Growth Plate Injuries

Growth plate or Physeal injuries.

The medical word for ‘break’ is fracture. Because children are growing, their bones have specialised areas for growth (physis) towards the ends of the bones.  The long bones that are regularly broken include the radius (forearm), the humerus (arm), the femur (thigh) and the tibia (shinbone).

Injury to these physeal growth plates account for about 30% of fractures in children.

The injuries occur in several typical patterns. They were described by Salter & Harris and the most commonly occurring are numbered Type 1-5.

They are usually diagnosed on plain x-rays but may require CT or MRI scans to accurately identify the detailed fracture pattern in some cases.

Type 1 accounts for about 75% of physeal fractures- they heal quickly in about 3 weeks and complications are rare.

Type 2 have a slightly higher complication rate when surrounding soft tissue becomes trapped between the fracture ends.  This may then necessitate surgery to remove the soft tissue and allow healing to occur

Type 3 makes up about 8% of physeal fractures.  This type is more prevalent in older children and can be complicated by disturbance in growth and joint problems resulting in arthritis.

Type 4- 10% of injuries. Frequently require surgery and prolonged follow up post operatively to monitor for growth disturbance.

Type 5 is caused by a crush injury to the growth plate.  They can be difficult to diagnose and often are only recognised after the fact when growth problems occur.

Treatment

Type 1-3 can frequently be managed in a cast and heal quickly, while type 4 if displaced require surgery.

 Damage to growth plates can be caused by trauma but other conditions such as avascular necrosis, infection, or non- union (when the break doesn’t heal) can also cause a disturbance of growth. Most of the consequences of this growth upset can be treated though this often means surgery