Related Topics
Care of Casts and Splints (http://orthoinfo.aaos.org/topic.cfm?topic=A00095)
Fractures Overview (http://orthoinfo.aaos.org/topic.cfm?topic=A00139)
Internal Fixation for Fractures (http://orthoinfo.aaos.org/topic.cfm?topic=A00196)
|
Copyright 2009 American Academy of Orthopaedic Surgeons
Growth Plate Fractures
The bones of children and adults share many of the same risks for injury. However, a child's bones are also subject to a unique injury called a growth plate fracture. Approximately 15% to 30% of all childhood fractures are growth plate fractures. These often require immediate attention because the long-term consequences may include limbs that are crooked or of unequal length. Although growth plate injuries are common, serious problems are rare. Growth deformity occurs in 1% to 10% of all growth plate injuries. Appropriate evaluation by an orthopaedic surgeon experienced in orthopaedic trauma will determine the nature of the growth plate injury, will provide counseling about treatment options, and will allow for longer term follow up to assess the outcome of the injuries.
![]() Diagram of a femur (thighbone) shows the location of the growth plates at both ends of the bone.
(Reproduced with permission from Sullivan JA: Introduction to the Musculoskeletal System, In Sullivan JA, Anderson SJ (eds): Care of the Young Athlete, Rosemont, IL, American Academy of Orthopaedic Surgeons and American Academy of Pediatrics, 2000, pp 243-258.)
The long bones of the body do not grow from the center outward. Instead, growth occurs at each end of the bone around the growth plate. The growth plate is the last portion of the bone to harden (ossify), which leaves it vulnerable to fracture. Because muscles and bones develop at different speeds, a child's bones may be weaker than the surrounding connective tissues (ligaments). Children's bones heal faster than adult's bones. This has two important consequences. First, it means that a child with an injury should see a doctor as quickly as possible, so the bone gets the proper treatment before it begins to heal. Ideally, this means seeing an orthopaedic specialist within five to seven days of the injury, especially if manipulation to align the bone is required. Second, the period of immobilization required for healing will not be as long as for an adult. To make the diagnosis, the doctor will examine the child and probably use X-rays to determine whether a growth plate fracture occurred. Occasionally, the doctor may request other diagnostic tests, such as magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound. Fractures can result from a single traumatic event, such as a fall or automobile accident, or from chronic stress and overuse. Most growth plate fractures -- more than 30% -- occur in the long bones of the fingers. They are also common in the the outer bone of the forearm (radius), and lower bones of the leg (the tibia and fibula). Who is at risk?
Any child who experiences an injury that results in visible deformity, persistent or severe pain, or an inability to move or put pressure on a limb should be examined by a doctor. Growth plate fractures are classified depending on the degree of damage to the growth plate itself. Treatment depends on the fracture type. Several classification systems of growth plate fractures have been developed. Perhaps the most widely used is the Salter-Harris system. The more recent Peterson classification better describes all growth plate fracture problems. In addition, there are other factors that may affect the bone growth and fracture healing. These include such things as the age and health of the patient, associated injuries, and the amount of displacement of the fractured ends of the bone (occuring through the growth plates). The following section describes the different types of growth plate fractures. Type I FracturesThese fractures break the bone through the growth plate, but no shift of the bone occurs. The fracture is often not visible on an X-ray.
Type II FracturesThese fractures break through part of the bone at the growth plate and crack through the bone shaft as well.
Type III FracturesThese fractures break through the bone at the growth plate, separating the bone end from the bone shaft and completely disrupting the growth plate.
Type IV FracturesThese fractures cross through a portion of the growth plate and break off a piece of the bone end.
Type V FracturesThese fractures break through the bone shaft, the growth plate, and the end of the bone.
Type VI FracturesThese fractures are similar to type V fractures, but the broken pieces of bone are missing. These fractures may involve lawnmowers, farm machinery, or gunshot wounds.
ResultsGrowth plate fractures must be watched carefully to ensure proper long-term results. In some cases, a bony bridge will form that prevents the bone from getting longer or will cause a curve of the bone. Orthopaedic surgeons are developing techniques that enable them to remove the bony bar and insert fat, cartilage, or other materials to prevent it from reforming. In other cases, the fracture actually stimulates growth so that the injured bone is longer than the uninjured bone. Surgical techniques can help achieve more even length. Regular follow-up visits to the doctor should continue for at least a year after the fracture. Complicated fractures (types IV, V, and VI) as well as fractures to the thighbone (femur) and shinbone (tibia) may need to be followed until the child reaches skeletal maturity. Last reviewed and updated: May 2009
AAOS does not review or endorse accuracy or effectiveness of materials, treatments or physicians.
Copyright 2009 American Academy of Orthopaedic Surgeons
Related Topics
Care of Casts and Splints (http://orthoinfo.aaos.org/topic.cfm?topic=A00095)
Fractures Overview (http://orthoinfo.aaos.org/topic.cfm?topic=A00139)
Internal Fixation for Fractures (http://orthoinfo.aaos.org/topic.cfm?topic=A00196)
Your Orthopaedic Connection
The American Academy of Orthopaedic Surgeons 6300 N. River Road Rosemont, IL 60018 Phone: 847.823.7186 Email: orthoinfo@aaos.org |
|||||||
| ||||||||
Copyright ©1995-2009 by the American Academy of Orthopaedic Surgeons. All material on this website is protected by copyright.
All rights reserved. This website also contains material copyrighted by third parties. |