Epiphyseal extension of benign pathology is regarded as an infrequent occurrence. This observation has been attributed to anatomical and biochemical phenomenon unique to physeal cartilage. We report a retrospective series of six patients over a period of four years, diagnosed with benign pathologies that showed crossing of an open physeal plate by the disease. Four of these cases were infections and two were benign tumors. The patients were aged between 5 and 11 years, all of them were treated at a tertiary referral centre and followed up for a minimum period of six months to evaluate the progress of disease. We believe that this is the first time that a large series has shown that the epiphysis does not necessarily act as a barrier to spread in all benign pathologies. The findings are more than just a pathological curiosity as they alter the management and surgical procedure that needs to be performed for these conditions. The recognition of the fact that benign tumors may occasionally present with transphyseal spread will prevent unjustified radical procedures that are best reserved for aggressive malignant conditions. Department(s) and institution(s) where work was done Department Of Orthopaedics,KEM Hospital,Parel , Mumbai, India. Introduction Crossing the physis by primary metaphyseal localized bone tumors and osteomyelitis in child hood has rarely been observed. The physis had been traditionally been considered as a strong barrier against spread of tumors and infection. However aggressive tumors like osteogenic sarcoma were frequently reported to cross the physis1,2,3. Due to the primary noninvasive nature of infections and non-malignant tumors, there have been only isolated case reports of transphyseal spread in these group4. A series of six cases in which such a spread was seen is presented here. We believe that this is the first large series describing such occurrence in a group of benign condition. Materials and Methods This retrospective study includes six patients in which there was transphyseal extension of a benign pathology. These cases were identified over a period of four years in a tertiary care institute. In all the patients the physeal plate was open. The cases were examined and clinical findings recorded, a biplane radiograph of all six patients was done, three of these patients also under went MRI scanning. An orthopedic radiologist without any prior knowledge of point of the question (epiphyseal extension) was asked to review the data and form an opinion as of transphyseal involvement; Epiphyseal incongruity and areas of local bone destruction on X-rays were taken as an indicator of involvement. A tissue diagnosis was obtained in each of the cases following which appropriate course of management instituted. All the cases were followed up for an average duration of one year (shortest follow up being six months and longest follow-up was of six years). During each clinical follow-up the past clinical charts were reviewed and appropriate radiographs taken. Illustrative Case reports Case 1 A case of chondroblastoma in an eight-year old child located in proximal humerus: the child presented with complaints of pain in the shoulder of 4 months duration, on examination there was local tenderness at upper humerus region and the shoulder range of motion was terminally restricted in all directions. Needle biopsy was done and histopathological diagnosis of chondroblastoma was established. The lesion was curetted transphyseally and the defect filled with bone graft without damaging the entire physis. At 6 month follow up there was no evidence of tumor recurrence and the defect had healed partially.
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