GROWTH PLATE INJURIES
Robert H. Sheinberg, DPM

The growth plate is an area of bone that contains specialized cells that are growing in number, which help to add thickness and length to that bone. As the cells grow in number and move farther away from the growth plate area, they undergo changes and begin to retain calcium, which helps transform them into mature bone.

Any injury to the growth plate must be evaluated on a timely basis and treated properly in order to minimize long-term problems, such as limb-length discrepancies, improper interface of the bones at joint surfaces which may lead to premature arthritis, and angular deformities of an extremity. Any of these implications can have a devastating effect on the development and functionality of an individual.

The growth plate is held together by tough fibrous tissue(similar in consistency to ligaments, but not quite as strong). This fibrous tissue acts as the 'glue' which holds the plate together. This area is the "weak link" in the overall structure of the growing bone.

A thorough history of the injury to determine the mechanism which caused it is necessary, combined with a comprehensive exam which will include x-rays and often special studies such as CT scans or MRI to obtain a full appreciation of the injury and develop an appropriate treatment plan.

There are 6 different patterns of injury commonly associated with growth plate injuries:

Often, a traction(pulling) force on the growth plate will be so great that a small separation between the ends of the growing bones will occur. A prime example is a twisting injury to the ankle in a child or adolescent, where ligaments will remain intact or stretch slightly but not tear. They then pull on their attachment to bones near the growth plate. A loss of stability at the growth plate occurs due to a stretching of the fibers holding the ends of the bones together. There is usually point tenderness in this area and the area of tenderness has a high correlation to the area of the growth plate when compared to x rays. Subtle increases in the space at the growth plate are appreciated, but aren't always observed.

When a traction injury occurs, immobilization and non weight bearing are necessary to allow the fibrous tissue to regain strength, and minimize chances of any displacement or malalignment of the growing bone ends. This is achieved with placing the injured part in a fiberglass cast and use of crutches for at least 2 weeks. During the course of healing, a transition into a fiberglass walking cast, then a removable walking cast boot will take place. Physical therapy is incorporated at the removable cast boot stage to restore muscle strength and range of motion of body joints that are in close proximity to the fracture.

If a fracture line occurs through the solid bone and travels across the growth plate, anatomic reduction, alignment, & stabilization is required. X-rays are necessary, and CT scans or MRI can aid in determining the extent of a fracture & malalignment. Surgery may be necessary to align fractures and provide fixation of the injured area. After surgery, a course of immobilization and non-weightbearing, followed by a transition to immobilization and weight-bearing and then to removable cast boot and physical therapy will take place.

Prompt evaluation and treatment of your child can help to ensure that long-term detrimental effects are minimized.

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