Description, Causes and Risk Factors:
Synchondrosis is defined as the development of a union between two bones by the formation of either hyaline cartilage or fibrocartilage. A synchondrosis is usually temporary and exists during the growing phase until the intervening cartilage becomes progressively thinner during skeletal maturation and ultimately becomes obliterated and converted into bone before adult life. In simple terms, a synchondrosis is a cartilaginous joint. It allows only slight movement between bones compared with the synovial joint, which has a much greater range of movement. Throughout the human body, cartilaginous joints can be found in the pubic symphysis, between the ribs and sternum, between adjacent vertebrae in the spinal column, and at the growth plates between the epiphysis and metaphysis of tubular bones. Three synchondroses are present along the midline of the cranial base: the sphenoethmoidal synchondrosis between the sphenoid and ethmoidal bones, the intersphenoid synchondrosis between two parts of the sphenoid bone and the sphenooccipital synchondrosis between the sphenoid and basioccipital bones.
A synchondrosis is a joint that is connected with cartilage. Such joints are stiff and very strong and they can be found in several areas of the body. Many appear in childhood only, disappearing as people mature into adulthood. Such joints provide limited flexibility where it is needed, without the range of motion found in other types of joints. This makes a synchondrosis more stable and supportive.
The most common disorder associated with a synchondrosis is a disruption of the epiphyseal hyaline cartilage plate. This is particularly evident in the proximal femur, specifically related to the hip. This disorder occurs mainly in young children as a result of a fall or other trauma. This disruption to the plate can lead to fracture, disruption of blood supply, and, if not treated appropriately, deformity of the hip. The medical term for this disorder is slipped capital femoral epiphysis.
The skull also has a number of synchondroses. When people are born, the skull is made up of a series of plates that are connected with cartilage. This allows the skull some room to grow, so that babies do not need to be born with full-sized heads to protect the brain. As people grow up, the seams between the skull plates gradually harden and smooth out. Specimens of skulls from people of various ages can be seen on display in some museums, illustrating how the stark lines found on younger skulls gradually fade with age.
People with connective tissue disorders can sometimes develop problems at a synchondrosis. This may be a result of overproduction of cartilage or excessive breakdown of cartilage. Because these joints are often sites of rapid growth in childhood and adolescence, they can also become cancerous. Cancers that develop in the bone can lead to bone pain and weakness and can be identified with medical imaging studies that will reveal growths in or on the bone. Treatment options are available to address overgrowths of cartilage and other problems that can develop with the bones.
Morphologically, a synchondrosis is similar to the longbone growth plate, except that growth at the synchondrosis is not unipolar but bipolar. Indeed, the synchondrosis can be regarded as two growth plates positioned back to back so that they share a common zone of actively proliferating chondroblasts, or the “rest zone”. The different zones of the synchondrosis mirror each other such that there is cartilage in the center and bone at each end. The intraoccipital synchondrosis is completely ossified by 5 weeks of postnatal development, whereas the intrasphenoid and sphenooccipital synchondrosis retain a small amount of cartilage into adulthood.
It is hard to estimate exactly how common synchondrosis is because many people with mild cartilage damage do not seek medical help. However, cartilage damage is thought to be quite common. Every year in the UK, around 10,000 people have cartilage damage that is serious enough to require treatment.
Cases of accidental synchondrosis are most common in people under 35 years old. This is because this age group are more likely to take part in sporting activities where there is a higher risk of injury than older people.
Synchondrosis that is associated with osteoarthritis is more common in adults who are 50 years old or over. It is also more common in women than in men.
Patients with injuries to synchondroses frequently develop some degree of growth deformity, sometimes a quite significant one. Among the sequelae are growth impairment, premature growth plate fusion, epiphyseal malposition and osteonecrosis.
Growth plate injuries may occur about the knee, ankle (triplane fracture, Tillaux fracture), shoulder (Little League shoulder syndrome), elbow and femoral head (slipped capital femoral epiphysis).
In many cases, patients who have joint injuries, such as meniscal or ligament tears, will also havecartilage damage. This damage may be hard to diagnose because hyaline cartilage does notcontain calcium and cannot be seen on an X-ray.If other injuries exist with cartilage damage, doctors will address all problems during surgery.
Most candidates for ssynchondrosis are young adults with a single injury, or lesion. Older patients, or those with many lesions in one joint, are less likely to benefit from the surgery. The knee is the most common area for cartilage restoration. Ankle and shoulder problems may also be treated.
Treatment of epiphyseal injuries must take the pathophysiology of the epiphyseal synchondrosis into account. According to the present state of knowledge, type I and type V injuries according to M
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