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Growth plate fracturesBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/growth-plate-fractures/DS00816
Growth plates are the softer parts of your child's bones, where growth occurs. Located at each end of a bone, growth plates are the weakest sections of the skeleton — sometimes even weaker than surrounding ligaments and tendons. Because growth plates are so fragile, an injury that would result in a joint sprain for an adult can cause a growth plate fracture in your child.
Growth plate fractures often need immediate treatment because they can affect how the bone will grow. An improperly treated growth plate fracture could result in a fractured bone ending up more crooked or shorter than its opposite limb. But the comforting news for your child is that with proper treatment, most growth plate fractures heal without complications.
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|Growth plate fracture|
Most growth plate fractures occur in bones of the:
- Forearms, at the wrist
- Lower leg
Signs and symptoms of a growth plate fracture may include:
- Severe pain that doesn't go away
- An inability to move the affected area
- An inability to put weight or pressure on the area
When to see a doctor
If you suspect a fracture — particularly if pain interferes with moving or putting pressure on a limb — take your child to be examined by a doctor. Additionally, have your child evaluated if you notice a visible malformation in your child's arms or legs, or if your child is having trouble playing sports because of persistent pain.
About 15 percent of all childhood fractures involve a growth plate. Growth plate fractures often are caused by a fall or a blow to the limb, as might occur in:
- A car accident
- Competitive sports, such as football, basketball, running, dancing or gymnastics
- Recreational activities, such as biking, sledding, skiing or skateboarding
Growth plate fractures can also be caused by overuse, which can occur during sports training.
Growth plate fractures occur twice as often in boys. They're most common between the ages of 9 and 15.
Girls age 12 and older experience these types of fractures less often because their growth plates have already matured and been replaced with solid bone.
Around 85 percent of growth plate fractures heal with no complications. The following factors can increase the risk of twisted or stunted bone growth.
- Severity of the injury. If the growth plate has been shifted, shattered or crushed, the risk of limb deformity is greater. Reduced blood supply to the tip of the bone also increases this risk.
- Age of the child. Younger children have more years of growth ahead of them, so they are at risk for a longer period of time.
- Location of the injury. Some growth plates grow more than others. Risk increases with injuries to the growth plates that grow the most — for example, the ones around the knee.
Preparing for your appointment
If your child is injured, you may go straight to an emergency room or urgent care clinic. Depending on the severity of the break, the doctor who first examines your child may recommend a consultation with a pediatric orthopedic surgeon.
What you can do
To prepare for your conversation with the doctor, you may want to write a quick list that includes:
- Your child's symptoms
- How the injury occurred
- Your child's key medical information, including any other medical problems and the names of all medications and vitamins he or she takes
- The sports or recreational activities in which your child regularly participates
- Questions you want to ask the doctor
What to expect from your doctor
Your doctor may ask:
- How did the injury happen?
- Where does it hurt?
- How much does it hurt?
- Does anything relieve the pain?
- Was there any pain in the affected area before the injury, such as during sports or recreational activity?
- What concerns do you have about your child's return to sports or play?
- Have there been previous fractures?
During the physical exam, your doctor will inspect the affected area for tenderness, swelling, deformity or an open wound.
Tests and diagnosis
Because growth plates haven't hardened into solid bone, they are difficult to interpret on X-rays. Sometimes, doctors ask for X-rays of both the injured limb and the opposite limb so that they can be compared. In some cases, scans that can visualize soft tissue — such as magnetic resonance imaging (MRI), computerized tomography (CT) or ultrasound — may be ordered.
Treatments and drugs
Treatment for growth plate fractures depends on the severity of the fracture. The least serious fractures usually require only a cast or a splint. Injuries in which a part of the bone end has separated from the bone shaft typically will need surgical repair.
If your child has had a growth plate fracture, your doctor may want to compare the growth of the injured limb with that of its opposite limb every three to six months for at least two years. Depending on the severity of the fracture, your child may need follow-up visits until his or her bones have finished growing.
- Mathison DJ, et al. General principles of fracture management: Fracture patterns and description in children. http://www.uptodate.com/home/index.html. Accessed Aug. 31, 2010.
- Geiderman JM, et al. Fractures. In: Marx JA, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo.: Mosby; 2009. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05472-0..00046-3--s0020&isbn=978-0-323-05472-0&sid=1046559067&type=bookPage§ionEid=4-u1.0-B978-0-323-05472-0..00046-3--s0055&uniqId=216942841-3#4-u1.0-B978-0-323-05472-0..00046-3--s0055. Accessed Aug. 31, 2010.
- Moeller JL, et al. Orthopedics. In: Rakel RE. Rakel: Textbook of Family Medicine. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/216942841-3/1046540165/1481/496.html#4-u1.0-B978-1-4160-2467-5..50044-0--cesec4_2535. Accessed Aug. 31, 2010.
- Questions and answers about growth plate injuries. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/hi/topics/growth_plate/growth.htm. Accessed Aug. 31, 2010.
- Growth plate fractures. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=244&topcategory=Children. Accessed Aug. 31, 2010.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 1, 2010.