Wednesday, December 26, 2007

Questions and answers around growth plate injuries

This fact sheet contains nonspecific information about growth plate injuries. It describes what the growth plate is, how injuries turn out, and how they are treated. At the end is a inventory of additional resources. If you own further questions after reading this booklet, you may preference to discuss them with your doctor.

* What Is the Growth Plate?

* Who Gets Growth Plate Injuries?

* What Causes Growth Plate Injuries?

* How Are Growth Plate Fractures Diagnosed?

* What Kind of Doctor Treats Growth Plate Injuries?

* How Are Growth Plate Injuries Treated?


* What Are Researchers Trying To Learn About Growth Plate Injuries?

* Where Can People Find More Information About Growth Plate Injuries?

What Is the Growth Plate?

The growth plate, also specified as the epiphyseal plate or physis, is the area of growing tissue practical the end of the long bones within children and adolescents. Each long bone has at least possible two growth plates: one at each conclude. The growth plate determines the future length and shape of the grown bone. When growth is complete--sometime during adolescence--the growth plates close and are replaced by solid bone.

Who Gets Growth Plate Injuries?

These injuries occur within children and adolescents. The growth plate is the weakest area of the growing skeleton, weaker than the contiguous ligaments and tendons that connect bones to other bones and muscles. In a growing child, a serious injury to a joint is more potential to damage a growth plate than the ligaments that stabilize the collective. An injury that would cause a sprain in an full-grown can be associated with a growth plate injury in a child.

Injuries to the growth plate are fractures. They comprise 15 percent of adjectives childhood fractures. They occur twice as habitually in boys as within girls, with the greatest incidence among 14- to 16-year-old boys and 11- to 13-year-old girls. Older girls experience these fractures smaller amount often because their bodies develop at an earlier age than boys. As a result, their bones finish growing sooner, and their growth plates are replaced by stronger, solid bone.

Approximately partially of all growth plate injuries materialize in the lower pause of the outer bone of the forearm (radius) at the wrist. These injuries also occur frequently contained by the lower bones of the leg (tibia and fibula). They can also occur within the upper leg bone (femur) or in the ankle, foot, or hip bone.

What Causes Growth Plate Injuries?

While growth plate injuries are cause by an acute event, such as a fall or a blow to a upper limb, chronic injuries can also result from overuse. For example, a gymnast who practices for hours on the uneven bar, a long-distance runner, or a baseball pitcher perfecting his curve bubble can all own growth plate injuries.

In one large study of growth plate injuries in children, the majority resulted from a plummet, usually while running or playing on furniture or playground equipment. Competitive sports, such as football, basketball, softball, track and field, and gymnastics, accounted for one-third of adjectives injuries. Recreational activities, such as biking, sledding, skiing, and skateboarding, accounted for one-fifth of adjectives growth plate fractures, while car, motorcycle, and all-terrain-vehicle accident accounted for only a small percentage of fractures involving the growth plate.

Whether an injury is acute or due to overuse, a child who have pain that persist or affects athletic performance or the power to move or put pressure on a limb should be examined by a doctor. A child should never be allowed or expected to "work through the affliction."

Children who participate surrounded by athletic activity recurrently experience some discomfort as they practice new movements. Some ache and pains can be expected, but a child's complaints always deserve far-sighted attention. Some injuries, if left untreated, can effect permanent destruction and interfere with proper growth of the involved upper limb.

Although many growth plate injuries are cause by accidents that go off during play or athletic activity, growth plates are also susceptible to other disorders, such as bone infection, that can alter their average growth and development.

Additional Reasons for Growth Plate Injuries

* Child knock about can be a cause of skeletal injuries, especially in drastically young children, who still enjoy years of bone growth remaining. One study reported that half of adjectives fractures due to child abuse be found in children younger than age 1, whereas just 2 percent of accidental fractures occur in this age group.

* Injury from extreme cold (for example, frostbite) can also disrupt the growth plate in children and result within short, stubby fingers or premature degenerative arthritis.

