$Pediatric Orthopedic Surgeons treating a growth plate fracture$

GROWTH PLATE INJURIES AND FRACTURES

A growth plate fracture affects the layer of growing tissue near the ends of a child’s bones. Growth plates are the softest and weakest sections of the skeleton.

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Growth Plate Injuries and Fractures

Growth plates are tender regions of growing cartilage on the ends of a child’s bones. The growth plates, which help determine the length and form of the bone, are where the long bones in a child’s body develop rather than from the bone’s center outward. The growth plates are vulnerable to damage when a child’s bones are growing and developing. Untreated growth plate injuries might prevent the bone from growing normally. The growth plates become bone when a youngster is completely developed.

Growth Plate Injuries

Growth Plate Fracture The patches of developing cartilaginous tissue present at the ends of children’s long bones are known as growth plates, sometimes known as the epiphyseal plate or physis. The size and form of the adult bone are determined by these growth plates. Because they are not as hard as bones, the growth plates are more prone to injury and they can crack or break. Children and teens who are developing frequently have growth plate injuries. When a youngster has a serious joint injury, the growth plate may shatter rather than suffer ligament damage.

A child’s growth plate can fracture from any accident that would only result in a sprain for an adult. Fractures commonly occur in children when they experience a growth plate injury. In contrast, growth plates can also suffer from overuse and repetitive motion injuries, just like adults.

Sports participation is a common cause of growth plate injuries brought on by repeated action and misuse. The following terms might also refer to a Growth Plate injury:

Little League elbow
Little League shoulder
Jumper’s knee
Saver’s disease

QUESTIONS AND ANSWERS

What is a growth plate injury, and how does it occur in children?

A growth plate injury, also known as a physeal fracture, occurs when there is damage to the growth plate, which is a cartilaginous area near the end of a child’s long bones. Growth plates are responsible for bone growth and elongation during childhood and adolescence. These injuries typically happen due to trauma or an accident, such as a fall or sports-related injury, where the force applied to the bone is concentrated at the growth plate. Children’s bones are still growing, and their growth plates are more vulnerable to injury than adult bones.

How can a growth plate injury be diagnosed and treated in children?

Diagnosis and treatment of growth plate injuries involve the following steps:

Clinical Evaluation: A healthcare provider will conduct a physical examination to assess the injured area, looking for signs of tenderness, swelling, and deformity. This hands-on assessment is crucial, as some growth plate fractures may not be visible on X-rays. These fractures often occur in the cartilage, which is less dense than bone, making them difficult to detect through imaging alone.
Understanding Bone Differences: Children’s bones differ structurally from adults’, necessitating a specialized approach. Pediatric specialists are trained to recognize subtle signs of growth plate fractures that might be missed or misinterpreted. For instance, minor changes visible on X-rays can sometimes indicate a fracture, but in other cases, these changes may simply reflect normal development or growth patterns.

The clinical exam, therefore, plays a vital role in ensuring accurate diagnosis, guiding the appropriate treatment plan, and ultimately supporting the healthy growth and recovery of the child.

Imaging: X-rays are commonly used to visualize the injury and assess its severity. In some cases, additional imaging techniques like MRI or CT scans may be necessary to obtain a more detailed view.
Classification: Growth plate injuries are classified into several types (e.g., Salter-Harris classification) based on the extent of damage to the growth plate and surrounding bone. The type of fracture determines the treatment approach.
Treatment: Treatment options may include:
- Casting or Splinting: Some growth plate injuries may be treated non-surgically with immobilization using a cast or splint.
- Surgery: In more severe cases, surgery may be required to realign the fractured bones and stabilize the growth plate.
- Close Monitoring: Close follow-up with a healthcare provider is essential to monitor the healing process and assess any potential complications.

What are the potential long-term effects of a growth plate injury in children?

