Femoral growth lines: bony birthmarks in infants

Skeletal Growth Arrest Lines in Fetal Remains: Histopathology and Correlative Placental Pathology

INTRODUCTION

Skeletal growth arrest lines (GAL) are transverse lines of metaphyseal radiodensity accompanying episodic severe physiological stress. They are poorly described in fetal remains.

MATERIALS AND METHODS

We searched our autopsy practice for instances of fetal GAL in post mortem radiology, and correlated them with long bone histology and placental pathology. We describe the appearance, distribution, and pathology of GAL in a cohort of fetal autopsies, and compare the placental pathology accompanying GAL to the placental pathology of asymmetrical growth restriction (AGR) in the same time period.

RESULTS

In 2108 consecutive fetal post mortems, we found 20 cases with GAL. About 16 were in singletons with AGR. In these 16, the distribution of placental pathologies was similar to a contemporaneous cohort of 113 cases with AGR. Of the remaining 4, two twins out of 9 sets of monochorionic twins with AGR demonstrated GAL. One case of GAL had symmetrical growth restriction with cytomegalovirus infection, and one case had no AGR and an old, unexplained retroplacental hemorrhage. On histology, GAL are characterized by a region of mineralized chondroid, which is variably incorporated into irregular trabecular bone.

DISCUSSION

GALs accompany a variety of placental pathologies and twin-twin transfusion, suggesting episodic disease progression.

Growth recovery lines: a specific indicator of child abuse and neglect?

BACKGROUND

Growth recovery lines are radiodense lines in long bones reported to be indicators of stress.

OBJECTIVE

The purpose of this study was to understand the distribution, quantity and associations of growth recovery lines in children ages 0-24 months with high and low risk for child maltreatment.

MATERIALS AND METHODS

We conducted a retrospective cohort study of children ages 0-24 months who had skeletal surveys and an assessment for maltreatment. Growth recovery lines, fractures and osteopenia were assessed independently by two pediatric radiologists blinded to the abuse likelihood.

RESULTS

Of the 135 children in this study, 58 were in the low-risk group, 26 were in the neglect group, and 51 were in the physical abuse group. Children in the neglected and physically abused groups had 1.73 times (95% confidence interval [CI] of 1.16, 2.59), P=0.007) and 1.84 times (95% CI 1.28, 2.63, P<0.001) more growth recovery lines than the low-risk group, respectively. Growth recovery lines occurred at an earlier age in the neglect group (age interaction P=0.03) and abuse group (age interaction P=0.01) compared to the low-risk group. The specificity for maltreatment in children with at least 10 growth recovery lines in the long bones was greater than 84%, while sensitivity was less than 35%. The most common locations for growth recovery lines were distal radius, proximal tibia and distal tibia.

CONCLUSION

In the absence of a known major stressor, physical abuse and neglect should be considered in children younger than 24 months with at least 10 growth recovery lines.

The pathology of incipient polymicrogyria

OBJECTIVE

To characterise the early tissue changes of post encephaloclastic polymicrogyria in the human fetus.

METHODS

We identified and reviewed the clinical histories and autopsy pathology of post ischemic fetal cerebral cortical injury at less than 30weeks gestational age (GA). The histology of local cortical abnormalities was examined with neuronal, glial, microglial and vascular immunohistochemical markers.

RESULTS

We identified eight cases ranging from 18 to 29weeks GA: 5 cases show full thickness cortical infarcts and 3 show periSylvian post-ischemic necrosis of the cerebral cortex. The maximal age is less than 10weeks after injury. There are abnormalities in gross fissuration as early as one month after injury. Disruption of the pia limitans was associated with a microglial and glial response and full thickness cortical injury. Macrophages were often seen accumulating deep to abnormal cortex. Hyperplasia of the subpial granular cell layer was universal in perilesional cortex. Cajal Retzius neuron hyperplasia, aggregation, and both superficial and deep displacement were noted. Where there was loss and dispersal of early cortical pyramidal neurons there was usually no pseudolaminar necrosis. Radial glia by 18weeks GA showed altered growth patterns and lateral branching. Altered migration of primitive elements was often prominent. Particularly prior to 20weeks GA subadjacent subplate neurons showed striking hypertrophy.

CONCLUSIONS

The array of histological changes encompasses all tissue elements of the affected brains, early in the evolution polymicrogyria. Although subpial alterations were ubiquitous, not all changes are referable to alterations in the pia limitans. The role of the necroinflammatory response in the genesis of abnormal cytoarchitecture deserves further study.

