{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:19:13Z","timestamp":1791825553330,"version":"4.3.4"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T00:00:00Z","timestamp":1666051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>The growth plate is the weakest structure in the skeleton of a child and a frequent site of injury or fracture; physeal injuries represent 15%\u201330% of all fractures in children. Of all growth plate fractures, the incidence of growth arrest and disorders is around 15%. Here, we discuss a female patient who, at the age of 5 years, was treated for a polytrauma that involved a complex lesion of the growth plates of the knee. Four days after trauma, she underwent closed reduction surgery and internal fixation with cannulated screws for femoral and tibial fractures of the growth plate. A 20\u00b0 valgus deviation of the left knee was found at 3-month postoperative clinical check-up likely as a result of a growth disorder of the femur. She was diagnosed with valgus knee secondary to epiphysiodesis of the lateral portion of the femoral physis and she was readmitted to the hospital. In the operating theater, an open femoral de-epiphysiodesis was performed with a burr; the drilled hole was then filled with bone wax. At 20-month post-trauma follow-up, the left knee was still valgus about 20\u00b0 relative to the other side. During follow-up, a slow but progressive improvement in the axis of the lower limbs was noted. Clinical and radiographic control 10 years after the trauma showed a complete recovery of the axis of the lower limbs. In the initial stages, the presence of bone wax in the area of de-epiphysiodesis allowed for stabilization of the deformity on the 20\u00b0 of preoperative valgus. The interpretation of the growth cartilage activity occurred in an asymmetrical way such as to realign the femoral load axis, it can be based on the different mechanical stimulus on the two knee areas due to the preexisting deformity. There is no unanimous evidence in the literature in terms of management of growth disorders resulting from this type of injury. Bone wax resulted in effectively filling the hole of de-epiphysiodesis in the distal femoral growth plate and allowed us to obtain the response of the growth plate and to improve the recovery time in young children.<\/jats:p>","DOI":"10.3389\/fsurg.2022.968214","type":"journal-article","created":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T05:00:05Z","timestamp":1666069205000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Bone wax in the treatment of partial epiphysiodesis of distal femoral growth plate: Case report at 10-year follow-up"],"prefix":"10.3389","volume":"9","author":[{"given":"Luca","family":"Basiglini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo Gabriele","family":"Aulisa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diletta","family":"Bandinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato Maria","family":"Toniolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Falciglia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","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"},{"key":"B2","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1007\/s43465-020-00338-6","article-title":"Management of physeal fractures: a review article","volume":"55","author":"Singh","year":"2021","journal-title":"Indian J Orthop"},{"key":"B3","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.mporth.2011.08.001","article-title":"Physeal fractures: basic science, assessment and acute management","volume":"25","author":"Dodwell","year":"2011","journal-title":"Orthop Trauma"},{"key":"B4","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1097\/01.bpb.0000191874.69258.0b","article-title":"Incidence of physeal injuries in Japanese children","volume":"15","author":"Kawamoto","year":"2006","journal-title":"J Pediatr Orthop B"},{"key":"B5","article-title":"Tachdjian\u2019s pediatric orthopaedics: From the Texas Scottish Rite Hospital for Children","author":"Ramo","year":""},{"key":"B6","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1302\/0301-620X.93B5.25422","article-title":"The effect of percutaneous pin fixation in the treatment of distal femoral physeal fractures","volume":"93","author":"Garrett","year":"2011","journal-title":"J Bone Joint Surg Br"},{"key":"B7","doi-asserted-by":"publisher","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"},{"key":"B8","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1097\/BPB.0000000000000664","article-title":"Physeal fractures of the distal femur: does a lower threshold for surgery lead to better outcomes?","volume":"29","author":"Adams","year":"2020","journal-title":"J Pediatr Orthop B"},{"key":"B9","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1007\/s00590-021-02933-1","article-title":"The clinical features, management options and complications of paediatric femoral fractures","volume":"31","author":"Duffy","year":"2021","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"S58","DOI":"10.1016\/j.jcot.2018.01.001","article-title":"Management of growth arrest: current practice and future directions","volume":"9","author":"Dabash","year":"2018","journal-title":"J Clin Orthop Trauma"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1007\/s11340-018-0424-1","article-title":"Mechanical stimulation of growth plate chondrocytes: previous approaches and future directions","volume":"59","author":"Lee","year":"2019","journal-title":"Exp Mech"},{"key":"B12","doi-asserted-by":"publisher","first-page":"267","DOI":"10.3109\/17453676708989640","article-title":"The possibilities of eliminating premature partial closure of an epiphyseal plate caused by trauma or disease","volume":"38","author":"Langenski\u00f6ld","year":"1967","journal-title":"Acta Orthop Scand"},{"key":"B13","doi-asserted-by":"publisher","first-page":"70","DOI":"10.13107\/jocr.2019.v10.i01.1642","article-title":"Desepiphysiodesis and reconstruction of the distal radial growth plate with an autologous iliac crest cartilage graft: a case report and review of literature","volume":"10","author":"Gigante","year":"2019","journal-title":"J Orthop Case Rep"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.968214\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T05:00:08Z","timestamp":1666069208000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.968214\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,18]]},"references-count":13,"alternative-id":["10.3389\/fsurg.2022.968214"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.968214","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,18]]},"article-number":"968214"}}