While children and adults can both injure their bones, children are at risk for an additional type of musculoskeletal injury: growth-plate injuries.
Growth plate injuries are as their name describes — injuries at the growth plate (or growth center) where tissue develops near the end of long bones in children and adolescents.
Until your child reaches skeletal maturity, each long bone in her body has at least two growth (epiphyseal plates) — one at each end. When growing is finished sometime during adolescence, the growth plate is replaced by solid bone.
The growth plate is the weakest part of your child's growing skeleton. It is weaker than nearby ligaments and tendons that connect bones to other bones and muscles. Because of this weakness, injuries frequently happen in the growth plate of children and adolescents.
An injury that would cause a sprain in an adult is more likely to cause a bone fracture in a child. As many as one-third of all childhood fractures are growth-plate injuries.
Growth-plate injuries are twice as likely to occur in boys than in girls. Girls' bodies mature earlier than boys' bodies, so their growth plates are replaced by stronger bone at an earlier age.
Growth plate fractures most often occur in these bones:
- Thighbone (femur)
- Lower bones of the leg (tibia and fibula)
- Outer bone of the forearm (radius), at the wrist
- Ankle, foot or hip bone
- Long bones of the fingers (phalanges)
Most growth plate injuries in children result from:
- A fall, usually while running or playing
- Competitive sports, such as football, basketball, baseball and softball, track and gymnastics
- Recreational activities, such as biking, sledding, skiing, skateboarding and roller blading
At Children's Hospital of Philadelphia (CHOP), growth-plate injuries are assessed by physicians in the Division of Orthopaedics or Sports Medicine and Performance Center who specialize in diagnosing and treating musculoskeletal injuries in children, teens and young adults.
World-renown orthopaedic experts will examine your child, assess your child's pain, learn about your child's medical history and perform diagnostic imaging to better understand the problem.
In most cases, an X-ray will show us cause of the injury. In some cases, we may perform additional imaging that may include: computerized tomography (CT scan), magnetic resonance imaging (MRI), EOS imaging, and bone scan.
Your child's treatment will depend on the severity of her growth-plate injury. In most cases when a fracture is found, our team will cast or splint the affected bone or joint.
In about 10 percent of cases, an orthopaedic physician will need to return the bones or joints to the correct positions. This may be done by hand manipulation or through surgery. After your child's bone position is corrected, the bone will be casted to allow it time to heal without movement.
Our casting experts will enclose the fractured growth plate and the joints on both sides of it. Casts need to remain in place from several weeks up to several months.
After any growth-plate injury, your child should receive follow-up care from her pediatrician or orthopaedic specialist. They can ensure your child's injury is healing properly and spot any issues that need further testing or treatment.
- Growth plates are areas at the end of certain bones that allow the bones to grow. A child continues to grow while the plates are “open.”
- A growth plate may fracture (break) due to a fall or another cause.
- A physical exam and X-rays are most often used to diagnose a growth plate fracture.
- Fractures of the growth plate can interrupt normal growth if not treated properly.
- Casting and splinting are common ways to treat growth plate fractures, but surgery may also be required in certain cases.
Growth plates, also called physes or epiphyseal plates, are discs of cartilage present in growing children. They are located between the middle and the end of the long bones, such as the bones of the arms and legs. Most long bones have one growth plate at each end. When a child is done growing because his or her growth plates have closed and are no longer creating new bone. Growth plates are vulnerable and may fracture — a similar injury would lead to a sprain in an adult.
How do growth plate fractures happen?
Growth plate fractures commonly result from falls or sports, bike and motor vehicle accidents. In some cases, a growth plate may fracture due to an overuse of a joint. An example is growth plate fractures that may occur in Little League pitchers because of excessive throwing.
Your child should be treated at your local emergency room or urgent care clinic immediately after the injury. The medical staff will be able to tell you whether surgery is needed. For fractures that do not require surgery, you should still make an appointment with your physician for follow-up care.
Types of Growth Plate Fractures
Growth plate fractures are classified based on which parts of the bone are damaged, in addition to the growth plate. Areas of the bone immediately above and below the growth plate may fracture. They are called the epiphysis (the tip of the bone) and metaphysis (the “neck” of the bone). The most common growth plate fracture runs through the metaphysis. For example, a tibial metaphyseal fracture is a growth plate fracture in the biggest of the leg bones below the knee.
Growth Plate Fracture Diagnosis
Many growth plate fractures are easily visible on X-rays. Usually, X-rays of the affected bone are sufficient. However, sometimes it is necessary to take images of the opposite side for comparison.
