Which sequence correctly lists the order of tibial growth plate closure?

• A. Central, Anteromedial, Posteromedial, Lateral
• B. Central, Posteromedial, Anteromedial, Lateral
• C. Central, Anteromedial, Lateral, Posteromedial
• D. Lateral, Central, Anteromedial, Posteromedial

Answer: (A)

Closure of the distal tibial growth plate occurs in a defined, regional sequence rather than all at once. Ossification begins in the center of the physis and propagates outward, with the tibia revealing a characteristic order: central first, followed by the anteromedial region, then the posteromedial region, and finally the lateral region. This progression reflects the underlying biology of ossification fronts and vascular/structural factors that influence which areas ossify earlier. Thus central closure starts the process, the anteromedial area closes next, the posteromedial area after that, and the lateral side remains open longest. That’s why the sequence central → anteromedial → posteromedial → lateral matches the observed pattern. Sequences that place lateral earlier or mix the regional fronts do not correspond to how the distal tibial physis typically closes.