Children’s Growth Plates:
Nutrition becomes 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 becomes damaged through sports accidents, they are painful and 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 with 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, composed of cartilage, are crucial areas at each end of long bones, such as the femur and tibia. They facilitate bone growth by contributing new bone tissue. Due to their softness, these regions are susceptible to injury during a child’s development. In fact, approximately 30% of fractures in children affect areas around growth plates. As the child grows, these plates gradually harden into solid bone, ceasing growth once fully closed. Any damage to these plates can disrupt normal bone growth, necessitating expert evaluation and care to ensure proper healing.
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 parents should have their child’s fracture evaluated by a pediatric orthopedic doctor.
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 similarly to broken bones, with trauma being a leading cause. Falls or collisions, common in contact sports like soccer and basketball, account for about 30% of growth plate injuries, while recreational activities contribute to another 20%. Overuse or repetitive injuries, such as those seen in young athletes like Little League baseball players or gymnasts, can also lead to growth plate damage, causing pain and swelling in affected areas. A growth plate can become damaged by the following:
A fall or collision results in 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 who 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, fractures involving this area need immediate attention by an expert. If a plate fracture is not treated correctly and timely, it can lead to a deformed limb (arm or leg) 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 a doctor provides the proper treatment.
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 most common 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
As mentioned earlier on this page, a child’s bones heal quickly, and a growth plate injury needs to be examined by a doctor as soon as possible. Ideally, a pediatric orthopedist should examine the injury 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
- Associated injuries.
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.
If the fragments of the bone are significantly displaced and the fracture is not stable, the doctor will recommend surgery. 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 surgeon will manipulate the bones so that they are properly aligned and sometimes fixed in place by using 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.
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.
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 result from 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 Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX. 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.