The role of secondary ossification centers in the management of epiphyseal and apophyseal fractures

The site where bone begins to form in the shaft of a long bone or the body of an irregular bone is called a primary ossification center. The site where bone formation continues after beginning in the long shaft or body of the bone, usually in an epiphysis is a secondary ossification center. A secondary ossification center is the center of bone formation appearing later than the punctum ossificationis primarium, usually in epiphysis. Secondary ossification centers for epiphyses and apophyses go through different stages of growth from the initiation of ossification to complete fusion. This paper will review the development of the secondary ossification centers, the mechanism of injuries, the pathophysiology of physical injuries, clinical diagnosis, investigations, and management. The goal of this review was to illustrate the variance in physeal injuries as they evolve during ossification and fusion. These patterns can be broadly broken down in to pre-ossification, ossification, and pre-fusion. This provides an understanding of particular patterns, mechanisms, diagnosis, and management options.