Growth Plate Fractures

What are growth plate fractures?

Growth plate fractures are a type of bone fracture (broken bone) that affects kids and teens. The growth plate is a section of cartilage children have at both ends of some bones, including the:

• Humerus (upper arm bone).
• Radius and ulna (forearm bones).
• Metacarpals (bones in the palm of your hand).
• Femur (thigh bone).

The growth plate is exactly what it sounds like — a special piece that helps bones grow and develop into the correct size and shape. Growth plates harden into solid bone when a child has finished growing.

Visit a healthcare provider if your child has bone pain, swelling or one of their body parts looks noticeably different or out of place. Most growth plate fractures take several weeks to heal, and it’s important to get them diagnosed and treated right away.

Types of growth plate fractures

Healthcare providers classify growth plate fractures using the Salter-Harris system which divides them into five types:

• Type 1 growth plate fractures: A break that separates the growth plate cartilage from the end of your child’s bone.
• Type 2 growth plate fractures: The crack in your child’s growth plate spreads to the shaft of their bone, too. Type 2 growth plate fractures are the most common type.
• Type 3 growth plate fractures: The fracture breaks a piece of growth plate and the end of the affected bone loose. Type 3 growth plate fractures are more common in teens and older children because their growth plate has started hardening into adult bone.
• Type 4 growth plate fractures: Similar to type 3 fractures, but more severe. The fracture breaks off a piece of growth plate, the end of the bone and its shaft.
• Type 5 growth plate fractures: A crack in the growth plate caused by crushing pressure on a bone. Type 5 fractures are the least common type.

How common are growth plate fractures?

Growth plate fractures are one of the most common bone injuries children experience. Around one-third of all childhood bone fractures are growth plate fractures.

What are growth plate fracture symptoms?

The most common growth plate fracture symptoms include:

• Pain (especially on or around a bone).
• Your child’s body part looking noticeably different (bent, crooked or out of place).
• Your child might not be able to bend or put pressure on the area around their injury (inability to move or use a body part).
• Swelling.
• Discoloration or bruising.
• Tenderness.

Younger children might not able to communicate that they’re injured or accurately describe their symptoms. Look for your child suddenly favoring a part of their body. They might reflexively hold their injured limb close their body, wince or limp.

What causes growth plate fractures?

Sudden traumas are the most common causes of growth plate fractures, including:

• Falls.
• Car accidents.
• Sports injuries.

Overtraining or specializing too soon in one sport can put repetitive stress on a child’s growth plates and lead to a fracture. Children and teens shouldn’t play the same sport year-round until their body finishes developing.

What are growth plate fracture risk factors?

Any child can experience a growth plate fracture, but some are more likely than others, including:

• Teens (most growth plate fractures affect teenagers).
• Boys. Boys are twice as likely to experience a growth plate fracture as girls. That’s because girls usually develop and mature faster. Their bones harden into adult bones faster.
• Athletes, especially kids who play sports that require lots of jumping like basketball, gymnastics, skiing or volleyball. Kids who play contact sports like football or hockey have a higher risk of injuries, including growth plate fractures.
• Kids who are physically active. Children can experience a growth plate fracture outside organized sports during physical activities like skateboarding, sledding or biking.

What are growth plate fracture complications?

Most growth plate fractures don’t lead to complications, especially if a healthcare provider diagnoses and treats them within a week of the original injury.

Growth plate fracture complications can include:

• Malunion: This happens when a broken bone doesn’t line up correctly while it heals.
• Nonunion: The bone may not grow back together fully or at all.
• Stunted growth: It’s rare, but severe growth plate fractures (especially type 5) can affect how that bone grows in the future. It might be shorter or smaller than usual. Your child might need surgery to prevent this.

How are growth plate fractures diagnosed?

A healthcare provider will diagnose a growth plate fracture with a physical exam and imaging tests. Your provider will examine the area around your child’s injury and ask about their symptoms. They might check your child’s range of motion (how far they can move part of their body) and compare it to their other, uninjured limb.

Tell your provider anything you know about what your child was doing before their injury, including when you first noticed something was wrong or when they felt pain.

What tests do providers use to diagnose growth plate fractures?

Your provider will use at least one type of imaging test to take pictures of your child’s bones and the other tissue around their injury. They might need:

• X-rays.
• Magnetic resonance imaging (MRI).
• Computed tomography (CT) scans.

How are growth plate fractures treated?

Providers usually treat growth plate fractures with a cast (immobilization). A cast will protect your child’s bone and hold it in the correct position while it heals. Your provider will tell you which type of cast your child will need, and how you can help them take care of it.

Growth plate fracture surgery

It’s rare to need surgery to repair a growth plate fracture. It’s more common with more severe fractures (types 3, 4 or 5). If your child needs surgery, their surgeon will perform what’s called an internal fixation. They’ll realign (set) your child’s bone, then put fasteners like metal screws, pins or wires in the bone to hold it in place while it heals. Your child might need follow-up surgery to remove the fasteners after their bone heals. Your provider or surgeon will tell you what to expect.

What is the usual growth plate fracture healing time?

Most kids need to wear a cast for around a month after a growth plate fracture (usually four to six weeks). It might take longer if they had a more severe type of fracture, or if they needed surgery.

Your provider will tell you what to expect. The healing time depends on which of your child’s bones was injured and the growth plate fracture’s severity.

Can I prevent a growth plate fracture?

There’s usually nothing you can do to prevent your child from experiencing a growth plate fracture because they’re caused by sudden accidents or injuries. But there are a few ways you can reduce your child’s injury risk. During sports or other physical activities, make sure your child:

• Wears the proper protective equipment.
• Doesn’t “play through the pain” if something hurts during or after physical activity.
• Gives their body time to rest and recover after intense activity.
• Stretches and warms up before playing sports or working out.
• Cools down and stretches after physical activity.

Follow these general safety tips to reduce your family’s injury risk:

• Always wear your seatbelt.
• Make sure your home is free from clutter that could trip anyone.
• Always use the proper tools or equipment at home to reach things. Never let children stand on chairs, tables or countertops.

What can I expect if my child has a growth plate fracture?

Most growth plate fractures heal without complications or long-term effects on a child’s health and development. The best way to reduce the odds of complications is to get a growth plate fracture diagnosed as soon as possible (within a week).

Ask your provider when it’s safe for your child to return to sports or resume physical activities. If your child’s growth plate hasn’t completely healed before they start putting stress on it again, there’s an increased risk of complications (including refracturing it).

When should I see my healthcare provider?

Visit a healthcare provider right away if your child experiences trauma like a severe fall or car accident.

Go to the emergency room (ER) right away if you think your child has a broken bone, or if they’re experiencing any of the following symptoms:

• Severe pain.
• They can’t move a part of their body.
• A part of their body is noticeably different-looking or out of place.
• You can see bone through their skin.
• Severe swelling.
• New bruising or discoloration that happens at the same time as any of these other symptoms.

What questions should I ask my healthcare provider?

• Does my child have a growth plate fracture or another injury?
• Which type of growth plate fracture do they have?
• Will my child need surgery?
• How long will my child need to wear a cast?
• When is it safe for my child to resume physical activities or play sports?