Growth recovery lines are more common in infants at high vs. low risk for abuse

BACKGROUND

Growth recovery lines, also known as growth arrest lines, are transverse radiodense metaphyseal bands that develop due to a temporary arrest of endochondral ossification caused by local or systemic insults.

OBJECTIVE

To determine if growth recovery lines are more common in infants at high risk versus low risk for abuse.

MATERIALS AND METHODS

Reports of American College of Radiology compliant skeletal surveys (1999-2013) were reviewed with clinical records. Infants at low risk for abuse had a skull fracture without significant intracranial injury, history of a fall and clinical determination of low risk (child protection team/social work assessment). Infants at high risk had significant intracranial injury, retinal hemorrhages, other skeletal injuries and clinical determination of high risk. There were 52 low-risk infants (mean: 4.7 months, range: 0.4-12 months) and 21 high-risk infants (mean: 4.2 months, range: 0.8-9.1 months). Two blinded radiologists independently evaluated the skeletal survey radiographs of the knees/lower legs for the presence of at least one growth recovery line.

RESULTS

When growth recovery lines are scored as probably present or definitely present, their prevalence in the low-risk group was 38% (standard deviation [SD] = 8%; reader 1 = 17/52, reader 2 = 23/52) vs. 71% (SD = 7%; reader 1 = 16/21, reader 2 = 14/21) in the high-risk group (P < 0.001; odds ratio 4.0, 95% CI: 1.7-9.5).

CONCLUSION

Growth recovery lines are encountered at a significantly higher rate in infants at high risk vs. low risk for abuse. This suggests that abused infants are prone to a temporary disturbance in endochondral ossification as a result of episodic physiological stresses.

Normal growth, altered growth? Study of the relationship between harris lines and bone form within a post-medieval plague cemetery (Dendermonde, Belgium, 16th Century)

OBJECTIVES

Harris lines (HLs) are defined as transverse, mineralized lines associated with temporary growth arrest. In paleopathology, HLs are used to reconstruct health status of past populations. However, their etiology is still obscure. The aim of this article is to test the reliability of HLs as an arrested growth marker by investigating their incidence on human metrical parameters.

METHODS

The study was performed on 69 individuals (28 adults, 41 subadults) from the Dendermonde plague cemetery (Belgium, 16th century). HLs were rated on distal femora and both ends of tibiae. Overall prevalence and age-at-formation of each detected lines were calculated. ANOVA analyses were conducted within subadult and adult samples to test if the presence of HLs did impact size and shape parameters of the individuals.

RESULTS

At Dendermonde, 52% of the individuals had at least one HL. The age-at-formation was estimated between 5 and 9 years old for the subadults and between 10 and 14 years old for the adults. ANOVA analyses showed that the presence of HLs did not affect the size of the individuals. However, significant differences in shape parameters were highlighted by HL presence. Subadults with HLs displayed slighter shape parameters than the subadults without, whereas the adults with HLs had larger measurements than the adults without.

CONCLUSIONS

The results suggest that HLs can have a certain impact on shape parameters. The underlying causes can be various, especially for the early formed HLs. However, HLs deposited around puberty are more likely to be physiological lines reflecting hormonal secretions. Am. J. Hum. Biol. 29:e22885, 2017. © 2016 Wiley Periodicals, Inc.

The acrophysis: a unifying concept for enchondral bone growth and its disorders. I. Normal growth

In order to discuss and illustrate the common effects on normal and abnormal enchondral bone at the physes and at all other growth plates of the developing child, the term "acrophysis" is proposed. Acrophyses include the growth plates of secondary growth centers including carpals and tarsals and apophyses, and the growth plates at the non-physeal ends of small tubular bones. The last layer of development of both physes and acrophysis is the cartilaginous zone of provisional calcification (ZPC). The enchondral bone abutting the ZPC shares similar properties at physes and acrophyses, including the relatively lucent metaphyseal bands of many normal infants at several weeks of age. The bone-in-bone pattern of the normal vertebral bodies and bands of demineralization of the tarsal bones just under the ZPC are the equivalent of those bands. The growth arrest/recovery lines of metaphyses similarly have equivalent lines in growth centers and other acrophyseal sites. Nearly the same effects can also be anticipated from the relatively similar growth plate at the cartilaginous cap of benign exostoses ("paraphysis"). The companion article will explore abnormalities at acrophyseal sites, including metabolic bone disease and dysplasias.