Growth Plate Fractures – Adolescent Injuries

While children and adults share many of the same risks for bone injury, but children are susceptible to a unique risk—their growing bones can suffer an injury called growth plate fracture, which occurs on the growth plates near the end of certain bones. This type of injury requires swift action, as the growth plate helps determine the future shape and length of the bone.

Anatomy and Description


Growth plates can be found in the bones of the body that are longer than they are wide, such as the femur or metacarpal bones in the hands. Most of these bones will have at least two growth plates, including one near each end. Growth on long bones doesn’t occur from the center out, but rather at the end of the bone around the growth plate. Once a child is fully grown, their growth plates will harden into solid bone.

Growth plate fractures are most common in the long bones of the fingers, the outer bone of the forearm and the lower bones of the leg. The most common system of classifying different types of fractures is the Salter-Harris system, which divides them into five different categories:

Type I fractures—These break through the bone, separating the bone end from the bone shaft and completely disrupting the growth plate.

Type II fractures—These break through part of the bone at the growth plate and crack through the bone shaft, as well. These types of fractures are the most common.

Type III fractures—These cross through part of the growth plate and break off a portion of the bone end. This type of fracture is more common in older children.

Type IV fractures—These break through the bone shaft, the growth plate and the end of the bone.

Type V fractures—These occur due to a crushing injury to the growth plate due to a compression force and are rare fractures.

Causes

Growth plate fractures are usually caused by a single event, such as a fall or car accident, but can also occur gradually due to repetitive stress on a bone. All growing children are at risk for growth plate fractures, but certain factors make them more likely to occur:

  • Growth plate fractures happen twice as often in boys because girls finish growing earlier than boys.
  • One-third of all growth plate fractures happen while a child is participating in competitive sports.
  • About 20 percent of all growth plate fractures happen during recreational activities such as biking or skateboarding.
  • The incidence of growth plate fractures peaks in adolescence.

Symptoms

Growth plate fractures can usually be identified by severe, persistent pain, but some other common symptoms include:

  • Visible deformity, such as a crooked appearance of the limb
  • An inability to move or put pressure on the limb
  • Swelling, warmth and tenderness in the area around the end of the bone, near the joint

Treatment

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Doctors will consider a number of factors when determining a treatment plan, including which bone is injured, the type of fracture, the child’s age and health and any associated injuries. Growth plate fractures can be treated both surgically and nonsurgically. Nonsurgical treatments typically involve immobilizing the afflicted area, meaning a cast is applied and the child is limited on certain types of activity. Doctors will use immobilization when broken bone fragments are not significantly out of place. If the bone fragments are significantly displaced and the fracture is unstable, surgery may be necessary. A cast is often applied after surgery to immobilize the area while the bone heals.

Recovery

A child’s bones will heal quickly, but growth plate fractures can still take a few weeks to heal. The length of time a cast is worn can vary depending on the severity of the fracture. After the bone is healed, your doctor may recommend exercises to strengthen muscles that support the injured area and improve range of motion.

To learn more about growth plate fractures, visit https://orthoinfo.aaos.org/en/diseases–conditions/growth-plate-fractures.