The long-term effects of a growth plate injury can vary depending on the type and severity of the injury. Because a child’s bones heal quickly, a potential growth plate injury should be examined by a doctor as quickly as possible. It is important that the bone receives the proper treatment before it begins to heal to prevent complications. Common considerations include:

Growth Impairment: Severe growth plate injuries can lead to unequal bone growth, resulting in limb length discrepancies or angular deformities.
Joint Function: Growth plate injuries near joints may affect joint function and mobility.
Arthritis: Some growth plate injuries, particularly those involving the joint surface, may increase the risk of developing arthritis in adulthood.
Recovery Time: The time it takes for a child to recover from a growth plate injury varies, but early diagnosis and appropriate treatment can help minimize long-term complications.

The emphasis on immediate medical evaluation cannot be overstated. Ensuring that the injury is properly assessed and treated swiftly is crucial to mitigating these risks and promoting optimal recovery.

Essential Follow-Up Care

To ensure favorable long-term outcomes, growth plate fractures with potential risks need early treatment and vigilant follow-up. Regular check-ups are vital, continuing for at least a year post-injury to make sure the growth plate is developing correctly.

Monitoring Complicated Fractures

More complex fractures, particularly those affecting the femur and tibia, may necessitate follow-up visits extending until the child reaches skeletal maturity. This extended monitoring is crucial to address any potential growth issues that could arise as the child’s bones mature.

These steps are essential to not only support recovery but also to preemptively manage any complications, safeguarding the child’s long-term health and mobility.

The doctors at Medical City Children’s Orthopedics and Spine Specialists, are experts in treating growth plate injuries and Fractures. To ensure your child’s bones heal properly, call us for an appointment

What are Growth Plate Fractures?

A child’s or adolescent’s growth plate can crack or break, and this condition is known as a growth plate fracture. A growth plate is a portion of cartilage-based tissue that is located at the extremities of the body’s long bones. Cartilage is a flexible, rubbery material (fingers, arms, and legs). Every long bone in the body has two growth plates, one on each end. As the kid develops, the growth plates dictate the length and form of the child’s bones. The growth plates will form into solid bone when a youngster has reached their maximum height.

Types of Growth Plate Fractures

Simple or open fractures are both possible:

Simple fractures are breaks or fissures in the bone that do not penetrate the skin.
Open fractures are breaks in which the bone protrudes through the skin.

Multiple Factors Can Result in Growth Plate Fractures:

Traumatic fractures develop as a result of trauma, such as falling when jogging, cycling, or using a skateboard. Children who are healthy and have strong bones can sustain these kinds of wounds. The bone fractures when it is subjected to a force it cannot withstand. Most fractures result from trauma. Growth plate injuries can result from trauma that fractures bones. Children who repeatedly perform the same position or action for extended periods risk developing stress fractures. Additionally, repeated movements might harm developing plates. Stress fractures are rare.

The reason why bones break pathologically is that they are weaker than usual. Typically, a pathologic fracture results from holes in the bone (bony cysts) or certain bone disorders, including brittle bone disorder (osteogenesis imperfecta), which causes bones to shatter readily. This is a rare reason for fractures.

Causes of Growth Plate Fractures

Growth plate fractures frequently result from a single incident, such as a fall or auto collision. As a result of recurrent stress on the bone, which can happen when a youngster overtrains in a sport, they can also develop gradually. Growth plate injuries can happen to any kid who is still developing, however, several things may increase the risk:

Boys get growth plate fractures twice as frequently as females do because girls reach their full height earlier than boys.
When taking part in competitive sports like football, basketball, or gymnastics, growth plate fractures frequently happen.
When engaging in leisure activities like riding, sledding, skiing, or skating, many growth plate fractures happen.
Adolescence is the time when growth plate fractures are most common.

Factors affecting the risk of growth problems from these fractures include:

The patient’s age: Younger patients may face increased risks of growth complications.
The bone involved: Different bones can have varying implications for growth, influencing recovery.
Specific fracture pattern: The complexity and nature of the fracture significantly impact potential growth issues.
Degree of displacement: How much the bone is out of alignment can affect the risk of future growth problems.

Understanding these factors is crucial for assessing the potential long-term effects of growth plate fractures and ensuring effective treatment and recovery strategies.

