Cozen’s phenomenon revisited

Burton, Alex; Hennrikus, William

doi:10.1097/bpb.0000000000000327

Cited by 12 publications

(7 citation statements)

References 17 publications

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“…During ACL reconstruction, there was no circumferential periosteal damage; instead, the drill hole was made from the metaphysis to the epiphysis, and the hole was filled with a tendon graft. The overgrowth was also reported in children with proximal metaphyseal fracture as Cozen’s phenomenon, and the overgrowth after proximal cortical breakage without extensive periosteal damage was confirmed in an animal study 10 , 11 . It is possible that, in addition to periosteal damage, there may be another mechanism related to the overgrowth of the bone.…”

Section: Introductionsupporting

confidence: 57%

Overgrowth of long bone in rabbits by growth stimulation through metaphyseal hole creation

Lee

Shah

et al. 2023

Sci Rep

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Overgrowth of long bones was noted in pediatric patients who underwent anterior cruciate ligament reconstruction. Hyperaemia during creating a metaphyseal hole and the microinstability made by the drill hole may induce overgrowth. This study aimed to determine whether metaphyseal hole creation accelerates growth and increases bone length and compare the effects of growth stimulation between metaphyseal hole creation and periosteal resection. We selected 7- to 8-week-old male New Zealand white rabbits. Periosteal resection (N = 7) and metaphyseal hole creation (N = 7) were performed on the tibiae of skeletally immature rabbits. Seven additional sham controls were included as age-matched controls. In the metaphyseal hole group, the hole was made using a Steinman pin at the same level of periosteal resection, and the cancellous bone beneath the physis was removed by curettage. The vacant space in the metaphysis below the physis was filled with bone wax. Tibiae were collected 6 weeks after surgery. The operated tibia was longer in the metaphyseal hole group (10.43 ± 0.29 cm vs. 10.65 ± 0.35 cm, P = 0.002). Overgrowth was higher in the metaphyseal hole group (3.17 ± 1.16 mm) than in the sham group (− 0.17 ± 0.39 mm, P < 0.001). The overgrowth in the metaphyseal hole group was comparable to that in the periosteal resection group (2.23 ± 1.52 mm, P = 0.287). In rabbits, metaphyseal hole creation and interposition with bone wax can stimulate long bone overgrowth, and the amount of overgrowth is similar to that seen in periosteal resection.

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Section: Introductionsupporting

confidence: 57%

Overgrowth of long bone in rabbits by growth stimulation through metaphyseal hole creation

Lee

Shah

et al. 2023

Sci Rep

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“…However, the prevalence and etiology of Cozen's phenomenon are still not fully understood. The prevalence of Cozen's phenomenon after proximal tibial metaphyseal fractures has been reported to be up to 90%, [16][17][18] although recent studies show a lower prevalence [17]. The suggested mechanisms of valgus deformity after proximal tibial fractures include asymmetric activity of the medial portion of the proximal tibial physis (overgrowth), tethering effect of the fibula, inadequate reduction, interposed soft tissue (pes anserinus), and loss of the tethering effect of the pes anserinus.…”

Section: Discussionmentioning

confidence: 99%

Trampoline-related fractures of the proximal tibia in children

et al. 2021

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Background Trampoline-related fractures of the proximal tibial metaphysis are common in children and have been linked to subsequent valgus deformity of the tibia. The purpose of this study was to investigate the characteristics of trampoline-related proximal tibial fractures in young children. Methods We evaluated 40 patients with proximal tibial fracture after trampolining between 2013 and 2019. The median duration of follow-up was 18 months. Standing long leg radiographs were obtained at the last follow-up to evaluate angular deformity and limb length inequality in the patients. The measurements recorded include the lower limb length, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), mechanical axis deviation (MAD), and anatomical tibio-femoral angle (aTFA). The anterior tilt angle (ATA) was measured using a lateral radiograph of the tibia. Results The median age at injury was 40.0 months. Using trampoline with a heavier person was the most common mechanism of injury. aTFA and MAD were found to be increased towards the valgus at the last follow-up in our patient; however, the increase was not statistically significant (p = 0.692 and p = 0.973, respectively). The anterior tilt angle was increased in the injured leg at the last follow-up. But the change was not statistically significant (p = 0.09). Conclusions Using trampoline with a heavier person carries the risk of trampoline-related proximal tibial fracture in young children. We did not find a significant change in limb alignment at a minimum of one year of follow-up.

