ORTHOPEDIC CONDITIONS

What are growth plate injuries?

Your child’s bones are constantly growing. On average, boys grow until about age 16 and girls grow until about age 14 (or two years after menarche). There is variability with some children completing their growth earlier or later.  Some growth plates can mature earlier, such as the hip or ankle growth plates compared to the knee. Others mature later. The growth plates in the clavicle, or collar bone, close last at about age 25.

While growing, most long bones grow from a region of soft cartilage.  This area is known as the growth plate, and it hardens into solid bone once your child finishes growing. However, while the growth plate is cartilage, it is highly susceptible to injury.  Because the growth plate is often weaker than surrounding ligaments and bone, injury patterns that are often associated with ligament sprains in adults can result in growth plate fractures in children.  The geometry of soft growth plates next to harder bony structures can result in unique injury patterns depending on the child’s age and injury location.

The growth plates are important because they determine the end length and shape of the adult bone. If your child sustains a growth plate injury, it’s vital to have them seen by a specialist as soon as possible.

Overuse Injuries to the Growth Plate

Some young athletes may sustain growth plate injuries from overuse. Widening of the upper humerus growth plate is seen most frequently in young baseball pitchers (“Little League Shoulder”). Growth plate injuries to the wrist, knee and other locations can be sustained by young gymnasts.

Apophysitis: Growth Plate inflammation at Tendon Insertions

Some growth plate injuries arise from overuse and are common in older children and young adolescents. A growth plate near a tendon insertion is called an apophysis; inflammation of these growth plates is called apophysitis.  Common types of apophysitis include but are not limited to the following.

• Osgood-Schlatter disease is a painful inflammation at the insertion of the patellar tendon to the tibia below the knee joint. 

• Sever’s disease or calcaneal apophysitis is a painful inflammation of the heel in growing children.

• Iselin’s disease is a painful inflammation of the fifth metatarsal base. 

Fortunately, these conditions can usually be treated with non-surgical measures, and very rarely require surgery. 

Growth Disturbance or Arrest

Growth plate injuries can be especially problematic if the growth plate does not recover and resume normal growth.  When the growth plate grows unevenly, this is called a growth disturbance and can lead to an angular deformity.  When the growth plate stops growing altogether, this is called a growth arrest and can lead to a limb length discrepancy (especially in the lower extremity) or disrupt relationships between adjacent bones (especially at the wrist and ankle).

The incidence of growth disturbance after growth plate fractures is influenced by the location, pattern, and severity of the fracture. Growth disturbance is seen in the majority (60%+) of patients with growth plate fractures to the lower femur, where fractures typically pass through multiple cartilage zones due to the growth plate’s wavy geometry.  With some other types of growth plate fractures, such as those involving the phalanges of the fingers and toes, growth disturbance is extremely rare with an incidence estimated in one study at approximately one in a thousand.  The incidence for most other bones fall somewhere between these two extremes. Growth disturbance is more problematic in younger children due to their large amount of remaining growth than in adolescents nearing skeletal maturity, who may have little remaining growth. 

What are the symptoms of a growth plate injury?

If your child is active in sports, it’s more likely that they’ll suffer a growth plate injury. The injury could be due to a fall or direct contact, as well as repetitive stress on a certain bone. Various symptoms may accompany growth plate fractures, including:

• Pain 

• Swelling (may be mild)

• Tenderness over the growth plate

• Trouble using the affected part of the limb

• Limp or refusal to bear weight

Depending on the area of the growth plate fracture, your child’s symptoms may range from mild to severe. Because nondisplaced growth plate injuries are often stable and without deformity, it is not uncommon for parents of children with these injuries to be unaware that a fracture is present until they are diagnosed by a pediatric orthopedic surgeon.

How are growth plate injuries treated?

If the team at C4K thinks your child may have a growth plate fracture, they will perform a clinical exam and order an x-ray.  Occasionally, subtle fractures may be detected only on MRI, although this imaging modality is unnecessary for the vast majority of growth plate injuries.

If your child has fractured their growth plate, there are many treatments that the practice provides to stabilize the fracture and potentially reduce risks of future problems. 

In mild growth plate fractures, a cast or splint may be applied to stabilize the bone as it heals. Displaced fractures may require the bone to be set.  More serious injuries may require surgery to align and stabilize the bone.  Overuse-related apophysitis may be treated with activity modification and anti-inflammatory medication alone, with immobilization reserved for severe or resistant cases.

If a displaced growth plate fracture needs to be set or repositioned, time is of the essence.  For many growth plate fractures, the bone can be set only within the first few days after injury.  After that time, the disruption of healing tissue in the growth plate can actually increase the risk of permanent growth plate damage.  When a patient with a displaced growth plate fractures presents after the appropriate window for setting the bone, sometimes it is necessary to wait for the fracture to heal and then to perform corrective surgery on a delayed basis to avoid further trauma to the growth plate. 

Based on the risk of growth disturbance after a growth plate injury, long-term follow-up imaging may be recommended for some fractures and may be unnecessary for others.  Because growth disturbance is not seen on initial x-rays but becomes manifest only over time, it may take  6-9 months after a fracture to know whether growth disturbance is present.

If you believe that your child may have suffered a  growth plate injury, call the office today, or book a consultation on the website