{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:49:51Z","timestamp":1787755791910,"version":"build-2784847793"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,7,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Long-bone fractures in children can lead to premature physeal bar formation and growth disturbance. Bar excision has been studied, but data on prophylactic tissue interposition into physeal fractures are limited. This study used an established animal model to evaluate acute placement of fat autograft. The number of animals was selected to give 80% power on the basis of pilot data on induction of radiographic bars in physeal fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Proximal tibial fractures were created in 30 rabbits by placing pins in the epiphysis and levering the distal tibia, propagating the fracture through the physis. Twenty fracture sites had interposed fat autograft (fat group), and 10 did not (fracture group). The 30 untreated contralateral limbs were the control group. Radiographs were assessed preoperatively and immediately, 10 days, and 6 weeks following fracture. Radiographic measurements were compared using repeated-measures analysis of variance. Micro-computed tomography (microCT) 3D reconstructions and histologic analysis further characterized the healing and control tibial physes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Fat and fracture groups were similar (age, weight, body length, surgical duration, and weight and body length increases over 6 weeks). No difference was observed in the probability of radiographic bar formation between the fat (12 of 20) and fracture (7 of 10) groups (p = 0.702). On the basis of the medial-lateral side difference, fat (0.66 \u00b1 1.64 mm) and fracture (0.53 \u00b1 1.36 mm) groups demonstrated increased valgus growth compared with controls (\u22120.74 \u00b1 1.16 mm) (p = 0.002 and p = 0.04). Six weeks following fracture, tibial length was less in the fat group compared with the control group (fat: 101.4 \u00b1 3.1 mm, control: 103.7 \u00b1 2.6 mm, p = 0.02). MicroCT 3D reconstructions demonstrated no difference in bone bridging between fat and fracture groups, and the fat group having more bone bridging than controls (83 \u00b1 102 versus 11 \u00b1 49, p = 0.004). Histologic analysis showed disorganized tissue without evidence of physeal cartilage preservation for most limbs in both treatment groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Fat autograft interposition did not reliably prevent radiographic bar formation or angular deformity when placed during physeal fracture reduction. 3D reconstructions and histology indicated that the fat was converted to bone just as readily as if a disrupted physis had no interposition, yet with a reduction in the surface area of bone bar formation that did not reach significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>Given these findings, we do not necessarily advocate for acute prophylactic fat interposition into physeal fractures for bar prevention in pediatric fractures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.01261","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T14:06:35Z","timestamp":1747922795000},"page":"1489-1499","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Acute Interpositional Fat Autograft Does Not Protect Against Bar Formation in Physeal Fractures"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1683-4283","authenticated-orcid":false,"given":"Mikhail S.","family":"Tretiakov","sequence":"first","affiliation":[{"name":"Rady Children\u2019s Hospital \u2013 San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7615-3749","authenticated-orcid":false,"given":"Christine L.","family":"Farnsworth","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital \u2013 San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6021-6490","authenticated-orcid":false,"given":"Garrett E.","family":"Rupp","sequence":"additional","affiliation":[{"name":"University of California San Diego, La Jolla, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1677-8373","authenticated-orcid":false,"given":"Kelly E.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital \u2013 San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9682-8426","authenticated-orcid":false,"given":"Kortney A.","family":"Ponce","sequence":"additional","affiliation":[{"name":"California Health Sciences University College of Osteopathic Medicine, Clovis, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8275-8322","authenticated-orcid":false,"given":"David B.","family":"Berry","sequence":"additional","affiliation":[{"name":"University of California San Diego, La Jolla, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2331-9214","authenticated-orcid":false,"given":"Suzanne M.","family":"Tucker","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital \u2013 San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5724-5645","authenticated-orcid":false,"given":"Eric W.","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital \u2013 San Diego, San Diego, California"},{"name":"University of California San Diego, La Jolla, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"issue":"9","key":"bib1-20260129","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/BOT.0b013e3181a4f25b","article-title":"Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis","volume":"23","author":"Basener","year":"2009","journal-title":"J Orthop Trauma."},{"issue":"8","key":"bib3-20260129","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.2106\/00004623-198769080-00037","article-title":"The evaluation and treatment of partial physeal arrest","volume":"69","author":"Ogden","year":"1987","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib4-20260129","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/01241398-199011000-00012","article-title":"Partial physeal growth arrest: treatment by bridge resection and fat interposition","volume":"10","author":"Williamson","year":"1990","journal-title":"J Pediatr Orthop."