* Radiation, which is used to treat certain cancer in children, can mess up the growth plate. Moreover, a recent study has suggested that chemotherapy given for childhood cancer may also negatively affect bone growth. The same is true of the prolonged use of steroids for rheumatoid arthritis.

* Children with unshakable neurological disorders that result in sensory deficit or muscular inequality are prone to growth plate fractures, especially at the ankle and knee. Similar types of injury are see in children who are born next to insensitivity to stomach-ache.

* The growth plates are the site of many adjectives disorders that affect the musculoskeletal system. Scientists are just germ to understand the genes and gene mutations involved in skeletal formation, growth, and nouns. This new information is raise hopes for improving treatment of children who are born near poorly formed or improperly functioning growth plates.

How Are Growth Plate Fractures Diagnosed?

After erudition how the injury occurred and examining the child, the doctor will use x rays to determine the type of fracture and resolve on a treatment plan. Because growth plates have not but hardened into solid bone, they don't show on x rays. Instead, they appear as gaps between the shaft of a long bone, call the metaphysis, and the end of the bone, call the epiphysis. Because injuries to the growth plate may be hard to see on x gleam, an x ray of the noninjured side of the body may be taken so the two sides can be compared. Magnetic resonance imaging (MRI), which is another track of looking at bone, provides useful information on the appearance of the growth plate. In some cases, other diagnostic test, such as computed tomography (CT) or ultrasound, will be used.


Since the 1960's, the Salter-Harris classification, which divides most growth plate fractures into five categories base on the type of damage, have been the standard. The category are as follows:

Type I

The epiphysis is completely separated from the end of the bone or the metaphysis, through the wide layer of the growth plate. The growth plate remains attached to the epiphysis. The doctor have to put the fracture back into place if it is significantly displaced. Type I injuries mostly require a cast to maintain the fracture in place as it heal. Unless there is smash up to the blood supply to the growth plate, the likelihood that the bone will grow usually is excellent.

Type II

This is the most common type of growth plate fracture. The epiphysis, together near the growth plate, is separated from the metaphysis. Like type I fractures, type II fractures typically have to be put support into place and immobilized.

Type III

This fracture occur only not often, usually at the lower end of the tibia, one of the long bones of the lower leg. It happen when a fracture runs completely through the epiphysis and separates part of the epiphysis and growth plate from the metaphysis. Surgery is sometimes critical to restore the joint surface to everyday. The outlook or prognosis for growth is good if the blood supply to the separated portion of the epiphysis is still intact and if the fracture is not displaced.

Type IV

This fracture runs through the epiphysis, across the growth plate, and into the metaphysis. Surgery is needed to restore the united surface to normal and to without a flaw align the growth plate. Unless perfect alignment is achieve and maintained during restorative, prognosis for growth is poor. This injury occurs most commonly at the shutting down of the humerus (the upper arm bone) near the elbow.

Type V

This extraordinary injury occurs when the bring to a close of the bone is crushed and the growth plate is compressed. It is most likely to go on at the knee or ankle. Prognosis is poor, since premature stunting of growth is almost inevitable.

A newer classification, call the Peterson classification, adds a type VI fracture, surrounded by which a portion of the epiphysis, growth plate, and metaphysis is missing. This usually occurs beside an open wound or compound fracture, commonly involving lawnmowers, farm machinery, snowmobiles, or gunshot wounds. All type VI fractures require surgery, and most will require after that reconstructive or corrective surgery. Bone growth is almost always stunted.

What Kind of Doctor Treats Growth Plate Injuries?

For adjectives but the simplest injuries, the doctor may recommend that the injury be treated by an orthopaedic surgeon (a doctor who specializes in bone and joint problems within children and adults). Some problems may require the services of a pediatric orthopaedic surgeon, who specializes in injuries and musculoskeletal disorders in children.

How Are Growth Plate Injuries Treated?

As indicated in the previous bit, 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:


The artificial limb is regularly put in a kind or splint, and the child is told to limit any buzz that puts pressure on the injured area.

