Growth Plate Injuries in Kids Who Play Sports

Complications From Bone Injuries in Children and Teens

growth plate injuries in active kids
growth plate injuries in active kids. Getty Images

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 the stopping bone growth or a bone growing unevenly. While most growth plate injuries heal without any lasting effects, there can be complications such as one limb ending up shorter than the other or being crooked.

The 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. The growth plate is the weakest area of the growing skeleton, so a serious injury to a joint is more likely to damage a growth plate than the ligaments around it. An injury that would cause a sprain in an adult can be a potentially serious growth plate injury in a young child.

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 cause permanent damage and interfere with proper physical growth.

Besides athletic activity, growth plates are also susceptible to other types of injury, infection, and diseases that can alter their normal growth and development.

Injuries to the knee are the most concerning for complications as the leg bones that meet in the knee joint grow more extensively and the knee is more at risk for nerve and blood vessel damage. Other risk factors for complications include a severe injury and 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 fracture and decide on a treatment plan. Because growth plates have not yet hardened into solid bone, they don’t show on X-rays. Instead, 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), computed tomography (CT), or ultrasound, will be used.

For all but the simplest injuries, the doctor may recommend that the injury is treated by an orthopedic surgeon—a doctor who specializes in bone and joint problems in children and adults. Some problems may require the services of a pediatric orthopedic surgeon, who specializes in injuries and musculoskeletal disorders in children.

Treatment

The treatment depends on the type of fracture. Treatment, which should be started as soon as possible after injury, generally involves a mix of the following:

Immobilization: The affected limb is often put in a cast or splint, and the child is 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 about one out of 10 cases, the doctor will have to put the bones or joints back in their correct positions, either by using his or her 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.

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 of matching limbs at three-month to six-month intervals for at least two years. Some fractures require periodic evaluations until the child’s bones have finished growing. Sometimes a growth arrest line may appear as a marker of the injury. Continued bone growth away from that line may mean that there will not be a long-term problem, and the doctor may decide to stop following the patient.

Source:

Growth Plate Injuries. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/growth-plate-injuries/advanced.