Growth Plate Injuries in Kids Who Play Sports

Injury to the growth plate is a concern for kids and teens who play sports. The growth plate (physis) is the area of developing tissue near the end of the long bones. An injury to the growth plate could result in bone growth stopping or a bone growing unevenly. While many growth plate injuries heal without any lasting effects, there can be complications, such as a limb being uneven or crooked.

Characteristics of Growth Plate Injuries

Each long bone has at least one growth plate at each end. When growth is complete during adolescence, the growth plates are replaced by solid bone. Growth plate injuries can occur in children and adolescents.

Most injuries to the growth plate are fractures. They are twice as common in boys, in part because girls stop growing at a younger age while boys continue to grow through their teen years when they are likely to play sports.

Growth plate fractures occur most often in the long bones of the fingers (phalanges), then the outer bone of the forearm (radius) at the wrist. These injuries also occur frequently in the lower bones of the leg—the tibia and fibula. They can also occur in the upper leg bone (femur) or in the ankle, foot, or hip bone.

Causes

While growth plate injuries can be caused by an acute event, such as a fall or a blow to the body, they are also caused by overuse. Children who participate in athletic activity often experience some discomfort as their bones and muscles grow and they practice new movements.

Some aches and pains can be expected, but a child’s complaints should be taken seriously. Untreated injuries can sometimes cause permanent damage and interfere with proper physical growth.

Injuries to the knee are one of the more concerning areas for complications as the leg bones that meet in the knee joint grow much more than other bones. Other risk factors for complications include a severe injury or an injury to a younger child who has many years of growth remaining.

Diagnosis

After learning how the injury occurred and examining the child, the doctor will probably use X-rays to determine the type of injury and decide on a treatment plan. Because growth plates have not yet hardened into solid bone, on X-rays they appear as gaps between the shaft of a long bone (metaphysis), and the end of the bone (epiphysis). 

Because injuries to the growth plate may be hard to see on X-ray, an X-ray of the noninjured side of the body may be taken so the two sides can be compared. In some cases, other diagnostic tests, such as magnetic resonance imaging (MRI), or computed tomography (CT) may be used.

For all but the simplest injuries, your child's doctor may recommend that the injury is treated by an orthopedic surgeon—a doctor who specializes in bone and joint problems. Some problems may require the services of a pediatric orthopedic surgeon. Being evaluated by a surgeon does not always mean that your child will need surgery.

Treatment

The treatment depends on the type of injury. Treatment should be started as soon as possible after injury. It usually includes some combination of these methods.

Immobilization

The affected limb may be placed in a cast or splint. If so, the child may be told to limit any activity that puts pressure on the injured area. The doctor may also suggest that ice be applied to the area.

Manipulation or Surgery

In some cases, the doctor will have to put the bones or joints back in their correct positions, either by using their hands (called manipulation) or by performing surgery. After the procedure, the bone will be set in place so it can heal without moving. This is usually done with a cast that encloses the injured growth plate and the joints on both sides of it.

The cast is left in place until the injury heals, which can take anywhere from a few weeks to several months for serious injuries. The need for manipulation or surgery depends on the location and extent of the injury, its effect on nearby nerves and blood vessels, and the child’s age.

Exercise

A healthcare provider may recommend strengthening and range-of-motion exercises. These treatments may also be recommended after the fracture is healed.

Long-Term Follow-up

It is usually necessary to monitor the child’s recuperation and growth. The evaluation may include X-rays at certain intervals, in some cases for at least two years. Some fractures require periodic evaluations until the child’s bones have finished growing.