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Growth Plate Fracture

Complete list of fracture information

A growth plate fracture poses the greatest risk because the long-term consequences may include limbs that are crooked or of unequal length.  Because of this growth plate fractures should receive immediate attention.

The growth plate  is an area of developing tissue near the ends of long bones, between the shaft of the bone  and the end of the bone. The growth plate regulates and helps determine the length and shape of the mature bone. 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).
 

Symptoms of Growth Plate Fractures

Symptoms can be similar to other fracture symptoms but here are some to watch for in children.

• Inability to play following an acute or sudden injury.
• Decreased ability to play because of long-term complications following an injury.
• Visible deformity of the child's arms or legs.
• Severe pain from acute injuries that prevent the use of an arm or leg.

How to judge if the risks of a Growth Plate Fracture.

• Severity of the injury--If the injury causes the blood supply to the epiphysis to be cut off, growth can be stunted. If the growth plate is shifted, shattered, or crushed, a bony bridge is more likely to form and the risk of growth retardation is higher. An open injury in which the skin is broken carries the risk of infection, which could destroy the growth plate.
• Age of the child--In a younger child, the bones have a great deal of growing to do; therefore, growth arrest can be more serious, and closer surveillance is needed. It is also true, however, that younger bones have a greater ability to remodel.
• Which growth plate is injured--Some growth plates, such as those in the region of the knee, are more responsible for extensive bone growth than others.
• Type of growth plate fracture--The five fracture types are described in the section, How Are Growth Plate Fractures Diagnosed? . Types IV and V are the most serious.

Types of Growth Plate Fractures and their treatment

Type I growth plate fractures break the bone above the growth plate, with a fracture line that extends down into the growth plate.

• Generally heal well. The bone remains aligned, and usually no surgery is required.
• Treated by cast immobilization

Type II growth plate fractures break through part of the bone at the growth plate and crack through the bone shaft as well.

• Generally heal well, although surgery may sometimes be required. This is the most common type of growth plate fracture.
• Most are treated with cast immobilization.

Treatment Options: Surgical

Type III fractures break through the bone at the growth plate, separating the bone end from the bone shaft and completely disrupting the growth plate.

• May result in arrested growth and requires surgical treatment.
• Often treated with internal fixation to ensure proper alignment.

Type IV growth plate fractures cross through a portion of the growth plate and break off a piece of the bone end.

• More common in older children. Because the center of the growth plate has begun to harden, the fracture does not continue across the bone, but angles down and breaks the bone end.
• Treated with surgery and internal fixation to ensure proper alignment of both the growth plate and the joint surface.

Type V growth plate fractures break through the bone shaft, the growth plate, and the end of the bone.

• Commonly result in arrested growth of the bone.
• Treated with surgery and internal fixation.

Type VI growth plate 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.

• Occur only with fractures that break the skin (open) or have multiple breaks (compound).
• Require initial surgery for repair and fixation; additional reconstructive or corrective surgery may also be needed.

Growth 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. 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.