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- What Is the Growth Plate?
- Who Gets Growth Plate Injuries?
- What Causes Growth Plate Injuries?
- How Are Growth Plate Fractures Diagnosed?
- What Kind of Doctor Treats Growth Plate Injuries?
- How Are Growth Plate Injuries Treated?
- What Is the Prognosis for Growth in the Involved Limb of a Child With a Growth Plate Injury?
- What Are Researchers Trying To Learn About Growth Plate Injuries?
- Where Can People Find More Information About Growth Plate Injuries?
What Is the Growth Plate?
The growth plate, also known as the epiphyseal plate or physis, is the area of growing tissue near the end of the long bones in children and adolescents. Each long bone has at least two growth plates: one at each end. The growth plate determines the future length and shape of the mature bone. When growth is complete--sometime during adolescence--the growth plates close and are replaced by solid bone.
Who Gets Growth Plate Injuries?
These injuries occur in children and adolescents. The growth plate is the weakest area of the growing skeleton, weaker than the nearby ligaments and tendons that connect bones to other bones and muscles. In a growing child, a serious injury to a joint is more likely to damage a growth plate than the ligaments that stabilize the joint. An injury that would cause a sprain in an adult can be associated with a growth plate injury in a child.
Injuries to the growth plate are fractures. They comprise 15 percent of all childhood fractures. They occur twice as often in boys as in girls, with the greatest incidence among 14- to 16-year-old boys and 11- to 13-year-old girls. Older girls experience these fractures less often because their bodies mature at an earlier age than boys. As a result, their bones finish growing sooner, and their growth plates are replaced by stronger, solid bone.
Approximately half of all growth plate injuries occur in the lower end of the outer bone of the forearm (radius) at the wrist. These injuries also occur frequently in the lower bones of the leg (tibia and fibula). They can also occur in the upper leg bone (femur) or in the ankle, foot, or hip bone.
What Causes Growth Plate Injuries?
While growth plate injuries are caused by an acute event, such as a fall or a blow to a limb, chronic injuries can also result from overuse. For example, a gymnast who practices for hours on the uneven bars, a long-distance runner, or a baseball pitcher perfecting his curve ball can all have growth plate injuries.
In one large study of growth plate injuries in children, the majority resulted from a fall, usually while running or playing on furniture or playground equipment. Competitive sports, such as football, basketball, softball, track and field, and gymnastics, accounted for one-third of all injuries. Recreational activities, such as biking, sledding, skiing, and skateboarding, accounted for one-fifth of all growth plate fractures, while car, motorcycle, and all-terrain-vehicle accidents accounted for only a small percentage of fractures involving the growth plate.
Whether an injury is acute or due to overuse, a child who has pain that persists or affects athletic performance or the ability to move or put pressure on a limb should be examined by a doctor. A child should never be allowed or expected to "work through the pain."
Children who participate in athletic activity often experience some discomfort as they practice new movements. Some aches and pains can be expected, but a child's complaints always deserve careful attention. Some injuries, if left untreated, can cause permanent damage and interfere with proper growth of the involved limb.
Although many growth plate injuries are caused by accidents that occur during play or athletic activity, growth plates are also susceptible to other disorders, such as bone infection, that can alter their normal growth and development.
Additional Reasons for Growth Plate Injuries
- Child abuse can be a cause of skeletal injuries, especially in very young children, who still have years of bone growth remaining. One study reported that half of all fractures due to child abuse were found in children younger than age 1, whereas only 2 percent of accidental fractures occurred in this age group.
- Injury from extreme cold (for example, frostbite) can also damage the growth plate in children and result in short, stubby fingers or premature degenerative arthritis.
- Radiation, which is used to treat certain cancers in children, can damage the growth plate. Moreover, a recent study has suggested that chemotherapy given for childhood cancers may also negatively affect bone growth. The same is true of the prolonged use of steroids for rheumatoid arthritis.
- Children with certain neurological disorders that result in sensory deficit or muscular imbalance are prone to growth plate fractures, especially at the ankle and knee. Similar types of injury are seen in children who are born with insensitivity to pain.
- The growth plates are the site of many inherited disorders that affect the musculoskeletal system. Scientists are just beginning to understand the genes and gene mutations involved in skeletal formation, growth, and development. This new information is raising hopes for improving treatment of children who are born with poorly formed or improperly functioning growth plates.
Signs That Require a Visit to the Doctor
- Inability to continue play because of pain following an acute or sudden injury
- Decreased ability to play over the long term because of persistent pain following a previous injury
- Visible deformity of the child's arms or legs
- Severe pain from acute injuries that prevent the use of an arm or leg.
Adapted from Play It Safe, a Guide to Safety for Young Athletes with permission of the American Academy of Orthopaedic Surgeons.