Following that skateboarding accident or complaints of pain after gymnastics practice, it may be time to visit your pediatrician to discuss a potential growth plate injury. Your pediatrician will do an initial evaluation and recommend you to a specialist if a growth plate fracture is suspected.
It’s important to get to a doctor as soon as possible to avoid any long-term trouble.
What are the types of growth plate fractures?
Since 1960, the Salter-Harris Classification system has been in place for growth plate fractures. The five levels of fractures are listed below.
• Type I – Fracture through the growth plate. In a type I fracture, the epiphysis (the rounded end of a bone) is cracked but still in alignment or completely separated from the end of the bone. A cast is typically needed and may require realignment if the epiphysis is significantly displaced.
• Type II – Fracture through the growth plate and metaphysis. This is the most common type of fracture. The fracture runs through the growth plate and metaphysis (narrow portion of the long bone) but does not result in significant displacement. Similar to type I, treatments involve a cast and potentially a realignment. The bone will strengthen over time.
• Type III – Fracture through the growth plate and epiphysis. A rare fracture, type III frequently occurs at the lower end of the tibia. The fracture line(s) run completely through the epiphysis and separates a portion of the epiphysis and the growth plate from the metaphysis. Surgery is occasionally needed to restore the surface of the joint.
• Type IV – Fracture through the growth plate, metaphysis and epiphysis. The fourth fracture type runs through the epiphysis, across the growth plate and up into the metaphysis. This fracture most often occurs at the end of the humerus (the bone of the upper arm or forelimb, forming joints at the shoulder and the elbow). Surgical restoration of the joint surface and to perfectly align the growth plate is often needed. Unless the growth plate is aligned perfectly and maintained during recovery, the prognosis for growth is poor. Angulation, or bending, of the bone may occur.
• Type V – Compression fracture through the growth plate. The most uncommon type of fracture involves the end of the bone being crushed and the growth plate being compressed. Most common in the knee or ankle, prognosis is poor and premature stunting of bone growth is almost inevitable.
What are general treatment options for a growth plate fracture?
An orthopedic surgeon is most qualified to treat a growth plate fracture. Treatment, which will depend on the type of fracture and the affected bone(s), should be started as soon as possible to avoid growth delay. Treatment options could include:
— Immobilization of the fractured bone. This includes a cast or splint and limited activity on the injured bone.
— Manipulation or surgery. This is needed if there is displacement (ends of the bones don’t meet as they should). The doctor may need to put the bones back by hand or with surgery. A surgical fix may involve the placement of screws and wire to hold the growth plate in place. Following surgery, the bone will be immobilized until the injury heals, which may take from a few weeks to two or more months for serious injuries.
— Physical therapy. This is often incorporated during the recovery process to build muscles back up following immobilization.
What are the outcomes and effects of a growth plate fracture?
Most growth plate fractures heal without lasting trouble. A delay in growth depends on the method of treatment and the following factors:
1. Injury severity. Was there blood loss/cut off? Was the growth plate shifted or crushed? This could result in premature closing of the plate. Was it an open injury with broken skin? This could potentially cause infection, which could destroy the growth plate.
2. Age of the child. Younger children need more supervision due to the amount of growth still needed, but also heal faster due to age.
3. Location of injured growth plate. Some have more involvement in extensive bone growth, such as the growth plates in the knees.
4. Type of fracture. Of the types listed above, types VI and V are the most severe and may present the most long-term trouble.
For more information about growth plate fractures, click here.