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Primary and Secondary Growth Centers
Arthur B. Meyers, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Primary (1°) growth (ossification) center
              • Secondary (2°) growth (ossification) center
            • Definitions

              • Endochondral ossification: Bone formation of preexisting cartilage model at 1° & 2° growth centers
                • Occurs at limbs, pelvis, vertebral column, & portions of clavicles, scapulae, skull base
              • Intramembranous ossification: Bone formation from mesenchymal cells without prior cartilage model
                • Occurs at cranial vault, facial bones, & portions of clavicles, scapulae
              • 1° growth centers: Provide majority of ossification
                • Form in central diaphyses of tubular bones in utero
                  • Ossification proceeds outward (proximal & distal)
                  • 1° growth plates (physes) form at leading edge(s) of expanding 1° ossification centers
                • Predominately found at tubular bone physes in childhood
                • Account for majority of longitudinal growth
              • 2° growth centers: Do not significantly contribute to longitudinal growth
                • Surrounded by 2° growth plate & unossified cartilage
                • Found at articulations of long bones (epiphyses) & epiphyseal equivalents (e.g., apophyses)
              • Accessory ossicles: Supernumerary bones commonly derived from unfused 2° ossification centers

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Natural History & Prognosis

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Walter WR et al: Pitfalls in MRI of the developing pediatric ankle. Radiographics. 41(1):210-23, 2021
                                  2. Nguyen JC et al: Imaging of pediatric growth plate disturbances. Radiographics. 37(6):1791-812, 2017
                                  3. Jaimes C et al: MR imaging of normal epiphyseal development and common epiphyseal disorders. Radiographics. 34(2):449-71, 2014
                                  4. Kwong S et al: Skeletal development of the proximal humerus in the pediatric population: MRI features. AJR Am J Roentgenol. 202(2):418-25, 2014
                                  5. Keats TE et al: Atlas of normal roentgen variants that may simulate disease. Philadelphia, Pa: Elsevier/Saunders, 2013
                                  6. Karwacki GM et al: Normal ossification patterns of atlas and axis: a CT study. AJNR Am J Neuroradiol. 33(10):1882-7, 2012
                                  7. Laor T et al: Juvenile osteochondritis dissecans: is it a growth disturbance of the secondary physis of the epiphysis? AJR Am J Roentgenol. 199(5):1121-8, 2012
                                  8. Thapa MM et al: MRI of pediatric patients: part 1, normal and abnormal cartilage. AJR Am J Roentgenol. 198(5):W450-5, 2012
                                  9. Thapa MM et al: MRI of pediatric patients: part 2, normal variants and abnormalities of the knee. AJR Am J Roentgenol. 198(5):W456-65, 2012
                                  10. Khanna PC et al: The growing skeleton: MR imaging appearances of developing cartilage. Magn Reson Imaging Clin N Am. 17(3):411-21, v, 2009
                                  11. Laor T et al: MR imaging insights into skeletal maturation: what is normal? Radiology. 250(1):28-38, 2009
                                  12. Nemzek WR et al: MR, CT, and plain film imaging of the developing skull base in fetal specimens. AJNR Am J Neuroradiol. 21(9):1699-706, 2000
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Synonyms

                                              • Primary (1°) growth (ossification) center
                                              • Secondary (2°) growth (ossification) center
                                            • Definitions

                                              • Endochondral ossification: Bone formation of preexisting cartilage model at 1° & 2° growth centers
                                                • Occurs at limbs, pelvis, vertebral column, & portions of clavicles, scapulae, skull base
                                              • Intramembranous ossification: Bone formation from mesenchymal cells without prior cartilage model
                                                • Occurs at cranial vault, facial bones, & portions of clavicles, scapulae
                                              • 1° growth centers: Provide majority of ossification
                                                • Form in central diaphyses of tubular bones in utero
                                                  • Ossification proceeds outward (proximal & distal)
                                                  • 1° growth plates (physes) form at leading edge(s) of expanding 1° ossification centers
                                                • Predominately found at tubular bone physes in childhood
                                                • Account for majority of longitudinal growth
                                              • 2° growth centers: Do not significantly contribute to longitudinal growth
                                                • Surrounded by 2° growth plate & unossified cartilage
                                                • Found at articulations of long bones (epiphyses) & epiphyseal equivalents (e.g., apophyses)
                                              • Accessory ossicles: Supernumerary bones commonly derived from unfused 2° ossification centers

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Natural History & Prognosis

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Walter WR et al: Pitfalls in MRI of the developing pediatric ankle. Radiographics. 41(1):210-23, 2021
                                                                  2. Nguyen JC et al: Imaging of pediatric growth plate disturbances. Radiographics. 37(6):1791-812, 2017
                                                                  3. Jaimes C et al: MR imaging of normal epiphyseal development and common epiphyseal disorders. Radiographics. 34(2):449-71, 2014
                                                                  4. Kwong S et al: Skeletal development of the proximal humerus in the pediatric population: MRI features. AJR Am J Roentgenol. 202(2):418-25, 2014
                                                                  5. Keats TE et al: Atlas of normal roentgen variants that may simulate disease. Philadelphia, Pa: Elsevier/Saunders, 2013
                                                                  6. Karwacki GM et al: Normal ossification patterns of atlas and axis: a CT study. AJNR Am J Neuroradiol. 33(10):1882-7, 2012
                                                                  7. Laor T et al: Juvenile osteochondritis dissecans: is it a growth disturbance of the secondary physis of the epiphysis? AJR Am J Roentgenol. 199(5):1121-8, 2012
                                                                  8. Thapa MM et al: MRI of pediatric patients: part 1, normal and abnormal cartilage. AJR Am J Roentgenol. 198(5):W450-5, 2012
                                                                  9. Thapa MM et al: MRI of pediatric patients: part 2, normal variants and abnormalities of the knee. AJR Am J Roentgenol. 198(5):W456-65, 2012
                                                                  10. Khanna PC et al: The growing skeleton: MR imaging appearances of developing cartilage. Magn Reson Imaging Clin N Am. 17(3):411-21, v, 2009
                                                                  11. Laor T et al: MR imaging insights into skeletal maturation: what is normal? Radiology. 250(1):28-38, 2009
                                                                  12. Nemzek WR et al: MR, CT, and plain film imaging of the developing skull base in fetal specimens. AJNR Am J Neuroradiol. 21(9):1699-706, 2000