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Growth Plate Injuries

The growth plate, also known as the epiphyseal plate or physis, is the area of growing tissue near the end of the long bones in children and adolescents. Each long bone has at least two growth plates: one at each end. The growth plate determines the future length and shape of the mature bone. When growth is complete - sometime during adolescence - the growth plates close and are replaced by solid bone.

The growth plate is the weakest part of the growing skeleton. Injuries to the plates are called fractures. They occur mainly at the wrist, bones of the legs, or in the ankle, foot, or hip bones. Growth plate injuries are most likely in 14- to 16-year-old boys and 11- to 13-year-old girls.

Diagnosis

After learning how the injury occurred and examining the child, the doctor will use x rays to determine the type of fracture and decide on a treatment plan. Because growth plates have not yet hardened into solid bone, they don’t show on x rays. Instead, they appear as gaps between the shaft of a long bone, called the metaphysis, and the end of the bone, called the epiphysis. Because injuries to the growth plate may be hard to see on x ray, an x ray of the noninjured side of the body may be taken so the two sides can be compared. Magnetic resonance imaging (MRI), which is another way of looking at bone, provides useful information on the appearance of the growth plate. In some cases, other diagnostic tests, such as computed tomography (CT) or ultrasound, will be used.

Causes

Growth plate injuries happen for many reasons. Most occur after a sudden accident, such as falling or being hit hard on the leg. People who sometimes get injuries from overuse include:

  • Gymnasts who practices for hours on the uneven bars
  • Long-distance runners
  • Baseball pitchers perfecting their curve balls.

The top reasons for growth plate injuries are:

  • Falling down
  • Competitive sports (like football)
  • Recreational activities
  • Car, motorcycle, and all-terrain-vehicle accidents (only in a small number of cases).

Other reasons for growth plate injuries are:

  • Child abuse
  • Injury from extreme cold (for example, frostbite)
  • Radiation (used to treat certain cancers)
  • Neurological disorders that cause people to lose their balance and fall
  • Some inherited disorders
  • Bone infections.

Treatment

Treatment, which should be started as soon as possible after injury, generally involves a mix of the following:

Immobilization

The affected limb is often put in a cast or splint, and the child is told to limit any activity that puts pressure on the injured area.

Manipulation or Surgery

If the fracture is displaced, the doctor will have to put the bones or joints back in their correct positions, either by using his or her hands (called manipulation) or by performing surgery (open reduction and internal fixation). After the procedure, the bone will be set in place so it can heal without moving. This is usually done with a cast that encloses the injured growth plate and the joints on both sides of it. The cast is left in place until the injury heals, which can take anywhere from a few weeks to two or more months for serious injuries. The need for manipulation or surgery depends on the location and extent of the injury, its effect on nearby nerves and blood vessels, and the child’s age.

Strengthening and Range-of-Motion Exercises

These treatments may also be recommended after the fracture is healed.

Long-Term Followup

Long-term followup is usually necessary to monitor the child’s recuperation and growth. Evaluation includes x rays of matching limbs at 3- to 6-month intervals for at least 2 years. Some fractures require periodic evaluations until the child’s bones have finished growing. Sometimes a growth arrest line may appear as a marker of the injury. Continued bone growth away from that line may mean that there will not be a long-term problem, and the doctor may decide to stop following the patient.

 

Reference:

National Institute of Arthritis and Musculoskeletal and Skin Diseases, USA.