Growth plate

• Growth plates fusion:

  • Girls: 13-15 years
  • Boys: 15-17 years
  • Can be up to the age of 25
• The involvement of the physis (growth plate) means that any mismanagement can result in limb shortening or abnormal growth.
• The growth plate:

  • Consists of 3 parts - epiphysis, physis and metaphysis
  • The physis is the hyaline cartilage plate found at each end of the long bones in children
  • Site of endochondral ossification, where chondrocytes replace cartilage with bone - growth of long bones
• Clinical features:

  • Most occur following a fall or twist - less commonly after repetitive activities such as gymnastics
  • Pain at the affected site and unable to weight bare
  • Bruising and swelling
  • Visible deformity at the fracture site in severe cases
  • Identify any safeguarding issues
• Salter-Harris classification:

  • Type I - fracture line straight across the growth plate with no bone involvement
  • Type II - fracture line involves the growth plate and the bone above - most common type
  • Type III - involves the growth plate and the bone below
  • Type IV - passes through the whole growth plate involving the metaphysis and epiphysis
  • Type V - crush injury of the growth plate
• Investigation:

  • Plain film X-ray in at least 2 views
  • Further CT or MRI imaging may be required to inform operative planning or assess surrounding soft tissue
• Management:

  • Type I and II - usually minimally displaced - closed reduction and cast
  • Type III and IV - greater displacement and instability - closed reduction should be attempted but low threshold for ORIF
  • Type V - more are diagnosed retrospectively when growth arrest or limb deformity has already occurred - referral to specialist centre
• Children with growth plate fractures may present late; if more than 5 days after the injury, then manipulation should not be attempted and if not well-aligned, then operative intervention may be needed.
• Complications:

  • Most have good prognosis
  • If fracture missed or mis-managed:
  • Disruption or early closure of the growth plate
  • Impaired function
  • Growth arrest
  • Limb deformity