We want our children to be active—ride their bikes, practice gymnastics, and do all of the activities they love. But when they hurt themselves, as children do, it’s important to make sure the injury hasn’t affected a growth plate, one of the layers at each end of a child’s long bones where the tissue is still growing. If a growth plate injury doesn’t heal properly, it could result in a crooked arm, a leg that is shorter than the other, or another problem that could affect mobility throughout their life.
"Recognizing a growth plate injury early and treating it appropriately is the best way to minimize damage to the growing bone," says Adrienne Socci, MD, a Yale Medicine orthopedist specializing in pediatrics and trauma surgery. “Pediatric orthopedists are familiar with injuries at every stage of growth and are best equipped to manage growth plate injuries.”
What are growth plates?
Growth plates are areas of cartilage found at either end of the long bones (bones that are longer than they are wide, like arm and leg bones) in children and adolescents. They allow bones to grow or lengthen until the child reaches his or her full height. Compared to surrounding ligaments and tendons, growth plates are softer and weaker, so they are more vulnerable to injury. Up until growth has finished—around age 14 for girls, and 16 for boys—the cartilage is replaced with hardened bone.
While growth plates can be found in long bones throughout the body, some of the most common growth plate injuries occur in the long finger bones and the outer bone of the forearm near the wrist. Other common growth plates fractures occur around the elbow, the knee, and the ankle.
How can a growth plate injury occur?
Growth plate injuries can be caused by a trauma from a fall or injury from a competitive sport. It can also be the result of overuse from a repetitive activity, such as softball pitching. Growth plate injuries account for approximately 15 to 30% of all fractures doctors treat in children and adolescents.
If I suspect my child has a growth plate injury, when should I take her to the doctor?
Take your children to the doctor if they have any pain, change in mobility, or any visible deformity in one or more of their limbs. If your child is diagnosed with a growth plate fracture, your doctor will monitor the healing and growth.
How is a growth plate injury diagnosed?
The doctor will take a medical history and examine your child, checking for warmth or swelling near the joint, and by pressing on the injured area to check for tenderness or pain. The doctor will want to know about any changes in your child’s ability to bend or move a limb and may ask about such symptoms as persistent pain.
Because growth plates are not solid bone, both the growth plates and potential fractures will not always show up on X-rays. They do, however, show up as gaps between the shaft and the end of the bone. As a result, the doctor may order an X-ray of the injured limb and the opposite limb, and look for differences between the two, Dr. Socci says.
Your doctor may also order other imaging tests, including a magnetic resonance imaging (MRI) or a computed tomography (CT) scan, but he or she may simply make a diagnosis based on the tenderness of the growth plate area.
How is a growth plate injury treated?
Treatment will depend on the severity of the injury and the amount of damage it has caused to the growth plate (certain knee injuries, for example, come with a higher risk of blood vessel and nerve damage, as well as high risk of growth disturbance); however, in most cases you can expect a full recovery.
Your child’s doctor may use a combination of the following approaches:
- A cast or splint to immobilize the injured area and allow it to heal
- Physical therapy or exercise after a fracture has healed
- Follow-up imaging
- Manipulation to move bones or joints that are out of place back into their correct position.
If the fracture becomes unstable or bone fragments become problematic, surgery may be an option. Surgery may also be used to place bones and joints that are healing improperly back into place.
How long does it take to recover from a growth plate injury?
With proper care, the vast majority of growth plate injuries heal without complication. This will typically involve a few weeks or months in a cast, depending on the location and severity of the injury. It’s important to follow the doctor’s instructions and allow the full time for healing. In some complex cases, the doctor will need to monitor the injury site until your child is fully grown and the growth plates have been replaced with bone.
How is Yale unique in the treatment of growth plate injuries?
Yale Medicine pediatric orthopedists offer the most advanced, minimally invasive techniques to help ensure quicker recoveries and less discomfort. They treat children with the goal of restoring their mobility and function as quickly as possible.
“Our orthopedic surgeons have access to a team of researchers and physical therapists who aspire to improve patient outcomes, and aim to keep patients active and doing what they love, safely,” says Dr. Socci.