Bone and Joint Institute, Inc
http://orthodoc.aaos.org/bonejointinstitute
Bone and Joint Institute, Inc
2325 Dougherty Ferry Rd
Suite 202
Des Peres, MO 63122 USA
Phone: 314 966 6480
Fax: 314 966 6416
Copyright 2010 American Academy of Orthopaedic Surgeons
Growth Plate Fractures
Description

The bones of children and adults share many of the same risks for injury. However, a child's bones are also subject to a unique injury called a growth plate fracture.

Growth plates are areas of developing cartilage tissue near the ends of long bones. The growth plate regulates and helps determine the length and shape of the mature bone.

The long bones of the body do not grow from the center outward. Instead, growth occurs at each end of the bone around the growth plate. When a child becomes full-grown, the growth plates harden into solid bone.

Growth plates are located between the widened part of the shaft of the bone (the metaphysis) and the end of the bone (the epiphysis). This diagram of a femur (thighbone) shows the location of the growth plates at both ends of the bone.
(Reproduced with permission from Sullivan JA: Introduction to the Musculoskeletal System, In Sullivan JA, Anderson SJ (eds): Care of the Young Athlete, Rosemont, IL, American Academy of Orthopaedic Surgeons and American Academy of Pediatrics, 2000, pp 243-258.)

Because growth plates are the last portion of bones to harden (ossify), they are vulnerable to fracture. In fact, because muscles and bones develop at different speeds, a child's bones may be weaker than the ligament tissues that connect the bones to other bones.

Children's bones heal faster than adult's bones. This has two important consequences:

  • A child with an injury should see a doctor as quickly as possible, so the bone gets the proper treatment before it begins to heal. Ideally, this means seeing an orthopaedic specialist within 5 to 7 days of the injury, especially if manipulation to align the bone is required.
  • The fracture will not need to stay in a cast for as long as an adult fracture would require for healing.

Appropriate evaluation by an orthopaedic surgeon experienced in orthopaedic trauma will determine the nature of the growth plate injury, will provide counseling about treatment options, and will allow for longer term follow up to assess the outcome of the injuries.

Statistics

Approximately 15% to 30% of all childhood fractures are growth plate fractures. These often require immediate attention because the long-term consequences may include limbs that are crooked or of unequal length.

Although growth plate injuries are common, serious problems are rare. Growth deformity occurs in 1% to 10% of all growth plate injuries.

Most growth plate fractures — more than 30% — occur in the long bones of the fingers. They are also common in the outer bone of the forearm (radius), and lower bones of the leg (the tibia and fibula).

Cause

Growth plate fractures can result from a single traumatic event, such as a fall or automobile accident, or from chronic stress and overuse.

Classification

Growth plate fractures are classified depending on the degree of damage to the growth plate itself.

Several classification systems of growth plate fractures have been developed. Perhaps the most widely used is the Salter-Harris system and is described here.

Salter-Harris classification of growth plate fractures.

Type I Fractures

These fractures break through the bone at the growth plate, separating the bone end from the bone shaft and completely disrupting the growth plate.

Type II Fractures

These fractures break through part of the bone at the growth plate and crack through the bone shaft as well.

Type III Fractures

These fractures cross through a portion of the growth plate and break off a piece of the bone end.

Type IV Fractures

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

Type V Fractures

These fractures occur due to a crushing injury to the growth plate from a compression force. They are rare fractures.

Risk

Who is at risk?

  • All children who are still growing are at risk for a growth plate injury. These injuries are reported to peak in adolescents.
  • Growth plate fractures occur twice as often in boys as in girls.
  • One third of all growth plate injuries occur in competitive sports, such as football, basketball, or gymnastics.
  • About 20 percent of growth plate fractures occur as a result of recreational activities, such as biking, sledding, skiing, or skateboarding.
Symptoms

Any child who experiences an injury that results in visible deformity, persistent or severe pain, or an inability to move or put pressure on a limb should be examined by a doctor.

Examination, Signs

The area around the end of the broken bone, near the joint, will be swollen, warm, very tender, and may appear crooked when compared to the uninjured side.

Investigation, Tests

To make the diagnosis, the doctor will examine the child and probably use x-rays to determine whether a growth plate fracture occurred. Occasionally, the doctor may request other diagnostic tests, such as magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound.

Treatment

Treatment depends on the fracture type, as described under "Classification" above.

In addition, there are other factors that may affect the bone growth and fracture healing. These include such things as the age and health of the patient, associated injuries, and the amount of displacement of the broken ends of the bone (occurring through the growth plates).

Type I Fractures

  • These fractures may result in disrupted bone growth.
  • Many can be treated with cast immobilization but surgical treatment may be necessary. If surgery is needed, these fractures are often treated with internal fixation (pins) to hold the bone together and ensure proper alignment.

Type II Fractures

  • These fractures generally heal well, although surgery may sometimes be required. This is the most common type of growth plate fracture.
  • Most are treated with cast immobilization.

Type III Fractures

This Type III fracture of the thighbone (femur) goes through the growth plate and down into the knee joint. The fracture is fixed in place with screws. This restores normal joint alignment.
  • These fractures are more common in older children. Because the center of the growth plate has begun to harden, the fracture does not continue across the bone, but angles down and breaks the bone end.
  • A Type III fracture is treated with surgery and internal fixation to ensure proper alignment of both the growth plate and the joint surface.

Type IV Fractures

  • These fractures commonly stop bone growth.
  • They are treated with surgery and internal fixation.

Type V Fractures

  • These fractures can often be treated with cast immobilization, or may require surgery.
  • There is almost always a growth disturbance with these fractures.
Long-Term Outcome

Growth plate fractures must be watched carefully to ensure proper long-term results.

In some cases, a bony bridge will form across the fracture line that prevents the bone from getting longer or causes the bone to curve. Orthopaedic surgeons have developed techniques to remove the bony bar and insert fat, cartilage, or other materials to prevent it from reforming.

In other cases, the fracture actually stimulates growth so that the injured bone is longer than the uninjured bone. Surgical techniques can help achieve a more even length.

Regular follow-up visits to the doctor should continue for at least a year after the fracture. Complicated fractures (types III, IV, and V) as well as fractures to the thighbone (femur) and shinbone (tibia) may need to be followed until the child reaches skeletal maturity.

Last reviewed: January 2010

Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist" program on this website.
Copyright 2010 American Academy of Orthopaedic Surgeons
Related Topics
Care of Casts and Splints (http://orthoinfo.aaos.org/topic.cfm?topic=A00095)
Forearm Fractures in Children (http://orthoinfo.aaos.org/topic.cfm?topic=A00039)
Fractures Overview (http://orthoinfo.aaos.org/topic.cfm?topic=A00139)
Internal Fixation for Fractures (http://orthoinfo.aaos.org/topic.cfm?topic=A00196)
Pediatric Thighbone (Femur) Fractures (http://orthoinfo.aaos.org/topic.cfm?topic=A00424)
OrthoInfo
The American Academy of Orthopaedic Surgeons
6300 N. River Road
Rosemont, IL 60018
Phone: 847.823.7186
Email: orthoinfo@aaos.org