Growth plate fractures are common in children as well as in adolescents. The growth plate is the feeblest part of the growing skeleton, weaker than the enclosing tendons & ligaments that join bones to other bones & muscles. In a developing child, any trauma to a joint is more likely to devastate growth plates than ligaments that uphold & firm the joint. An injury or deformation that would cause tension or pressure in adults can be associated with growth plate injury in children. Harsh injuries to growth plates are fractures. They comprise nearly 10 percent of all tender age fractures. Occurrences of growth plate fractures are found to be twice as often in males as in females, with the highest incidence among 13 to 17 year old boys & 12 to 14 year-old girls. Older girls mature at an earlier age than boys & hence, they often experience fewer fractures. Due to maturity of bones growth plates are replaced by solid & stronger bone. It is seen that approximately half of all growth plate fractures happen at the lower end of the external bone of the forearm (radius) at the wrist. These fractures also occur successively in tibia & fibula (lower leg bones). However, they can also occur in femur (upper leg bone) or in the foot, ankle or hip bone.
What are Growth Plate Fractures?
Growth plate fractures disturb the layer of developing tissue near the end points of a child’s bone. Growth plates are the weakest & the softest sections of the skeleton, sometimes even delicate than nearby enclosing tendons & ligaments. Any injury that might account for a joint sprain in an adult can result in growth plate fractures in children. Growth plate fractures often require prompt treatments because they can severely affect how the bone will flourish. An inappropriately treated growth plate fracture could outgrow in a fractured bone & end up more bowed or smaller than its opposite limb. With suitable treatment, most growth plate fractures heal without causing complications.
Growth plate injuries or fractures are often caused by a single event, such as a car accident or fall. They can also eventually take place as a result of repeated stress on the bone, which may happen when children overstrain in some physical activity. The majority of children who are still in growing phase are at risk for growth plate fractures, but there are several factors that may make them more likely to happen. These are described as follows.
- Growth plate fractures are observed twice as often in boys as in girls, because girls complete growing earlier than boys.
- One-third of all growth plate fractures account during participation in competitive sports such as basketball, football or gymnastics.
- About 10 – 15 percent of all growth plate fractures occur during participation in recreational activities such as skiing, sledding, biking or skateboarding.
- Prevalence of growth plate fractures peak in the puberty phase.
Most growth plate fractures eventuate in bones of the forearm, fingers & lower leg. Some common signs & symptoms of a growth plate fractures generally include the following.
- Tenderness & pain, particularly in response to strain on growth plate.
- Disability to move the damaged area or to put pressure or weight on limb.
- Swelling & warmth at the edge of bone, nearby joints.
When parents suspect that the child is having a fracture, they should take them to a pediatric orthopedist for examination. Also, the child must be taken to hospital for evaluation if any visible deformity is observed in child’s legs or arms, or if the child is having difficulty playing sports because of continuous pain.
Many classification structures have been developed that identify different types of growth plate fractures. Perhaps the most broadly identified fractures by pediatric orthopedists are explained below.
- Type I Fractures – These fractures emerge at the growth plate, segregating the bone end from the bone shaft & wholly agitating the entire growth plate.
- Type II Fractures – This category of fractures break through a portion of bone at the growth plate & emerge through the bone shaft, as well. It is one the most prevalent kind of growth plate fractures.
- Type III Fractures – These types of fractures cross through a part of growth plate & break away a segment of bone end. This type of fracture is more frequently noticed in older children.
- Type IV Fractures – These fractures emerge through growth plates, bone shaft & the end of bone.
- Type V Fractures – These types of fractures are very rare & usually happen due to a compressing injury to growth plate from a confining force.
Growth plate fractures must be noticed attentively to ensure desired long-term results.
As a child’s bone heals rapidly, potential growth plate fractures should be assessed by pediatric orthopedists as quickly as possible, ideally within 4 to 6 days of time. It is extremely essential that bone gets suitable treatment before it starts to heal.
- Medical History & Physical Assessment – After discussing the child’s symptoms & medical history, pediatric surgeons will carry out a careful physical evaluation of the damaged portion.