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“…The deformity resolved in 2 patients, but the author noted that litigation was threatened in 3 of the 4 injuries and advised that families be warned about the possibility of valgus deformity after nondisplaced and minimally displaced proximal tibia fractures in children. Following Cozen's report, there have been numerous articles published which detail posttraumatic genu valgum in children following proximal tibia fractures; [35][36][37][38][39][40][41][42][43][44] the vast majority of these articles are case series, and most include several different types of proximal tibia fractures (buckle fractures, fractures with a proximal fibula fracture, fractures with a medial gap, and completely displaced fractures). In some series which report Cozen's phenomenon; 37,38,[42][43][44][45] the incidence of posttraumatic genu valgum is wide and ranges from 0/7 45 to 28/31 (90%).…”

Section: Minimally Displaced Proximal Tibial Fractures and Posttrauma...mentioning

confidence: 99%

“…Following Cozen's report, there have been numerous articles published which detail posttraumatic genu valgum in children following proximal tibia fractures; [35][36][37][38][39][40][41][42][43][44] the vast majority of these articles are case series, and most include several different types of proximal tibia fractures (buckle fractures, fractures with a proximal fibula fracture, fractures with a medial gap, and completely displaced fractures). In some series which report Cozen's phenomenon; 37,38,[42][43][44][45] the incidence of posttraumatic genu valgum is wide and ranges from 0/7 45 to 28/31 (90%). 40 Some authors report the incidence of posttraumatic genu valgum by fracture type, 37,38,40,44,45 and in general these authors note that the rate of posttraumatic genu valgum is higher in displaced fractures and fractures with a medial gap than in nondisplaced and buckle fractures.…”

Section: Minimally Displaced Proximal Tibial Fractures and Posttrauma...mentioning

confidence: 99%

“…The timing of onset of deformity is variable [34][35][36]39,41 ; some series have patients with deformity noted at cast removal, which implies malunion after immobilization. It has been recommended by several authors 34,35,41,43 that families be informed at the outset about the risk of posttraumatic genu valgum in the setting of proximal tibia fractures, even those which are nondisplaced. Yang recommends routine radiographic follow up only in the instance of the fractures which carry the highest risk (fractures with initial valgus greater than 4°, a medial metaphyseal gap, or an ipsilateral fibula fracture).…”

Section: Minimally Displaced Proximal Tibial Fractures and Posttrauma...mentioning

confidence: 99%

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“TRASH” Lesions of the Pediatric Lower Extremity

Holmes

2019

Journal of the Pediatric Orthopaedic Society of North America

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TRASH lesions have been coined as a group of pediatric elbow injuries which are underappreciated on radiographs, and which “if treated insufficiently result in chronic long-term consequences.”1 We describe a series of injuries in the pediatric lower extremity, which are similar to elbow TRASH lesions, in that they are often overlooked or dismissed as inconsequential and may have serious ramifications if managed inappropriately. These injuries include traumatic hip dislocations with subsequent intraarticular pathology, greater trochanteric avulsion fractures, patellar sleeve fractures, minimally displaced proximal tibial metaphyseal fractures, and minimally displaced Salter-Harris III and IV fractures of the medial malleolus. Making the correct diagnosis and implementing appropriate treatment, including adequate follow up, is paramount. Key Points: Traumatic hip dislocations in the pediatric and adolescent hip populations can result in intraarticular pathology, which is not visualized on advanced imaging. Greater trochanteric avulsion fractures, while rare, may be complicated by avascular necrosis of the femoral head. Patellar sleeve fractures may be easily missed on radiographs, and inadequate management can result in significant sequelae. Proximal tibial metaphyseal fractures, even when nondisplaced, may result in posttraumatic genu valgum, and caregivers should be warned of this possibility. Non- and minimally displaced Salter-Harris III and IV fractures of the medial malleolus can lead to premature physeal closure, and radiographic follow up of these injuries is warranted.

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Cozen’s phenomenon revisited

Cited by 12 publications

References 17 publications

Overgrowth of long bone in rabbits by growth stimulation through metaphyseal hole creation

Overgrowth of long bone in rabbits by growth stimulation through metaphyseal hole creation

Trampoline-related fractures of the proximal tibia in children

“TRASH” Lesions of the Pediatric Lower Extremity

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