Growth Plate Fracture

Children and adolescents should avoid athletic activities that place prolonged or repeated stress on bones. Correct technique, body placement and the right equipment will also reduce the chance of sustaining a growth plate fracture.

A growth plate fracture is a partial or complete break in an area of young bone known as the physis, found on the ends of long bones in children and adolescents. In girls, the growth plate continues to develop until puberty while in boys, the developing cartilage is often active until early adulthood, when it is replaced by bone.

How Injury Occurs
In adults, ligaments and tendons are most prone to injury. In children and adolescents, the ligaments and tendons can usually absorb the stress of a fall or blow, while growth plates are more likely to fracture. Prolonged and repeated stress due to athletic activities can also contribute to breaks. Faulty body mechanics, improper technique, tired muscles and using the wrong equipment all increase the risk of injury. Growth plate fractures can occur in any long bone, but the majority occur in the wrist and ankles.

Symptoms
The symptoms of growth plate fractures may resemble those associated with a sprain. They include pain, swelling and, in some cases, deformity. See your doctor right away to prevent permanent damage to the plate.

Risk Factors
All children and adolescents are vulnerable but a boy's risk of sustaining a fracture is twice that of a girl's. Approximately 75% of all growth plate fractures occur between the ages of 10 and 15.

Diagnosis
Your doctor will ask questions about the nature of the injury and will examine the area. Growth plate fractures are not always visible on X-rays, so a CT (computed tomography) scan, MRI (magnetic resonance imaging) or ultrasound may be ordered to get a clearer picture of the damage. After the fracture has been located and classified, treatment can be planned.

Classification
The Salter-Harris classification system is used to categorize the different types of growth plate fractures. There are 5 types of injuries:

• Type I is a fracture through the physis. The bone is usually not displaced and healing is typically rapid.
• Type II, the most common injury, is a fracture of the physis and metaphysis.
• Type III involves the physis and epiphysis.
• Type IV is a break through the epiphysis, physis and metaphysis.
• Type V is a compression fracture of the physis, a serious injury with a poor prognosis.

Treatment
Treatment depends on the type and severity of the fracture. Hands-on manipulation may be needed to set the bone in proper alignment. Surgery is indicated when the joint surface, blood supply or nerves are damaged. A rigid cast or splint may be used to hold the bone in place during healing. Exercises can help in regaining strength and range of motion, so your doctor may recommend physical or occupational therapy.

Complications
Most patients heal without long-term complications. However, because of their location, growth plate fractures can cause stunted or uneven bone growth. Recovery depends on the age of the child, the type, location and severity of the break and how well the rehabilitation program is followed.