Pediatric Growth Plate Fractures

Growth plates are areas of cartilage located near the ends of the bones. Because they are the last portion of a child’s bone to harden (ossify), growth plates are particularly vulnerable to fracture.

Approximately 15% to 30% of all childhood fractures are growth plate fractures. Because the growth plate helps determine the future length and shape of the mature bone, this type of fracture requires prompt attention. If not treated properly, it could result in a limb that is crooked or unequal in length when compared to its opposite limb. Fortunately, serious problems are rare. With proper treatment, most growth plate fractures heal without complications.

Anatomy

Growth plates are found in the long bones of the body. Examples of long bones include the femur (thighbone), the radius and ulna in the forearm, the tibia and fibula in the lower leg, and the metacarpal bones in the hands. Most long bones have two growth plates, one at each end of the bone. Growth plates are located between the widened part of the shaft of the bone (the metaphysis) and the very end of the bone (the epiphysis). When a child is fully grown, the growth plates harden into solid bone.

Cause

Growth plate fractures are often caused by a single event, such as a fall. They can also occur gradually as a result of repetitive stress on the bone, which may occur when a child over trains in sports. All children who are still growing are at risk for growth plate injuries.

Classification of Growth Plate Fractures

The Salter-Harris system is the most widely used classification system for growth plate fractures.

Salter Harris Type I Growth Plate Fracture
These fractures break through the bone at the growth plate; for this reason, radiographs are typically normal. However, there may be evidence of widening at the growth plate.

Salter Harris Type II Growth Plate Fracture
These fractures break through part of the bone at the growth plate and extend into shaft of the bone (the metaphysis). This is the most common type of growth plate fracture.
Salter Harris Type III Growth Plate Fracture
These fractures cross through a portion of the growth plate and extend into the end of the bone (the epiphysis). This is more common in older children.
Salter Harris Type IV Growth Plate Fracture
These fractures break through the shaft of the bone, the growth plate, and the end of the bone.
Salter Harris Type V Growth Plate Fracture
These fractures occur due to a crushing injury to the growth plate, typically from a compressive force.