Symptoms of a Growth Plate Fracture

Depending on how bad the fracture is, different growth plate fracture symptoms may occur. A youngster may have moderate discomfort occasionally, while at other times the damage may be more obvious and urgent. A growth plate fracture may cause the following symptoms:

Swelling or pain in the affected limb.
The wounded region has a clear malformation.
Inability to use or move the damaged region normally.
The wounded region may feel heated, bruised, or red.

Complications

Serious complications from growth plate fractures are quite uncommon. When identified and treated promptly, the majority of these fractures recover smoothly and without lasting issues. Growth plates, found in children and adolescents, are zones of cartilage near the ends of long bones where growth occurs. While they are vulnerable to injury, effective medical treatment can usually prevent long-term damage.

Key Points to Consider:

Timeliness of Treatment: Prompt medical attention is crucial. The sooner a fracture is diagnosed and treated, the better the outcome.
Medical Interventions: Standard treatments, such as casting or surgical intervention, are generally successful in ensuring proper healing.
Monitoring Recovery: Follow-up appointments are essential to track recovery progress and adjust treatment if necessary.

Overall, with appropriate care, the likelihood of severe issues arising from growth plate fractures is low.

Treatment of Growth Plate Injuries

The nature of the damage determines the treatment plan for growth plate injuries. Following an accident, therapy should begin as soon as feasible and often consists of one or more of the following.

Fracture Reduction

Following the standard alignment of fractured bones, the doctor places the afflicted limb in a cast or splint to inhibit movement and give the bone time to heal. Your kid or teen should minimize any activities that put pressure on the wounded region to assist in encouraging recovery. The doctor will typically need to realign the bones or joints in your child’s body if their injuries result in the ends of the broken bones being out of alignment (displaced).

The name of this process is Fracture reduction. The method that surgeons use to fix bones depends on the kind of growth plate fracture that your kid has. When a doctor does a closed reduction, they use their hands to set and position the bone.

Open Reduction

Based on the injury, some growth plate injuries and fractures will require surgery to align and stabilize the bones. The surgery usually requires smooth metal pins to hold the bone in place to cause the proper fusion of the damaged growth plate. After surgery, doctors often use a cast to immobilize the injured area to allow proper bone healing. The cast should stay in place until the injury is fully healed.

The bone can, for instance, be misaligned or a little longer or shorter than intended. Your doctor will often advise follow-up visits to check on the progress of the bone and look for any changes in growth and development to help prevent issues with bone growth. Most kids and teenagers who get prompt treatment recover without experiencing further developmental issues. Depending on the sort of activity and your child’s recuperation, you can determine when your child can resume normal activities and sports.

Exercises for Enhancing Strength and Motion

After the wound has healed, your child’s doctor could suggest activities to strengthen the muscles that support the wounded portion of the bone. A stronger youngster will move his or her limbs easier, and for others, physical therapy can strengthen the body as necessary. To create an activity program, a physical therapist can collaborate with your child.

How is a Fractured Growth Plate Managed?

To prevent it from impeding normal bone growth, a growth plate fracture needs treatment that is very carefully and expertly implemented. The severity of the growth plate and connected bone fracture will determine the appropriate course of treatment. The treatment approach for growth plate fractures is tailored to several critical factors. Understanding these can guide the appropriate medical response:

Injury Location: The specific bone injured can greatly affect how the fracture becomes treated.
Fracture Type: Different types of fractures require distinct treatment strategies.
Bone Displacement: The degree to which the broken ends of the bone are displaced becomes crucial in determining the need for realignment.
Child’s Age and Health: Younger children may heal differently than older ones, and overall health can impact recovery.
Associated Injuries: Other injuries can complicate treatment and may require additional medical attention.

The Salter-Harris classification system is a widely recognized method used to categorize growth plate fractures, crucial in pediatric orthopedics. This system helps healthcare professionals understand the severity and implications of each fracture type. Here’s a breakdown:

Type I fracture

Type I fractures occur when the fracture line passes through the growth plate, effectively separating the bone end from the bone shaft. This complete disruption of the growth plate is a defining characteristic of Type I fractures. In order to preserve the growth plate as it heals, the doctor may frequently advise the patient to wear a cast. In most situations, the bone will have healed properly when the doctor removes the cast.