},{"issue":"2","key":"bib5-20260129","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1089\/ten.teb.2017.0274","article-title":"Regenerative Medicine Approaches for the Treatment of Pediatric Physeal Injuries","volume":"24","author":"Shaw","year":"2018","journal-title":"Tissue Eng Part B Rev."},{"issue":"1","key":"bib6-20260129","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/01241398-198101010-00002","article-title":"Surgical treatment of partial closure of the growth plate","volume":"1","author":"Langenski\u00f6ld","year":"1981","journal-title":"J Pediatr Orthop."},{"issue":"11","key":"bib7-20260129","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1097\/01.rli.0000084254.92161.9c","article-title":"Imaging findings after fat graft interposition in an injured growth plate: an experimental study in rabbits","volume":"38","author":"Cheon","year":"2003","journal-title":"Invest Radiol."},{"issue":"6","key":"bib8-20260129","doi-asserted-by":"crossref","first-page":"e422","DOI":"10.1097\/BPO.0000000000001349","article-title":"Excision of Physeal Bars of the Distal Femur, Proximal and Distal Tibia Followed to Maturity","volume":"39","author":"Yuan","year":"2019","journal-title":"J Pediatr Orthop."},{"issue":"3","key":"bib9-20260129","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1097\/01241398-200005000-00002","article-title":"Free fat interpositional graft in acute physeal injuries: the anticipatory Langenski\u00f6ld procedure","volume":"20","author":"Foster","year":"2000","journal-title":"J Pediatr Orthop."},{"issue":"1","key":"bib10-20260129","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s40634-019-0214-4","article-title":"Periosteal incarceration versus interposition adipose tissue grafting in physeal fractures: pilot study in immature rabbits","volume":"6","author":"Edmonds","year":"2019","journal-title":"J Exp Orthop."},{"issue":"2","key":"bib13-20260129","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research","volume":"15","author":"Koo","year":"2016","journal-title":"J Chiropr Med."},{"issue":"4","key":"bib14-20260129","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/01241398-198707000-00002","article-title":"Growth of fat grafts after operation for partial bone growth arrest: demonstration by computed tomography scanning","volume":"7","author":"Langenski\u00f6ld","year":"1987","journal-title":"J Pediatr Orthop."},{"issue":"6","key":"bib15-20260129","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1097\/01241398-200211000-00002","article-title":"Physeal fractures, part I: histologic features of bone, cartilage, and bar formation in a small animal model","volume":"22","author":"Wattenbarger","year":"2002","journal-title":"J Pediatr Orthop."},{"issue":"6","key":"bib16-20260129","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1097\/01241398-200211000-00003","article-title":"Physeal fractures, part II: fate of interposed periosteum in a physeal fracture","volume":"22","author":"Gruber","year":"2002","journal-title":"J Pediatr Orthop."},{"issue":"6","key":"bib17-20260129","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1097\/01241398-200311000-00010","article-title":"Premature physeal closure following distal tibia physeal fractures: a new radiographic predictor","volume":"23","author":"Barmada","year":"2003","journal-title":"J Pediatr Orthop."},{"issue":"5","key":"bib18-20260129","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1097\/BPO.0b013e3182880279","article-title":"Salter-Harris II fractures of the distal tibia: does surgical management reduce the risk of premature physeal closure?","volume":"33","author":"Russo","year":"2013","journal-title":"J Pediatr Orthop."},{"issue":"9","key":"bib19-20260129","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1007\/s00247-015-3280-5","article-title":"Imaging of physeal bars in children","volume":"45","author":"Wang","year":"2015","journal-title":"Pediatr Radiol."},{"key":"bib20-20260129","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/2001-1326-3-12","article-title":"Pluripotent muse cells derived from human adipose tissue: a new perspective on regenerative medicine and cell therapy","volume":"3","author":"Simerman","year":"2014","journal-title":"Clin Transl Med."},{"issue":"1","key":"bib21-20260129","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s10856-016-5821-3","article-title":"Expression of CD68 positive macrophages in the use of different barrier materials to prevent peritoneal adhesions-an animal study","volume":"28","author":"Brochhausen","year":"2017","journal-title":"J Mater Sci Mater Med."},{"issue":"12","key":"bib22-20260129","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1089\/ten.tec.2019.0180","article-title":"Rabbit Model of Physeal Injury for the Evaluation of Regenerative Medicine Approaches","volume":"25","author":"Yu","year":"2019","journal-title":"Tissue Eng Part C Methods."},{"issue":"2","key":"bib23-20260129","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1148\/radiology.215.2.r00ap50504","article-title":"Cartilaginous path of physeal fracture-separations: evaluation with MR imaging\u2014an experimental study with histologic correlation in rabbits","volume":"215","author":"Jaramillo","year":"2000","journal-title":"Radiology."},{"issue":"5","key":"bib24-20260129","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1002\/jor.1100120519","article-title":"Histological and radiographic determination of the age of physeal closure of the distal femur, proximal tibia, and proximal fibula of the New Zealand white rabbit","volume":"12","author":"Kaweblum","year":"1994","journal-title":"J Orthop Res."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.01261","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:52:22Z","timestamp":1787752342000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.01261"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,22]]},"references-count":21,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.24.01261","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,22]]}}}