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Growth plates, also called 
the epiphyseal plate or physis,

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are the areas of growing 
cartilaginous tissue found

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at the ends of the long 
bones in children.

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These growth plates 
determine the length and shape

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of the mature bone. 
The growth plates are more susceptible

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to damage from trauma because 
they are not as hard as bones.

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Growth plate injuries 
commonly occur

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in growing children and teenagers.

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In children, severe injury 
to the joint may result

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in a growth plate fracture 
rather than a ligament injury.

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Any injury that can cause 
a sprain in an adult

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can cause a growth plate 
fracture in a child.

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Growth plate fractures 
are more common in boys than girls

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because the plates develop 
into mature bone faster in girls.

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Growth plate fractures 
commonly occur at the wrist,

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long bones of the forearm 
(radius and ulna)

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and fingers (phalanges), 
legs (tibia and fibula),

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foot, ankle or hip 
during sports activities

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such as football, 
basketball and gymnastics.

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Types of growth plate fractures.

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Growth plate fractures 
can be classified into five categories

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based on the type of damage caused.

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Type I - Fracture 
through the growth plate.

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The epiphysis is separated 
from the metaphysis

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with the growth plate 
remaining attached to the epiphysis.

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The epiphysis is the rounded end 
of the long bones below

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the growth plate 
and the metaphysis is the wider part

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at the end of the long bones 
above the growth plate.

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Type II - Fracture through the 
growth plate and metaphysis.

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This type is the most common 
type of growth plate fracture.

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The growth plate and metaphysis 
are fractured without involving

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the epiphysis.

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Type III - Fracture through the 
growth plate and epiphysis.

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In this type of injury, 
the fracture runs through the epiphysis

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and separates the epiphysis 
and growth plate from the metaphysis.

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It usually occurs 
in the tibia, one of the long bone

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of the lower leg.

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Type IV - Fracture through growth 
plate, metaphysis, and epiphysis:

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Type IV is when the fracture 
goes through the epiphysis

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and growth plate, 
and into the metaphysis.

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This type often occurs 
in the upper arm near the elbow joint.

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Type V - Compression fracture 
through growth plate:

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This type of fracture 
is a rare condition

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where the end of the bone 
gets crushed and the growth plate

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is compressed. It can occur 
at the knee or ankle joint.

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Causes.

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Growth plate injuries 
are caused by accidental falls

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or blows to the limbs 
during sports activities

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such as gymnastics, 
baseball, or running.

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They may also result 
from overuse of tendons

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and certain bone disorders 
such as infection that can affect

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the normal growth 
and development of the bone.

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The other possible 
causes which can lead

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to growth plate injuries are:

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Child abuse or neglect - 
Growth plate fractures

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are one of the most common 
fractures that occur

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in abused or neglected children.

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Exposure to intense 
cold (frostbite) -

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Extremely cold climatic conditions 
can cause damage to the growth

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plates resulting in short fingers 
and destruction

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of the joint cartilage.

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Chemotherapy and medications - 
Chemotherapy to treat cancer

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in children and continuous 
use of steroids for arthritis

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may affect bone growth.

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Nervous system disorders - 
Children with disorders of the nerves

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may have sensory deficits 
and muscular imbalances

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that can cause them to 
lose their balance and fall.

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Genetic disorders - 
Gene mutations may result

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in poorly formed or 
malfunctioning growth plates

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which are vulnerable to fracture.

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Metabolic diseases - 
Diseases such as kidney failure

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and hormonal disturbances 
affect the proper functioning

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of the growth plates and increase 
susceptibility to fractures.

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Signs and symptoms 
of a growth plate injury include:

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Inability to move or put pressure 
on the injured extremity.

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Severe pain or discomfort 
that prevents the use of an arm or leg.

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Inability to continue playing 
after a sudden injury

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because of pain.

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Persistent pain 
from a previous injury.

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Malformation of the legs or arms 
as the joint area near the end

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of the fractured bone may swell.

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In children, fractures heal faster.

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If a growth plate fracture 
is left untreated it may heal

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improperly causing 
the bone to become shorter

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and abnormally shaped.

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Diagnosis.

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Your doctor will evaluate 
the condition by asking you

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about the injury 
and performing a physical examination

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of the child.

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X-rays may be taken to determine 
the type of fracture.

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Since the growth plates 
have not hardened

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and may not be visible, 
X-rays of the injured

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as well as the normal limb 
are often taken to look

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for differences in order 
to help determine the place of injury.

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Other diagnostic tests 
your doctor may recommend include

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computed tomography (CT) scan 
or magnetic resonance imaging (MRI).

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These tests are helpful 
in detecting the type and extent

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of injury as it allows 
the doctor to see the growth plate

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and soft tissues.

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Treatment.

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The treatment for growth plate injuries 
depends upon the type

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of fracture involved. 
In all cases, the treatment

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should begin as early as possible 
and include the following:

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Immobilization: 
The injured limb is covered with a cast

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or a splint may be given to wear. 
The child will be advised

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to limit activities and avoid 
putting pressure on the injured limb.

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Manipulation or surgery: 
If the fracture is displaced

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and the ends of the broken bones 
do not meet in proper position,

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then your doctor 
will unite the bone ends

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into correct position 
either manually (manipulation)

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or surgically. 
Sometimes, a screw or wire

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may be used to hold the 
growth plate in place.

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The bone is then immobilized 
with a cast to promote healing.

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The cast is removed 
once healing is complete.

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Physical therapy: 
Exercises such as strengthening

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and range-of motion exercises 
should be started only after

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the fracture has healed. 
These are done to strengthen

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the muscles of the injured area 
and improve the movement

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of the joint. 
A physical therapist will design

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an appropriate exercise 
schedule for your child.

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Long-term follow up: 
Periodic evaluations are needed

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to monitor the child's growth. 
Evaluation includes X-rays

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of matching limbs 
at intervals of 3 to 6 months

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for at least 2 years.

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Most growth plate fractures heal 
without any long-term problems.

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Rarely, the bone may stop 
growing and become shorter

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than the other limb.