Growth Plate Injuries

Growth plates are found in the long bones of the body—the bones that are longer than they are wide. Examples of long bones include the femur (thighbone), the radius and ulna in the forearm, as well as the metacarpal bones in the hands.

Most long bones in the body have at least two growth plates, including one at each end. Growth plates are located between the widened part of the shaft of the bone (the metaphysis) and the end of the bone (the epiphysis). The long bones of the body do not grow from the center outward. Instead, growth occurs at each end of the bone around the growth plate. When a child is fully grown, the growth plates harden into solid bone.

Most growth plate fractures occur in the long bones of the fingers. They are also common in the outer bone of the forearm (radius) and lower bones of the leg (the tibia and fibula).

Growth plate fractures are often caused by a single event, such as a fall or car accident. They can also occur gradually as a result of repetitive stress on the bone, which may occur when a child overtrains in a sports activity.

All children who are still growing are at risk for growth plate injuries, but there are certain factors that may make them more likely to occur:

• Growth plate fractures occur twice as often in boys as in girls, because girls finish growing earlier than boys.
• One-third of all growth plate fractures occur during participation in competitive sports such as football, basketball, or gymnastics.
• About 20% of all growth plate fractures occur during participation in recreational activities such as biking, sledding, skiing, or skateboarding.
• The incidence of growth plate fractures peaks in adolescence.

A growth plate fracture usually causes persistent or severe pain. Other common symptoms include:

• Visible deformity, such as a crooked appearance of the limb
• An inability to move or put pressure on the limb
• Swelling, warmth, and tenderness in the area around the end of the bone, near the joint

Because a child's bones heal quickly, a potential growth plate injury should be examined by a doctor as quickly as possible, ideally within 5 to 7 days. It is important that the bone receives the proper treatment before it begins to heal.

After discussing your child's symptoms and medical history, your doctor will perform a careful physical examination of the injured area.

Your doctor will likely order an x-ray to determine whether a growth plate fracture has occurred. X-rays provide clear images of dense structures, such as bone. If greater detail is needed, your doctor may order other diagnostic imaging tests that can better show the soft tissues, or a cross-sectional view of the injured area. These types of scans include magnetic resonance imaging (MRI) scans and computed tomography (CT) scans.

Treatment for growth plate fractures depends on several factors, including:

• Which bone is injured
• The type of fracture
• How much the broken ends of the bone are out of alignment (displaced)
• The age and health of the child
• Any associated injuries

Although most growth plate fractures heal without any lasting effect, complications can occur.

Rarely, a bony bridge will form across the fracture line, stunting the growth of the bone or causing the bone to curve. If this occurs, your doctor may perform a procedure to remove the bony bar and insert fat or other materials to prevent it from reforming.

In other cases, a growth plate fracture may actually stimulate growth so that the injured bone ends up longer than its opposite, uninjured limb. If this occurs, surgery can help achieve a more even length.

A child's bones heal quickly, but a growth plate fracture can still take several weeks to heal. If cast immobilization is used, the length of time the cast is worn will vary depending on the severity of the fracture.

After the bone heals, your doctor may recommend specific exercises to strengthen the muscles that support the injured area of bone and improve the range of motion of the joint.

Growth plate fractures must be watched carefully to ensure proper long-term results. Regular follow-up visits to the doctor should continue for at least a year after the fracture to make sure that the growth plate is growing appropriately.

More complicated fractures, as well as fractures to the thighbone (femur) and shinbone (tibia), may require follow-up visits until the child reaches skeletal maturity.

Statistical data on this webpage was reviewed by the AAOS Department of Research and Scientific Affairs.