Growth Plate Fractures
Growth plate fractures occur in areas at the ends of bones. These areas (called growth plates) are what enable children to grow. Growth plate fractures occur only in children and adolescents.
A growth plate may be fractured when repeated stress is put on a bone or when children are injured.
If a growth plate is fractured, the area over it is painful and swollen, and children have trouble moving the affected limb.
The bone may stop growing or grow crookedly.
Doctors suspect this fracture based on symptoms and can usually diagnose it based on x-rays.
Some growth plate fractures are treated with a cast or splint, but if the fracture is more severe, the broken pieces of bone are put back in place (reduced) with or without surgery, and then a cast is applied.
Growth plates are areas of cartilage in long bones (such as the arm and leg bones). They enable bones to lengthen until children reach their full height. When growth is completed, growth plates are replaced with bone. When growth stops varies by bone, but all growth plates are replaced with bone by age 20.
Because cartilage is more fragile than bone, growth plates are particularly vulnerable to fracture. When a growth plate is fractured, the bone may stop growing or grow crookedly. If a joint is involved, it may be permanently damaged, resulting in arthritis.
A fracture may occur straight across a growth plate, separating the bone from the cartilage. Or a fracture may extend above or below the growth plate, sometimes all the way through the end of the bone and into the joint. The most serious type of fracture is a compression fracture—when the growth plate is crushed.
If children have symptoms that suggest a growth plate fracture, they should be taken to a doctor or to an emergency department.
Doctors suspect a growth plate fracture based on symptoms.
X-rays can detect most growth fractures. However, certain types of growth fractures may not be detected. So sometimes children are assumed to have a fracture and are treated accordingly (with a cast or splint). Then they are reexamined in a few days. If the area is still tender and painful, they probably have a growth plate fracture.
Some growth plate fractures are treated by immobilizing the affected area—for example, with a cast or splint. If broken pieces of bone are widely separated or the fracture extends into a joint, the broken pieces are realigned, or put back in place (called reduction).
Depending on the type of growth fracture, reduction may or may not involve surgery. When possible, doctors move the pieces of bone back in place from outside the body—without making an incision. Then a cast or splint is used to hold the bones in place.
Sometimes reduction requires surgery, typically open reduction and internal fixation (ORIF—see Surgery). When ORIF is done, the broken bones are held in place using a combination of metal wires, pins, screws, rods, and plates.
If the growth plate is crushed, children are referred to a pediatric orthopedist because such injuries almost always result in abnormal growth.