What is a growth plate fracture?

A growth plate fracture is a crack or break in the growth plate in the bone of a child or adolescent. A growth plate is a section of tissue, made up of cartilage, a rubbery, flexible substance, that is found at the ends of the long bones of the body (finger, arms and legs).

There are two growth plates, one at each end of each long bone in the body. The growth plates determine the shape and length of the child’s bone as he or she grows. Once a child has stopped growing, the growth plates will harden into solid bone.

How common are growth plate fractures?

Up to one-third of all the fractures that occur in children are growth plate fractures. They are more common in boys than girls. In fact, boys are twice as likely to have growth plate fractures as girls, because girls’ bones stop growing and harden at an earlier age.

What causes growth plate fractures?

Fractures occur in the growth plate because it has not fully hardened into bone yet. The main causes of growth plate fractures are falls, accidents, or other types of trauma to the body. Repetitive or constant use of a joint—for instance, when a child is overworking the limb or joint when practicing sports such as pitching or gymnastics—can also cause growth plate fractures.

Other issues may cause a fracture of the growth plate include:

• Inherited medical problems
• Certain types of medication
• Physical abuse
• Bone infections
• Radiation
• Exposure to extreme cold

What are the symptoms of a growth plate fracture?

Symptoms of a growth plate fracture include:

• Pain
• Favoring the uninjured fingers, leg or arm
• Limited movement of a limb or joint
• A limb that looks different or bends awkwardly
• Swollen, bruised or tender area around the joint of the bone

Because children may not be able to tell anyone that that they are injured, adults must be alert for the symptoms or complaints from the child.

How is a growth plate fracture diagnosed?

If there is concern that a child may have a growth plate fracture, it is important that the child be seen by a doctor as soon as possible. The doctor will examine the patient and ask the parent or caregiver about the child’s medical history. As part of the examination, the doctor will gently touch the injured area and may carefully move the limb to check its range of motion.

The doctor may order X-rays of both the injured limb and the healthy one to look for any differences. The doctor may also order other imaging tests, such as a computerized tomography (CT) scan, magnetic resonance imaging (MRI) or ultrasound.

Growth plate fractures are usually categorized according to the Salter-Harris classification:

• Type I fracture: The bottom portion of the growth plate separates completely from the end of the bone. The bone remains in position.
• Type II fracture: This is a break that affects the growth plate and also part of the bone. It is the type most often seen in children.
• Type III fracture: This fracture is rare, and usually happens in older children. It occurs when the fracture goes through the growth plate and breaks off an end piece of the bone. This type of fracture often occurs in the lower leg.
• Type IV fracture: This affects the growth plate, the end of the bone, and a portion of the bone shaft. These fractures are most common in the upper arm bone near the elbow.
• Type V fracture: This fracture occurs when the growth plate is squeezed together and the end of the bone is crushed. This type of fracture is rare, and most often affects the bones of the ankle or knee.

How is a growth plate fracture treated?

A growth plate fracture must be treated quickly because it may interfere with proper bone growth. Treatment varies depending on how badly the growth plate and attached bone are fractured.

This is how the various types of growth plate fractures are treated:

• Type I fracture: The doctor will usually recommend a cast for the patient to help protect the growth plate while it is healing. In most cases, after the cast is removed, the bone will have healed normally.
• Type II fracture: A cast may be required and the doctor may need to set the bone, or move it into place, to make sure it heals properly. Normal healing then takes place.
• Type III fracture: Surgery may be recommended in these cases, but healing occurs normally.
• Type IV fracture: This type of break usually requires surgery. Metal screws, pins, or plates may also be recommended to make sure all the fractured pieces are aligned for healing.
• Type V fracture: This fracture is a serious injury and will affect the child’s growth, and requires surgery.

Although everyone is different, the healing process for a growth plate fracture typically takes several weeks. The doctor may also request a year of follow-up appointments to monitor the child and make sure the bones are continuing to heal and grow normally. X-rays are usually taken at the follow-up appointments.

After the fracture has healed, the doctor may recommend special exercises or physical therapy for the patient. This will help the patient regain mobility, strengthen the surrounding muscles, and lessen any stiffness that may occur from weeks of not moving the injured body part.

What are the complications associated with a growth plate fracture?

Most growth plate fractures heal quickly and without complications. However, patients who have Type IV and V fractures are at greater risk for further problems. Occasionally, the fracture may cut off the blood supply to the growth plate, which would cause slow healing and stunted growth.

If the growth plate is crushed, or severely injured, it may close and harden too early, before growth has been completed. If this happens, the patient is left with a hardened section of bone over the fracture line that may need to be repaired with surgery.

What is the prognosis (outlook) for patients who have a growth plate fracture?

If a growth plate fracture is diagnosed quickly after the injury occurs (within the first five days or so) and treated in a timely manner, the patient will recover and have no lasting issues. Occasionally, if the fracture is severe, affects multiple bones, or if bones are crushed, complications such as stunted growth may occur.