Growth plate 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 — sometimes even weaker than surrounding ligaments and tendons. An injury that might cause a joint sprain for an adult can cause a growth plate fracture in a child.

Growth plate fractures often need immediate treatment because they can affect how the bone will grow. An improperly treated growth plate fracture could result in a fractured bone ending up more crooked or shorter than its opposite limb. With proper treatment, most growth plate fractures heal without complications.

Most growth plate fractures occur in bones of the fingers, forearm and lower leg. Signs and symptoms of a growth plate fracture may include:

• Pain and tenderness, particularly in response to pressure on the growth plate
• Inability to move the affected area or to put weight or pressure on the limb
• Warmth and swelling at the end of a bone, near a joint

When to see a doctor

If you suspect a fracture, take your child to be examined by a doctor. Also have your child evaluated if you notice a visible deformity in your child’s arms or legs, or if your child is having trouble playing sports because of persistent pain.

Growth plate fractures often are caused by a fall or a blow to the limb, as might occur in:

• A car accident
• Competitive sports, such as football, basketball, running, dancing or gymnastics
• Recreational activities, such as biking, sledding, skiing or skateboarding

Growth plate fractures can occasionally be caused by overuse, which can occur during sports training or repetitive throwing.

Growth plate fractures occur twice as often in boys as in girls, because girls finish growing earlier than do boys. By the age of 12, most girls’ growth plates have already matured and been replaced with solid bone.

Most growth plate fractures heal with no complications. But the following factors can increase the risk of crooked, accelerated or stunted bone growth.

• Severity of the injury. If the growth plate has been shifted, shattered or crushed, the risk of limb deformity is greater.
• Age of the child. Younger children have more years of growth ahead of them, so if the growth plate is permanently damaged, there is more chance of deformity developing. If a child is almost done growing, permanent damage to the growth plate may cause only minimal deformity.
• Location of the injury. The growth plates around the knee are more sensitive to injury. A growth plate fracture at the knee can cause the leg to be shorter, longer or crooked if the growth plate has permanent damage. Growth plate injuries around the wrist and shoulder usually heal without problems.

Because growth plates haven’t hardened into solid bone, they are difficult to interpret on X-rays. Doctors may ask for X-rays of both the injured limb and the opposite limb so that they can be compared.

Sometimes a growth plate fracture cannot be seen on X-ray. If the child is tender over the area of the growth plate, your doctor may recommend a cast or a splint to protect the limb. X-rays are taken again in three to four weeks and, if there was a fracture, new bone healing will typically be seen at that time.

For more-serious injuries, scans that can visualize soft tissue — such as magnetic resonance imaging (MRI), computerized tomography (CT) or ultrasound — may be ordered.

Treatment for growth plate fractures depends on the severity of the fracture. The least serious fractures usually require only a cast or a splint. If the fracture crosses the growth plate or goes into the joint and is not well-aligned, surgery may be necessary. Growth plates that are surgically realigned may have a better chance of recovering and growing again than do growth plates that are left in a poor position.

At the time of injury, it’s difficult to tell if a growth plate has permanent damage. Your doctor may recommend checking X-rays for several years after the fracture to make sure the growth plate is growing appropriately. Depending on the location and severity of the fracture, your child may need follow-up visits until his or her bones have finished growing.

If your child is injured, you may go straight to an emergency room or urgent care clinic. Depending on the severity of the break, the doctor who first examines your child may recommend a consultation with a pediatric orthopedic surgeon.

What you can do

To prepare for your conversation with the doctor, you may want to write a quick list that includes:

• Your child’s symptoms
• How the injury occurred
• Your child’s key medical information, including any other medical problems and the names of all medications and vitamins he or she takes
• The sports or recreational activities in which your child regularly participates
• Questions you want to ask the doctor

What to expect from your doctor

Your doctor may ask:

• How did the injury happen?
• Where does it hurt?
• How much does it hurt?
• Does anything relieve the pain?
• Was there any pain in the affected area before the injury, such as during sports or recreational activity?
• What concerns do you have about your child’s return to sports or play?
• Have there been previous fractures?