This approach ensures that the growth plate is protected during the healing process, promoting proper bone development and reducing the risk of long-term complications.

Type II fracture

Type II growth plate fractures are characterized by a break through part of the bone at the growth plate and a crack extending through the bone shaft. This is the most common type of growth plate fracture, often occurring in children and adolescents during their growth spurts. To ensure that the bone heals properly, doctors will recommend placing the limb in a cast after the doctor puts the bones into their proper position. After that, normal healing happens.

Understanding the nature of these fractures is crucial for effective treatment, which typically involves immobilizing the limb to allow the growth plate and bone shaft to heal correctly.

Type III fracture

Type III fractures cross through a portion of the growth plate, breaking off a piece of the bone end. This type of fracture is more common in older children, affecting their developing bones uniquely. In such cases, doctors may recommend surgery. This approach helps ensure proper alignment and healing, which is crucial for maintaining long-term bone health and function.

Type IV fracture

Type IV fractures are complex and involve a break through the bone shaft, the growth plate, and the end of the bone. This type of fracture affects multiple critical areas, making its management crucial for proper healing. Surgery is frequently required for this kind of break. To make sure all the broken components are aligned for healing, doctors will use metal screws, pins, or plates.

By addressing the fracture path through essential bone structures, healthcare professionals can better formulate an effective treatment plan, ensuring the best possible recovery outcomes.

Type V fracture

Surgery is necessary for this fracture since it refers to a significant injury that will stunt the child’s growth. These fractures occur due to a crushing injury to the growth plate from a compression force. As a result, the growth plate suffers severe damage, which can lead to long-term developmental issues if not addressed promptly.

Type V fractures are rare, which makes them particularly challenging to diagnose and treat effectively. The rarity underscores the importance of specialized medical attention to mitigate the potential impact on growth and development.

By considering these factors and fracture types, medical professionals can offer a tailored treatment plan that best supports the child’s recovery and long-term health.

Where Do Most Growth Plate Fractures Occur?

Growth plate fractures are most frequently found in several key areas of the body. Primarily, they affect the long bones within the fingers. Additionally, these fractures frequently occur in the forearm, particularly in the radius, which is the bone located on the outer side of the forearm. Another common site for these injuries is the tibia and fibula, the lower bones of the leg.

By focusing on these areas, healthcare professionals can better diagnose and treat growth plate injuries, crucial for ensuring proper bone development in growing children and adolescents.

Conclusion

Even though every person is unique, recovery from a growth plate fracture usually takes several weeks. A child’s bones do heal quickly, but the duration can vary based on the fracture’s severity. If cast immobilization is used, the length of time the cast is worn will also depend on how severe the fracture is.

To keep an eye on the child and ensure that the bones are continuing to repair and grow normally, the doctor may also ask for numerous follow-up sessions. These visits often include X-rays to ensure that bone growth is proceeding correctly. Growth plate fractures with risks for complications must be treated early and monitored carefully for proper long-term results.

The Medical City Children’s Orthopedics and Spine Specialists

The Medical City Children’s Orthopedics and Spine Specialists doctors only treat children. Our doctors at Medical City Children’s Orthopedics and Spine Specialists are located in five convenient locations: Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX, for families in the Dallas and Fort Worth area. Selecting a pediatric orthopedic doctor for your child is a crucial decision that requires careful consideration.

Doctors Shyam Kishan, Richard Hostin, and Kathryn Wiesman have spent years studying children’s health and have devoted their lives to treating them. This will aid in the patient’s recovery of mobility, strengthen the muscles around the wounded area, and minimize any stiffness that may develop after weeks of immobilization.

Regular follow-up visits to the doctor should continue for at least a year after the injury to ensure the growth plate is developing appropriately. More complicated fractures, such as those involving the femur and tibia, may require follow-up until the child reaches skeletal maturity, ensuring optimal outcomes for their growing bones.

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Footnote:

American Academy of Orthopaedic Surgeons: Growth Plate Fractures

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