- Imaging Tests – Pediatric orthopedists will likely order imaging tests including x-rays so as to decide whether a growth plate fracture has in fact happened. X-rays cater clear pictures of dense structures, such as bone. If higher detail is required, surgeons may recommend some other diagnostic imaging tests that can exceedingly show delicate tissues or a cross-sectional contour of the damaged area. These types of scans include computed tomography (CT) scans & magnetic resonance imaging (MRI) scans.
When a child is badly injured, parents may go straight to an urgent care clinic. Depending upon the seriousness of joint break, the family doctor will first examine the child & may suggest a consultation with a pediatric orthopedic surgeon. In order to prepare for initial consultation with the surgeon, parents should write a quick list that includes the following.
- Child’s symptoms
- Cause of injury
- Child’s key healthcare information, including any other health issues & list of all medications & vitamins he/she is regularly consuming
- Recreational activities or sports in which the child regularly participates
Doctors may ask the following important questions to parents.
- How did the injury occur?
- Where does it hurt him/her?
- How much pain does it cause to the child?
- Does anything help to relieve harsh pain?
- Was there any serious pain in the affected region prior to injury, such as during any recreational activity or sports?
- What concerns & queries do you have about your child’s return to play?
- Have there been any previous fractures?
Parents may wish to discuss some important aspects & concerns regarding the treatment of growth plate fractures with the child’s doctor. Following list of queries may be helpful.
- What is growth plate fractures?
- Who is prone to growth plate injuries?
- What has caused growth plate injury to my child?
- Can you explain results of diagnostic test?
- How are growth plate fractures treated?
- Will the injured limb of my child still grow normally?
- Where can I find more information about growth plate fractures?
- Will my child be able to live a normal life after recommended treatment?
In addition to these questions, parents can ask any minor doubts they might be having, with pediatric orthopedists.
Treatment of growth plate fractures reckons on several factors, which majorly include the following.
- Bone which is damaged
- Type of fracture
- How much the ruptured edges of bones are misaligned (displaced)
- Health & age of child
- Any associated fractures or injuries
- Non-Surgical Treatment for Growth Plate Fractures – Various growth plate fractures can heal favorably when treated with immobilization. Cast is applied to the damaged portion & some kinds of activities of children are restricted. Pediatric orthopedists most often use cast immobilization when crippled fragments of bone are not acutely out of place. Cast will help cushion & protect bones & hold them in appropriate position while they heal.
- Surgical Treatment for Growth Plate Fractures – When bone fragments of the fractured area are disturbed & fracture is unsteady, surgery may be required. Most common surgical technique used to treat growth plate fractures is known as open reduction & internal fixation. During this surgical procedure, bone fragments are first relocated into the regular alignment (known as reduction). Bones are then properly settled into suitable position with special implants like wires or screws, or by connecting metal plates to the external surface of bone. Cast is often applied to cushion & weaken the impaired area while it recovers. Recovery is generally faster in young children.
Child’s bones heal speedily, but growth plate fractures can still take many weeks to heal accurately. In a case of cast, immobilization technique is used, a span of time for which the cast is worn will alter depending upon the seriousness of fracture. After the bone heals, pediatric orthopedists may suggest certain exercises strengthen muscles that hold the wounded area of bone & enhance the range of movement of bone joint.
The majority of growth plate fractures heal with no complications. But the following factors can enhance the risk of bowed, increased or stunted growth of bone.
- Seriousness of Injury – When growth plate has been shattered, shifted or crushed, risk of limb deformity becomes higher even after treatment.
- Age of Child – Young children have more years of development ahead of them, so if the growth plate is conclusively broken, there is more chance of developing irregularity. In case the child is almost done growing, lasting damage to growth plate may cause only slightest deformity.
- Position of the Injury – Growth plates around the knee are much more sensitive to injury. A growth plate fracture at the knee can cause leg to be crooked or shorter if growth plate is permanently damaged.
Growth plate fractures must be treated carefully to confirm convenient long-term outcomes. Consistent follow-up sessions with pediatric orthopedists should continue for at least a year after growth plate fracture treatment so as to make sure that it is growing properly. More complicated fractures, as well as fractures to the shinbone (tibia) & thighbone (femur), may need follow-up visits until the child arrives at skeletal maturity.
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