What Is Growth Plate Fracture

 A break in the growth plate of a bone in a child is a growth plate fracture. In this article, you will read about the causes behind this fracture and learn about the management and treatment of growth plate fracture.

Overview

The growth plate, also known as the epiphyseal plate, is the area of cartilage present near the ends of long bones in children and is the last part to harden. The growth plate determines the future length and shape of the child’s bone once it is done growing.

Typically, a long bone (e.g. the thigh bone), the bones in the forearm (radius and ulna), and the bones in the hands and fingers (metacarpals)—has at least two growth plates, one at each end. Once your child has reached their last growing stage, the growth plate closes and is replaced by solid bone.

Causes of growth plate fracture

Growth plates are vulnerable to injury because they are softer and weaker. All growing children are at risk of growth plate injuries, but it peaks around adolescence. Injuries to the growth plate are called growth plate fractures which can be caused from:

• Various traumatic events such as a fall, overuse (repetitive stress), or a road traffic accident
• Participating in highly competitive and demanding sports like basketball, gymnastics, and baseball, or participating in activities such as biking, skateboarding and skiing
• A rare medical condition that may interfere with the growth and development of the child

Signs and symptoms of growth plate fracture

Symptoms of a growth plate injury include:

• Persistent pain and tenderness after a sudden injury. You may notice that your child is continuously complaining of pain and has limited the amount of time playing
• Visible redness and change in temperature, swelling and tenderness at the end of a bone
• Changes in the bone where it  appears misshapen compared to before the injury
• Lack of ability to move, or bear weight on a limb because of pain

Management and treatment of growth plate fracture

If you suspect your child has a growth plate fracture, you should seek medical advice immediately. The doctor will initially take a thorough medical history and examine your child. As growth plates consist of soft bone, fractures may not always show up on an X-ray. Other tests a doctor may suggest are Magnetic Resonance Imaging (MRI) or CT scans, but they may also go by the history and examination alone.

Treatment for growth plate fractures depends on

• The bone that is injured
• The type of fracture
• The age of the child
• Past medical history of the child

Nonsurgical treatment

Growth plate fractures can be treated conservatively and many such cases have been successfully healed. This may involve:

• Supportive aids like a cast or splint to immobilise the area
• Reducing pain through the use of painkillers as required
• Rest to allow the area to heal 
• Seeing a Physiotherapist to provide exercises once the fracture has healed

In cases where the broken fragments of bone are misplaced, cast immobilisation is recommended by the doctors, wherein a cast is applied to the injured area that protects the bone and keeps it in its original position. 

Surgical Treatment²

Reduction and internal fixation are two procedures that are opted for in the case of a surgical approach. If the injury is unstable and the bone fragments are displaced completely, a surgical approach is required.

There are two types of fracture reduction:

• Closed reduction- This is done without any incision. The child is given medicines to ease the pain and once the pain eases, the close reduction is performed. During the procedure, the bone fragments are first repositioned into their normal alignment. Afterwards, a cast is applied and the area is immobilised until the bone is healed
• Open reduction- This is done under anaesthesia. Metal plates and screws are used to fix the bones into the correct position
• Rehabilitation- Following any injury to the growth plate, it is important to increase the joint range of motion, build muscle strength and let the child participate in activities that help build endurance

FAQs

How is growth plate fracture diagnosed?

The clinician will look for the signs and symptoms like

• Presence of any deformity
• Whether the child can move the affected body part 
• Presence of pain and swelling

Sometimes, a clinical examination proves to be better than imaging tests because the growth plate is a part of the cartilage which is not as dense as a bone hence the imaging tests sometimes fail to identify a growth plate fracture. The doctor may request an X-ray, or in some cases an MRI or CT scan.

How can I prevent growth plate fracture?

Growth plate fracture can be prevented by

• Proper warmups and cool downs pre and post-sports or exercises respectively.
• Using appropriate equipment and gears.
• Not overperforming any particular activity.

Who is at risk of growth plate fracture?

Children in their growing age are at risk of growth plate fractures. Playing competitive and physically demanding sports such as football or gymnastics may be a risk factor given the repetitive movements. Recreational activities such as biking, skiing, or skateboarding may also present a risk of a sudden fall or collision.

How common is growth plate fracture?

Approximately 15 to 30 % of childhood fractures are growth plate fractures.¹

Children assigned male at birth (AMAB) are more prone to growth plate fractures, twice as much as children assigned female at birth (AFAB) because the latter finish growing faster than the former. 

When should I see a doctor?

 You should go to see your doctor as soon as you suspect there could be a problem. This may be if you notice any changes in the warmth of the skin, a visible swelling, or differences in the posture of your child and if the child limits or avoids playful activities.

Summary

The growth plate  is an area of cartilage near the ends of long bones in children that helps to determine the future length and shape of the bone. Any injury to it requires immediate attention from a medical professional. Most children recover from a growth plate fracture without significant complications. Timely diagnosis and treatment and routine follow-ups are helpful to manage growth plate fractures.