KidsMD Health Topics

Growth Plate Fractures

  • Here at Boston Children's Hospital, we have specialized expertise in treating growth plate fractures and other pediatric bone conditions. This important because, since children’s bones are still growing, they are very different from adult bones.

    The long bones in a child’s body grow not from the center of the bone outward, but from each end. The bone grows through softer pieces of developing cartilage tissue called growth plates, which help define the length and shape of the bone. 

    When a child is fully grown, their bones stop growing and the growth plates harden. As they develop, the growth plates are prone to injury; if they’re injured and not treated properly, it can lead to permanent problems with the bone and with growth. 

    Growth plate fractures happen the way any fracture can happen, most commonly through sports or playground accidents. They vary from mild fractures to more serious cases. They are usually diagnosed by physical examination and an X-ray.

    How Boston Children's Hospital approaches growth plate fractures

    How a growth plate fracture is treated depends on which bone is fractured, and how seriously. It can range from a splint in some cases to surgery in others. 

    With quick diagnosis and the right treatment, the vast majority of growth plate injuries in children heal completely without any long-term problems. Occasionally, after injury the growth plate will stop growing, and may require longer follow up or further treatment. 

    At Boston Children’s Hospital, the experts in our Orthopedic Center see children with growth plate fractures every day. Our team has the experience and expertise to deal with them safely and efficiently.

    Growth plate fractures: Reviewed by Michael P. Glotzbecker, MD
    © Boston Children's Hospital; posted in 2012

    Orthopedic Center
    Boston Children's Hospital

    300 Longwood Avenue
    Fegan 2
    Boston MA 02115
    617-355-6021

  • Growth plate fractures happen the way any fracture can happen, most commonly through sports or playground accidents. When the break involves a crack through the bone, it’s called a fracture. When the break in the bone goes through the growth plate, it’s called a growth plate fracture.

    The Salter Harris classification system can help determine what kind of fracture your child has, but it doesn’t indicate what treatment she will need—your doctor will use imaging tests to decide how to proceed.

    Symptoms 

    The symptoms of a growth plate fracture vary depending on the degree of seriousness. Sometimes, a child may feel mild pain, and other times the injury may be more visible and urgent. 

    Symptoms of a mild growth plate fracture may include:

    • Soreness
    • Swelling
    • Tenderness over a growth plate
    • Pain while moving or putting pressure on a limb 

    Symptoms of a more extreme growth plate fracture may include:

    • Open wounds that make the bone visible
    • Crookedness
    • Other visible deformities
    • When your child arrives at the emergency room, a doctor will check to see if the affected area is swollen, warm, or has a visible deformity, like crookedness or broken skin.
    • The doctor will X-ray the area to determine the degree of the fracture, whether the bone has been displaced or moved and what other testing, imaging or treatment might be necessary.
    • Because there can sometimes be a stretching of the nerves during an injury, the doctor may do a neurological exam by asking your child to wiggle her fingers or toes.
    • The doctor may also put pressure on different areas around the injury to gauge soreness.

    If your child is seen at Boston Children’s Hospital after already being seen in another emergency room, the doctor may request to see the previous X-rays, or re-do X-rays to make sure that nothing has changed.

  • At Boston Children's Hospital, our orthopedic experts specialize in diagnosing and treating fractures in children, since these fractures differ from those seen in adults. Our specialists see a large volume of pediatric growth plate fractures in children every year, and have the experience and knowledge to treat them well. 

    Our doctors work to treat growth plate fractures as early, safely and efficiently as possible, so your child can get back to her normal routine. Your child's immediate and long-term treatment depends on the how severe the fracture is, and whether the growth plate has moved. If your child's bone has been displaced or moved, it may require more extensive treatment than if it is non-displaced. 

    Splint, cast or walking boot

    If your child has a minor, non-displaced fracture, the doctor may treat it like a sprain, and suggest a splint, cast or walking boot to protect the area for four to six weeks. Usually, these types of fractures do not require long-term care.

    Setting the bone back in place

    When a child's bone has moved or been displaced, an orthopedist can set the bone back in place in the emergency room without having to operate. Your child will be sedated in the emergency department, and the doctor will use X-rays to determine where to properly place the bone. Once the bone has been set, a cast is placed to keep it in place. Usually you will be able to go home that night from the emergency department, but occasionally you will be admitted to make sure there is not too much swelling. Follow-up may include physical therapy and doctor's visits for the first six months. 

