Growth Plates

Children’s Growth Plates:

Nutrition is very important in maintaining the normal growth and development of a child. However, a child’s growth also depends on the bone growth plates themselves. When a plate is damaged through sports accidents, they are not only painful but can affect how long the arms, legs, hands, and feet of the child can grow.

Here at the Medical City Children’s Orthopedics and Spine Specialists, our doctors specialize in evaluating and treating limb deformities. Specifically, those that affect children, adolescents, and teenagers. That’s why we have fracture clinics available throughout the day. We have highly trained professionals in at least one of our offices available for walk-in patients throughout the day. Children’s emergencies are just that and we are available for you and your child. We will provide the right diagnosis and care for children with damaged or injured growth plates to help your child’s bones heal and grow properly.

What Are Growth Plates?

Growth plates refer to areas of cartilage in children at each end of the long bones (for instance the femur and tibia). These bones grow as a result of the contribution of new bone from the plate. Due to how soft they are, these areas are prone to be injured while a child is developing. This region is usually weaker than the tendons and ligaments that surround it. Hence, about 30 percent of fractures found in children can be found around these plates.

What Is the Function of a Growth Plate?

Growth plates are one of the ways through which bones grow.  They are usually found in each of the long bones and they increase the length and width of the bone.

As a child grows, the growth plate becomes hard and turns into a solid bone. A growth plate becomes closed after it has completely hardened into solid bone. The bones will not continue to grow after closure. That’s why it is so important to have your child’s fracture evaluated by a pediatric orthopedic.

When Growth Plates close

Growth plates close as the child approaches puberty. For girls, they close and become hard around the ages of 13 to 15 For boys, it closes around 15 to 17 years of age.

How Growth Plates Are Damaged

Growth plate injuries occur in the same way as broken bones. It depends on where the bone is damaged as to if the plate is a factor to consider. And if the plate is damaged, our pediatric orthopedic surgeons can determine the best plan for your child’s bone to heal correctly. A growth plate can be damaged by the following:

Trauma

A fall or collision is responsible for about 30% of growth plate injuries. This usually occurs while playing contact sports, like soccer, football, and basketball. Recreational activities, such as skiing and skateboarding, cause about 20% of plate injuries while the remaining 50% are due to general accidents.

Overuse/ repetitive injuries

An example of this type of injury is the little league baseball shoulder. Growth plates can get damaged by chronic stress or repetitive movement. For example, when our little leaguer throws balls too much. This stress or repetitive moment of his or her shoulder can lead to pain and swelling. This type of damage can also occur in the wrists of gymnasts and the body of athletes that participate in repetitive training.

Growth Plate Fractures

The bones of children and adults have most of the same risks for injury. However, since the bones of children are still growing, they are prone to a special type of injury known as a growth plate fracture. Since growth plates are soft and the last areas of the child’s bone get hard, they are vulnerable to fracture and damage.

Since growth plates determine the future length and shape of the bone, this form of fracture needs to be attended to promptly and by an expert. If a plate fracture is not treated correctly and timely, it can lead to a limb (arm or leg) that is deformed or unequal in length when compared to the other limb. Fortunately, serious growth plate problems are rare. Most plate fractures can easily heal without complications if the proper treatment is administered.

Most growth plate fractures take place in the long bones in the fingers. They also occur in the radius (i.e. the outer bone of the forearm) and the tibia and fibula (the lower bones of the leg).

Classification of Growth Plate Fractures

Different classification systems have been developed to classify the different forms of growth plate fractures. The Salter-Harris system, which is the most widely used classification system by doctors, is shown below:

Type I fractures

These types of fractures break through the bone at the growth plate. They separate the bone end from the bone shaft. This completely disrupts the plate’s ability to continue to grow bone.

Type II fractures

This class of fractures breaks through part of the bone at the growth plate and also cracks through the bone shaft. It is the commonest type of plate fracture.

Type III fractures

These fractures are usually found in older children. The fractures break through a section of the growth plate, thereby breaking off a piece of the end of the bone.

Type IV fractures

The fractures break through the bone shaft, the growth plate, and the end of the bone.