Some growth plate fractures cannot be seen right away on an X-ray. Other tests may need to be done, including ultrasound, CT scans or MRI scans. Your doctor may also rely on the location of the pain or other signs and symptoms for diagnosis.
Growth Plate Fracture Treatment
Growth plate fractures are generally treated with splints or casts. Sometimes, the bone may need to be put back in place to allow it to heal in the correct position. This may be done before or after the cast is placed and is called a closed reduction. The length of time your child needs to be in a cast or splint depends on the location and severity of the fracture. Your child’s age also matters: younger patients heal faster than older patients.
If the fracture was manipulated (reduced), you will need to follow up with your child’s orthopaedic specialist more frequently. The fracture must be closely monitored after it’s healed to make sure the bone continues to grow normally.
Some growth plate fractures require surgery to ensure the growth plate is optimally aligned for normal growth of that bone. The surgery is called open reduction and internal fixation. It consists of exposing the bone to put it in place with screws and plates.
What are possible complications of growth plate fractures?
The most serious complication is early closure (complete or partial) of the growth plate.
- Complete closure means the entire growth plate of the affected bone has stopped expanding. This results in the affected bone not growing as long as the opposite side.
- Partial closure means the damaged part of the growth plate has stopped working. In the meantime, the undamaged portion continues to produce new bone. This results in the bone growing at an abnormal angle.
The severity of and need for treatment of growth plate closures depend on the location of the fracture and the age of the patient. Treatment options include:
- Surgically shutting down the growth plate on the opposite side.
- Surgical lengthening of the injured bone.
- Shortening of the normal bone.
Other complications of growth plate fractures include delayed healing of the bone, nonhealing, infection and loss of blood flow to the area, causing death of part of the bone.
Medically Reviewed by Dan Brennan, MD on January 18, 2022
When you're in the ER with your child because they broke a bone, you may hear the doctor say they need to check if it's a "growth plate" fracture. It can sound a little scary, but most injuries like that heal easily. There can be complications, though, if it's not treated correctly or if the problem is severe enough. Growth plates are areas of soft tissue at the ends of your child's long bones. They are found in many places, including the thigh, forearm, and hand. As the name suggests, growth plates help your child's bones grow. Adults don't have them -- only young kids or teens do. Once your child stops growing, they turn into bone. The age this happens varies, but it's usually by the time they reach 20. Because the growth plates are soft, they're easily injured. When that happens it's called a "growth plate fracture." One problem is something your child's doctor may call "growth arrest." This is when the injury causes their bone to stop growing. They could end up with one leg or arm shorter than the other. Your child's likely to get crooked legs or one leg shorter than the other if their growth plates were damaged at their knee. That's because there are a lot of nerves and blood vessels in that area that can be hurt along with the growth plate. Sometimes, a growth plate fracture can also cause the bone to grow more, but this has the same result: One limb ends up longer than the other. A less common problem is when a ridge develops along the fracture line. This can also interfere with the bone's growth or cause it to curve. If the bone is sticking out of the skin, there's also a chance of infection, which can damage the growth plate even more.
Younger children are more likely to get complications because their bones still have a lot of growing to do. But one benefit is that younger bones tend to heal better.
To come up with a treatment plan, the doctor will take into account your child's age, general health, and if there are any related injuries.
If the fracture isn't severe and the broken parts of the bone still line up right, your child's doctor might just put on a cast, splint, or brace. Your child won't be able to move their limb that way, which gives the growth plate time and space to heal. Immobilizing the fracture will also help control pain. If the fractured bits of bone aren't meeting in a straight line, your doctor will have to move them back into place. This is called a "reduction" and can be done either with or without surgery. If it's done without surgery, the doctor usually just moves the bones back in line with their hands without cutting into the skin. This is called "manipulation" and can be done in the emergency room or an operating room. Your child will get pain medication so he doesn't feel anything. If surgery is done, the doctor cuts into the skin, puts the bones back in line, and puts in screws, wires, rods, pins, or metal plates to hold the pieces together. Your child will have to wear a cast until the bones heal. This can take from a few weeks to 2 months or more. If a ridge forms at the fracture line, your child's doctor may recommend surgery to remove the ridge. They can then pad the area with fat or another material to keep it from growing back. Most of the time, kids get back to normal after a growth plate fracture without any lasting effects. One exception is if the growth plate is crushed. When that happens, the bone will almost always grow differently. After the injury has healed, your child's doctor may suggest exercises to strengthen the injured area and make sure their limb moves like it's supposed to. Some children need another operation, such as reconstructive surgery, if the injury is serious enough. Your child should have follow-up appointments for at least a year. Once everything is healed and your doctor gives their OK, your child can get back to having fun with the activities they love.