over the medial malleolus and then extends laterally, a pattern of closure that affects fracture patterns (e.g., the fracture of Tillaux). The distal fibular physis also begins as a transverse structure that becomes undulated and has extensive peripheral lappet formation. This physis usually becomes level with the articular surface of the distal tibia after the first year. Enchondromalike extensions of the physis into the metaphysis are common. Accessory ossification may develop at the distal end.
出生时，胫骨远端骨骺板是一个横向结构。然而，随着胫骨直径增大以及骨骺骨化中心成熟，骨骺板变得越来越起伏不平，并形成周边的垂片。前内侧区域是最早出现起伏的部位（波兰氏驼峰）。这不应被误解为创伤后的损伤或过早骨骺闭合。胫骨二级骨化中心在中央骨骺内形成。内侧边缘不规则，可能有周边骨化灶。在7至8岁之间，这个二级中心延伸至内踝，在青春期到达远端尖端。踝尖可能会出现副骨化。生理性骨骺闭合始于内踝上方，然后向外侧延伸，这种闭合模式会影响骨折类型（如Tillaux骨折）。腓骨远端骨骺板最初也是横向结构，随后变得起伏不平，并形成广泛的周边垂片。这个骨骺板通常在出生后第一年与胫骨远端关节面平齐。骨骺板向干骺端的软骨样延伸很常见。远端可能会出现副骨化。