Manipulation or Surgery

If the fracture is displaced, the doctor will own to put the bones or joints hindmost in their correct positions, any by using his or her hands (called manipulation) or by performing surgery (open cutback and internal fixation). After the procedure, the bone will be set in place so it can heal in need moving. This is usually done with a strike that encloses the injured growth plate and the joint on both sides of it. The cast is vanished in place until the injury heal, which can take anywhere from a few weeks to two or more months for serious injuries. The obligation for manipulation or surgery depends on the location and extent of the injury, its effect on nearby nerves and blood vessel, and the child's age.

Strengthening and Range-of-Motion Exercises

These treatments may also be recommended after the fracture is healed.

Long-Term Followup

Long-term followup is usually obligatory to monitor the child's recuperation and growth. Evaluation includes x rays of matching limb at 3- to 6-month intervals for at least 2 years. Some fractures require intervallic evaluations until the child's bones have finished growing. Sometimes a growth arrest chain may appear as a marker of the injury. Continued bone growth away from that splash may mean that in that will not be a long-term problem, and the doctor may decide to stop following the forgiving.


About 85 percent of growth plate fractures alleviate without any persistent effect. Whether an arrest of growth occurs depends on the following factor, in descending instruct of importance:

* Severity of the injury--If the injury cause the blood supply to the epiphysis to be cut off, growth can be stunted. If the growth plate is shifted, shattered, or crushed, a bony bridge is more credible to form and the risk of growth retardation is higher. An unfurl injury in which the skin is broken carry the risk of infection, which could destroy the growth plate.

* Age of the child--In a younger child, the bones enjoy a great deal of growing to do; accordingly, growth arrest can be more serious, and closer surveillance is needed. It is also true, however, that younger bones have a greater proficiency to remodel.


* Type of growth plate fracture--The five fracture types are described within the section, How Are Growth Plate Fractures Diagnosed?. Types IV and V are the most serious.

Treatment depends on the above factor and also bears on the prognosis.

The most frequent complication of a growth plate fracture is premature arrest of bone growth. The artificial bone grows less than it would enjoy without the injury, and the resulting feeler could be shorter than the opposite, safe and sound limb. If singular part of the growth plate is injured, growth may be lopsided and the feeler may become crooked.

Growth plate injuries at the knee are at greatest risk of complications. Nerve and blood vessel prejudice occurs most frequently in attendance. Injuries to the knee own a much higher incidence of premature growth arrest and crooked growth.

What Are Researchers Trying To Learn About Growth Plate Injuries?

Researchers verbs to develop methods to optimize the diagnosis and treatment of growth plate injuries and to improve merciful outcomes. Examples of such work include:

* Removal of a growth-blocking "bridge" or bar of bone that can form across a growth plate following a fracture. After the bridge is removed, tubby, cartilage, or other materials are inserted in its place to prevent the bridge from forming again.

* The investigation of drugs that protect the growth plate during radiation treatment.

* Development of methods to regenerate musculoskeletal tissue by using principles of tissue engineering.

To revolutionize the early diagnosis of growth plate injuries, the National Institute of Arthritis and Musculosketetal and Skin Diseases (NIAMS) is supporting a study to evaluate the use of MRI to visualize childlike bones and enable prompt, appropriate treatment. In May 1997, the NIAMS, together near the National Institute of Child Health and Human Development (NICHD), the American Academy of Orthopaedic Surgeons (AAOS), and the Orthopaedic Research and Education Foundation, supported a conference on skeletal growth and development. The resulting publication, Skeletal Growth and Development: Clinical Issues and Basic Science Advances, can be obtain from the AAOS at the address listed fundamental the end of this booklet. In March 2000, the NIAMS supported the First International Conference on Growth Plate.

The NIAMS is working next to the NICHD, the National Institute of Dental and Craniofacial Research, and the National Institute of Diabetes and Digestive and Kidney Diseases to support a research initiative in the area of skeletal growth and nouns. The purpose of the initiative is to:

* Stimulate research to identify and understand the goings-on of the genes that regulate skeletal development

* Evaluate factors that affect growth plate function

* Develop animal models to study disturbances within skeletal growth and development

* Find new ways to correct musculoskeletal deformity.

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