Type V fractures

These types of fractures are rare. They occur as a result of a compression force which causes a crushing injury to the growth plate.

Symptoms of Growth Plate Damage

If a child complains of having pain in the joints or shoulder, do not assume there is no pain because the child can still move his or her fingers or toes or because there is no visible bruising or swelling.

The most significant sign of a growth plate injury is tenderness at a single spot. The injury may not hurt anywhere apart from that point. Also, it may not look like something is wrong.

Other signs include the following:

• A deformed limb or slow-growing.
• Pain that causes an inability to continue activities.
• A change in the child’s performance in sports.
• Trouble walking

Our specialty-trained doctors will devise a personal treatment plan for your child’s growth plate injury to help the bone heal and grow properly.

When To See the Doctor

Since a child’s bones heal quickly, a growth plate injury needs to be examined by a doctor as soon as possible. Ideally, the injury should be examined within 5 to 7 days. The bone must receive the proper treatment before it starts healing.

After you have discussed your child’s symptoms and medical history with your doctor, he or she will carry out a detailed physical examination of the injured bone.

Your doctor may request an X-ray to further decide exactly where the injury is and if a growth plate fracture has occurred. The X-ray will provide clear images of the bone. If more details are required, your doctor may also ask for other tests that can reveal the soft tissues or a cross-sectional view of the injured area. These types of tests are diagnostic imaging tests like computed tomography (CT) scans and magnetic resonance imaging (MRI) scans.

Treatment of Growth Plate Fractures

The actual treatment for a growth plate fracture is determined by different factors which include:

• The bone that is injured
• The specific type of fracture
• The degree of displacement of the broken ends of the bone
• The child’s age and health, and
• Associated injuries.

Non-surgical treatment

Most growth plate fractures can successfully heal when a cast is applied to the injured area and some types of activities are limited. Doctors usually use immobilization when the broken bone fragments are not significantly displaced. The cast is used to protect the bones and hold them in the right position while the bones and growth plates heal.

Surgery

If the fragments of the bone are significantly displaced and the fracture is not stable, surgery may be required. The most common type of surgery used for this type of fracture is referred to as open reduction and internal fixation.

During the surgical procedure, the fragments of the bone are first repositioned to their alignment; a process referred to as reduction. Then, the bones will be fixed into place by using implants such as screws or wires, if needed. The surgeon can also attach metal plates to the outer part of the bone. The injured area is then protected and immobilized as it heals by using a cast.

Complications

Although most growth plate fractures can heal without any permanent effect, complications can still occur, this is why follow-up appointments are very crucial to your child’s healing process, so your doctor can monitor the healing process and make sure it is on track.

In rare cases, a bony bridge will form across the line of the fracture. This stunts the growth of the bone by curving the bone. If this is the case, the doctor can carry out a procedure to get rid of the bony bar and insert fat to prevent it from forming again.

A growth plate fracture may also stimulate growth that makes the injured bone end up longer than the opposite, uninjured limb. In this case, your doctor may recommend surgery to help the limb grow to an even length.

Recovery

Although a child’s bones heal quickly, a growth plate fracture may take several weeks to heal. If cast immobilization is used to treat the fracture, the period the cast is worn depends on how severe the fracture is.

After the bone has healed, your doctor will recommend some exercises that will strengthen the muscles supporting the injured area of the bone. These exercises will improve the motion of the joint in the affected area.

Request An Appointment At Medical City Children’s Orthopedics and Spine Specialists

If you detect any sign of a growth plate fracture in your child, ensure you make a doctor’s appointment as quickly as possible for a thorough evaluation. Without treatment, children are prone to pain and severe damage that can stunt their growth. When a child feels pain, the pain may be a result of a sprain, strain, or injury on the ligament. Immediate attention is usually necessary to figure out what the problem is and provide the right treatment.

The Medical City Children’s Orthopedics and Spine Specialists with offices in Dallas, Arlington, Frisco, and McKinney, Texas are board-certified physicians and fellowship-trained orthopedic surgeons.  They use a full range of treatments to heal growth plate fractures and return kids to the activities they enjoy. Get in touch with us today to schedule an appointment – at 214-556-0590.

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National Institute of Health: Growth Plate Fractures

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