Growth plates are the areas of new bone growth in children and teens. They are made up of cartilage, a gelatinous tissue and are found near the ends of the long bones. Growth plates are one of the ways the bones grow. As children grow, the growth plates harden and eventually close. After the closure of the growth plate at a certain age, the height stops increasing.
Bone fractures in children heal quickly as compared to adults, but fractures of the growth plate may require several weeks to heal. The length of immobilization time (rest) varies depending on the severity of the fracture. In a worst-case scenario, if a child’s growth plate is disrupted, the bone can undergo what is called growth arrest, which means the bone stops growing. This is rare and usually only happens if the fracture is not diagnosed and treated properly. The other bones will continue to grow, and this affects the joint near the injury. An injured growth plate can cause the bone to be short compared to the normal bone, resulting in disfigurement or disability.
- After the fracture heals, the orthopedist may recommend specific exercises to strengthen and improve the range of motion of the joints involved.
- Fractures of the growth plate should be carefully monitored to ensure good long-term results. Regular follow up with the orthopedist should continue for at least one year after the injury to exclude the possibility of any complication.
- More complex fractures may require monitoring until the child reaches skeletal maturity. Ongoing observation after healing may also be required to ensure proper growth.
- Returning to the doctor periodically to measure the injured limb’s growth in comparison to its corresponding limb is recommended in certain cases.
With proper treatment and maintenance, most growth plate fractures will heal without significant problems.
What are growth plate fractures?
Growth plate fractures are quite common injuries. Most fractures of the growth plate do not result in any problems. However, sometimes, the fracture injures enough of the growth cartilage to prevent it from growing properly. The growth plates are particularly vulnerable because they form the last stage of development in children. About 15 to 30 percent of childhood fractures are related to the growth plate and they determine the future shape and length of the bone. A growth plate fracture can occur quite unexpectedly due to the sensitive nature of that area of the skeleton. The fracture often occurs from injuries that would cause only joint sprains in adults. Salter-Harris grading system is the most widely used classification system by the medical community to grade fractures.
- Type I fractures break at the growth plate, separating the bone end from the bone shaft, completely disrupting the growth plate itself.
- Type II fractures break through part of the bone at the growth plate and crack through the bone shaft as well. This is the most common type of growth plate fracture.
- Type III fractures cross through a portion of the growth plate and break off a piece of the bone end as well. This type of fracture is more common in older children.
- Type IV fractures break through the bone shaft, the growth plate and the end of the bone.
- Type V fractures occur due to a crushing injury to the growth plate from a compression force. Fortunately, these types of growth plate fractures are relatively rare.
Signs and symptoms of a growth plate injury are the same as those for a broken bone and include
- The inability to put weight or pressure on the limb
- Pain or discomfort
- The inability to move the limb
Causes of growth plate injuries and fractures
- Most of the time, growth plate injuries happen from falling or twisting.
- Contact sports (such as football or basketball) or fast-moving activities (such as skiing, skateboarding, sledding or biking) are common causes.
- Injuries can also happen from activities that require repetitive training, such as gymnastics, track and field or pitching a baseball.
- Other causes may also include
What are the treatment options for growth plate fractures?
The method of treatment will depend on the type of fracture and the acuteness of the injury. Most of the time only splinting or casting is necessary, followed by resting the extremity. If the bones are out of place, they must be put back together in correct alignment by a reduction procedure. There are two types of reductions
- A closed reduction is moving the bones back into place without operating or making an incision. The skin remains closed.
- An open reduction involves surgery and possible placement of plates, pins or screws. This is done under general anesthesia. The bones are then immobilized by a cast or splint with prolonged rest of the arm or leg.
Since a child’s bones heal quickly, a possible growth plate fracture assessment by a pediatric orthopedist physician is critical within five to seven days from the injury to provide the proper treatment before healing begins. With accurate diagnosis and treatment, most growth plate injuries heal without complications. If left untreated, permanent damage can impact the proper growth of the involved limb.
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Yale Medicine: "Growth Plate Injuries." https://www.yalemedicine.org/conditions/growth-plate-injuries
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