Growth plates, also called the epiphyseal plate or physis, are areas of soft, growing cartilage found at the ends of long bones in children. These plates are essential in determining the final size and shape of the bones once they have fully grown. Since they are softer and less strong than the surrounding bone, they are more likely to be injured during accidents or trauma.
Growth plate injuries are common in children and teenagers. In younger people, serious joint injuries often affect the growth plates rather than the ligaments. What might be a sprain in an adult can result in a growth plate fracture in a child.
These fractures are more frequently seen in boys than in girls, as growth plates in girls typically fuse into bone earlier. They commonly occur in areas such as the wrist, forearm bones (radius), fingers (phalanges), legs (tibia and fibula), foot, ankle, or hip. Such injuries often result from sports activities like football, basketball, and gymnastics.
Types of growth plate fractures
Growth plate fractures can be classified into five categories based on the type of damage caused.
Type I – Fracture through the growth plate
The epiphysis is separated from the metaphysis with the growth plate remaining attached to the epiphysis. The epiphysis is the rounded end of the long bones below the growth plate and the metaphysis is the wider part at the end of the long bonesabove the growth plate.
Type II – Fracture through the growth plate and metaphysis
This is the most frequently occurring kind of growth plate fracture. It involves both the growth plate and the metaphysis, but it does not extend to the epiphysis.
Type III – Fracture through the growth plate and epiphysis
This injury occurs when a fracture passes through the epiphysis, separating it from both the growth plate and metaphysis. It most often affects the tibia, one of the major
long bones in the lower leg, leading to significant complications.
Type IV – Fracture through growth plate, metaphysis, and epiphysis:
Type IV is a fracture that passes through the epiphysis and the growth plate, continuing into the metaphysis. This type of fracture is most commonly observed in the upper arm, particularly near the elbow joint, and requires careful medical
attention.
Type V – Compression fracture through growth plate:
This type of fracture is a rare condition where the end of the bone gets crushed and the growth plate is compressed. It can occur at the knee or ankle joint.
Causes
Growth plate injuries typically occur due to accidental falls or impacts on the arms and legs, often during activities like gymnastics, baseball, or running. They may also result from repetitive stress or overuse of tendons, as well as certain bone-related conditions, such as infections, which can interfere with normal bone growth and development. Additional contributing factors that may lead to growth plate injuriesinclude various external and internal causes.
- Child abuse or neglect – Growth plate fractures are among the most frequent types of fractures seen in children who have been abused or neglected.
- Exposure to intense cold (frostbite) – Extremely cold climatic conditions can cause damage to the growth plates resulting in short fingers and destruction of the joint cartilage.
- Chemotherapy and medications – Chemotherapy used to treat cancer in children, along with the ongoing use of steroids for arthritis, can have an impact on the development of bones.
- Nervous system disorders –Children with disorders of the nerves may have sensory deficits and muscular imbalances that can cause them to lose their balance and fall.
- Genetic disorders –Gene mutations may result in poorly formed or malfunctioning growth plates which are vulnerable to fracture.
- Metabolic diseases –Diseases such as kidney failure and hormonal disturbances affect the proper functioning of the growth plates and increase susceptibility to fractures.
Signs and symptoms
Signs and symptoms of a growth plate injury include:
- Inability to move or put pressure on the injured extremity
- Unable to keep playing after an unexpected injury due to pain
- Severe pain or discomfort that stops someone from using an arm or a leg
- Persistent pain from a previous injury
- Abnormal shape of the legs or arms, as the joint area close to the end of the broken bone may become swollen
In children, bones usually heal faster than in adults. If a fracture that affects the growth plate is not treated correctly, it may heal improperly, causing the bone to become shorter and develop an abnormal shape.
Diagnosis
Your doctor will evaluate the condition by asking you about the injury and performing a physical examination of the child.
X-rays can help determine the type of fracture. Since the growth plates have not completely hardened and may not appear clearly on the image, X-rays of both the injured limb and a healthy limb are typically taken. This allows for a comparison between the two and helps pinpoint the exact location of the injury.
Other diagnostic tests your doctor may recommend include computed tomography(CT) scan or magnetic resonance imaging (MRI). These tests are helpful in detecting the type and extent of injury as it allows the doctor to see the growth plate and soft tissues.
Treatment
The treatment for growth plate injuries depends upon the typeof fracture involved. In all cases, the treatment should begin as early as possible and include the following:
- Immobilization:The injured limb may be covered with a cast or a splint, which the child is instructed to wear. The child will also be told to restrict their activities and refrain from applying pressure to the injured limb.
- Manipulation or surgery:If the fracture is displaced and the broken bone ends are not aligned correctly, your doctor will realign them into the proper position either by manually adjusting the bones or through surgery. In some cases, screws or wires may be used to keep the growth plate stable. Once the bones are properly aligned, a cast is applied to keep them in place and allow the bone to heal. The cast is taken off once the healing process is complete.
- Physical therapy:Exercises such as strengthening and range-of-motion activities should only start after the fracture has completely healed. These exercises help improve the strength of the muscles surrounding the injured area and increase the flexibility of the joint. A physical therapist will design an appropriate exercise plan that is suited to your child's specific requirements.
- Long-term follow up: Periodic evaluations are needed to monitor the child’s growth. Evaluation includes X-rays of matching limbs at intervals of 3 to 6 months for at least 2 years.
Most growth plate fractures typically heal without causing any lasting issues. In very rare cases, the affected bone may stop growing, resulting in it being shorter than the other limb.
