Children's Hospital Colorado

Growth Plate Injury

What is a growth plate?

Until they reach skeletal maturity, kids have growth plates, also sometimes called epiphysial plates or physes, in the long bones of their legs and arms. These growth plates are basically areas of rapidly growing cartilage located at either end of the bone. As the cartilage cells divide, they mature and stiffen into bone cells. It's through this process that the bones lengthen and grow.

Growth plate injuries happen when fractures or other bone injuries affect the growth plate. In some cases, parts of these injuries can heal as bone, rather than cartilage, effectively closing the growth plate before the bone matures. Because the bone can't grow as it normally would, this kind of injury can lead to deformities such as uneven limbs over time.

Who gets a growth plate injury?

Growth plates close up as teens reach late adolescence, usually around age 16 — a little earlier for girls than boys. Because adults don't have growth plates, these injuries happen in kids and teens, about twice as many boys as girls. Boys ages 14 to 16 are most likely to get them.

About 30% of the fractures we see in the Orthopedics Institute at Children's Hospital Colorado affect the growth plate. About 3% of those injuries may lead to the premature closure of the growth plate.

Growth plate injuries don't always involve obvious broken bones. Overuse injuries from sports such as baseball, gymnastics and ballet can lead to small "microfractures" that can affect the growth plate. Extreme, frostbite-inducing cold and even radiation from cancer treatment can injure growth plates as well. Some genetic disorders also affect the growth plate.

What are the signs and symptoms of growth plate injury?

Any fracture in a child's arms or legs could potentially affect the growth plate. Because growth plates are unique to kids, it's important to seek our pediatric expertise to assess the possibility of a growth plate injury whenever there's a possible injury to the bone.

If a child is in serious pain or unable to participate in normal activities because of pain, a pediatric orthopedic specialist can assess a possible fracture and whether the growth plate may be affected. Any visible deformity in a child's arms or legs can also be a sign that a previously treated fracture hasn't healed correctly. In that case, see a pediatric orthopedic specialist right away.

What tests are used to diagnose growth plate injuries?

Our pediatric orthopedic specialists start by assessing a possible fracture with X-ray. Since growth plates are not bone, they're difficult to see with X-ray and our specialists may compare several different angles. In some cases, we also use MRI or CT scans to get a more complete picture of the injury.

How do providers at Children's Colorado diagnose growth plate injuries?

Through images, examination and talking with the patient and family about the nature of the symptoms and how they came about, our specialists get as complete an understanding as possible of the injury. From there, growth plate injuries are generally grouped into five categories, depending on seriousness. These categories help determine the course of treatment.

Type I

Since the growth plates are structurally the weakest areas of the bone, fractures sometimes run right through the growth plate. As long as the growth plate remains attached to the end of the bone and the blood supply isn't seriously affected, these types of injuries generally fully heal with a cast.

Type II

The most common type of growth plate injury, these run though part of the growth plate and part of the end of the bone from the middle. These also typically heal fully with casting.

Type III

This fracture runs through part of the growth plate and part of the end of the bone. Relatively rare, these injuries are difficult to set and some may require surgery. If the growth plate and blood supply are still intact, however, these typically will fully heal.

Type IV

Rather than running through the growth plate, these fractures intersect it. These injuries almost always require surgery to align the bone and prevent the growth plate from closing prematurely.

Type V

These injuries occur when the end of the bone is crushed. Unfortunately, in these cases, the growth plate is unlikely to recover. However, a pediatric orthopedic specialist or surgeon can discuss other options for reconstructing and healing the bone.

Why choose Children's Colorado for a growth plate injury diagnosis?

The signs of a growth plate injury can be subtle and hard to spot at first — but because kids' bones are continually growing, failing to catch one and treat appropriately can lead to long-term consequences, such as uneven limbs. Since growth plate injuries aren't always evident at the time of the fracture, a pediatric specialist may want to monitor the area of the fracture for even several years after the injury, to make sure the bone is healing appropriately.

Our pediatric orthopedic specialists care for kids and only kids. With that experience and expertise, they're well equipped to diagnose these injuries and determine the right course of treatment, right from the start.

How is a growth plate injury treated?

Many growth plate injuries can heal with the same familiar treatments normally applied to broken bones: alignment of the fracture and casting. In these cases, growth plate fracture healing time is about the same as it is for fractures not affecting the growth plate, about 6 to 8 weeks.

More complex growth plate injuries may require surgery, whether to align the fracture using screws or to remove sections of bone that have replaced growth plate tissue. Sometimes our pediatric orthopedic surgeons will use grafts of fat or bone cement to prevent bone from invading the growth plate, in order to keep it open until the bone can finish growing.

Why choose Children's Colorado for your child's growth plate injury treatment?

As part of a nationally ranked top-20 pediatric Orthopedics Institute, our surgeons and specialists are among the best in the nation at what they do. Because we treat kids and only kids, our specialists have seen hundreds of growth plate injuries of all types, which means they're the best at spotting them, diagnosing them and anticipating how best to heal them.

It also means we have the expertise to apply the very latest treatments. Leading the way in growth plate research, our specialists are developing new technologies and techniques for healing growth plate injuries and even regenerating growth plate tissue. These advancements are still a few years away from being used in the hospital setting — but when they are, our patients will be among the first to get access.