    Surgical procedures

    An unstable growth plate fracture that can't be held enough with only a cast can be held in place with a pin. The child will be sedated in the operating room while the doctor sets the bone into place. The pin is inserted through the bone to hold it securely. Finally, a cast is placed over the fracture. Three to four weeks later, the child will return to the doctor's office, have the pin easily removed and may receive a new cast at that time. 

    More complex fractures, or fractures that can't be set in the emergency department may require a slightly bigger surgery. Because children's fractures can be more complicated than adult fractures, doctors at Boston Children's specialize in this difference, and make sure that your child's surgery protects bone growth as much as possible.

    To increase the chances of the bone setting properly, your child's doctor will decide very early in treatment whether to operate. If the fracture does involve a joint, then an incision can be made to realign the joint and hold it in place with screws, a plate or a pin. Patients who go through surgery receive a cast and long-term follow up instructions, which may include physical therapy. 

    After your fracture has healed

    Depending on the location and degree of a growth plate fracture, it can sometimes cause the bone to stop growing (called growth plate arrest). While one of the most common growth plate fracture is in the wrist, the risk for growth arrest after a wrist injury is just 4 percent. On the other hand, the knee is also commonly fractured, but approximately 50 percent of these fractures cause the bone to stop growing.  

    If the growth plate stops growing, your child may not have any symptoms. Even after the fracture is completely healed and she has returned to normal activities, your child will be asked to follow up to check on the growth plate. Follow-up will include X-rays of the broken bone, and sometimes other images such as a CT scan or MRI are needed.

    What effect could growth plate arrest have on my child?

    Growth arrest may affect the angle of bone growth and overall height of a child. When a body part with two parallel bones, like the wrist, experiences growth arrest, each bone needs to be examined separately. If one bone stops growing, there is risk that the parallel bone might continue to grow and surpass it, making the wrist grow at an angle. Also, if one leg were to stop growing because of a growth arrest, the legs could end up being different lengths. Orthopedic surgeons can usually prevent angled bone growth or unequal bone growth with early treatment. 

    Usually, an orthopedist can determine whether a child's bones have stopped growing within the first three to six months after the injury. If the bone has stopped growing, then your child's doctor will decide whether or not to stunt the bone that matches it. For example, if one of your child's thigh bones stops growing, the doctor will then decide whether or not to stop the growth of the other thigh bone, so that your child's legs will be the same length.

    If the bone has continued to heal and grow after treatment, then your child may not require more follow-up care. 

    • Older children have already done most of their growing, and therefore the consequences can be less substantial.
    • Younger children's bones have more growing to do, and therefore if a bone stops growing, the consequences could be more severe.

    Most people are concerned with how growth arrest may affect their child's height. Since height is determined by multiple growth plates in the hips, knees and ankles, having growth arrest in just one of these areas may not ultimately impact a child's height significantly.

    Coping and support

    If your child is admitted to Boston Children's Hospital or needs more extensive care, your family may want to take advantage of our Center for Families, which can help connect you with resources, should you need them: 

    • Getting to Boston Children's
    • Accommodations
    • Navigating the hospital experience
    • Resources that are available for your family

    Boston Children's can help you connect with extensive resources to help you and your family through this stressful time, including: 

    Patient education: From doctor's appointments to physical therapy and recovery, our nurses and physical therapists will be on hand to walk you through your child's treatment and help answer any questions you may have. 

    Parent-to-parent: Do you want to talk with someone whose child has been treated for growth plate fractures? We can often put you in touch with other families who've been through the same process or procedure that you and your child are facing, and who will share their experiences. 

    Faith-based support: If you're in need of spiritual support, we'll connect you with the Boston Children's chaplaincy. Our program includes nearly a dozen clergy—representing Protestant, Jewish, Muslim, Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience. 

    Emotional support: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial issues.

  • Researchers around the country are trying to find new ways to better treat and diagnose growth plate fractures. In the future, there may be new ways to help bones keep growing after fractures, and there may be new methods to help other damaged areas—like muscles, joints, tendons and ligaments—grow back as well.

    Other researchers are working toward finding ways to protect growth plates for children who go through radiation for treatment of cancer.

    Learn more about research at Boston Children's Hospital.

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