Doctor’s diagnose growth plate injuries by
- Asking about the injury and how it occurred.
- Examining your child.
- Ordering x-rays.
Often the doctor will x ray your child’s injured limb and the opposite limb as well. Because growth plates have not yet hardened into solid bone, neither the structures themselves nor injuries to them show up on x rays. Instead, growth plates appear as gaps between the shaft of a long bone, called the metaphysis, and the end of the bone, called the epiphysis. By comparing x rays of your child’s injured limb to those of their non-injured limb, doctors can look for differences that indicate an injury.
Very often the x ray is negative, because the growth plate line is already there, and the fracture is undisplaced (the two ends of the broken bone are not separated). The doctor can still diagnose a growth plate fracture on clinical grounds because of tenderness of the plate. Children do get ligament strains if their growth plates are open, and they often have undisplaced growth plate fractures.
Other tests doctors may use to diagnose your child’s growth plate injury include:
- magnetic resonance imaging (MRI).
- computed tomography (CT).
- ultrasound.
Because these tests enable doctors to see the growth plate and areas of other soft tissue, they can be useful not only in detecting the presence of an injury, but also in determining the type and extent of the injury.
Treatment for growth plate injuries depends on the type of injury. In all cases, treatment should be started as soon as possible after injury and will generally involve a mix of the following:
Immobilization
The doctor puts the injured limb in a cast or splint, and your child or teen is told to limit any activity that puts pressure on the injured area.
Manipulation or Surgery
If the your child’s fracture is displaced (meaning the ends of the injured bones no longer meet as they should), the doctor will have to put or set the bones or joints back in their correct positions. Doctors do this by
- Manipulation. The doctor uses his or her hands to set the bone.
- Performing surgery. Sometimes the doctor needs to fix the break and hold the growth plate in place with screws or wire. After the procedure, the bone will be set in place (immobilized) 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.
After manipulation or surgery, the doctor places a case on the injured area. The cast is left in place until the injury heals, which can take anywhere from a few weeks to 2 or more 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
Your child’s doctor may recommend exercises to strengthen the muscles that supports the injured area of the bone. Strengthening can help to improve your child’s ability to move the joint in the way that it should. Doctor’s usually recommend these after the fracture has healed. A physical therapist can work with your child and his or her doctor to design an appropriate exercise plan. Long-term follow-up is usually necessary to monitor the child’s recuperation and growth.
For all but the simplest injuries, your child’s doctor will probably refer him or her to an orthopaedic surgeon (a doctor who specializes in bone and joint problems in children and adults) for treatment. Some problems may require the services of a pediatric orthopaedic surgeon, who specializes in injuries and musculoskeletal disorders in children.
Most growth plate fractures heal without any lasting effect. However, some children experience complications. The most frequent complication of a growth plate fracture is premature arrest or a stop of bone growth. Whether your child experiences an arrest in growth depends on the type of treatment your child received and the following factors:
- Severity of the injury. If your child’s injury causes the blood supply to the epiphysis to be cut off, growth can be stunted. If the growth plate is shifted, shattered, or crushed, the growth plate may close prematurely, forming a bony bridge or “bar.” The risk of growth arrest is higher in this setting. An open injury in which the skin is broken carries the risk of infection, which could destroy the growth plate.
- Age of your child. In a younger child, the bones have a great deal of growing to do; therefore, growth arrest can be more serious, and closer surveillance is needed. It is also true, however, that younger bones have a greater ability to heal.
- Which growth plate is injured. Some growth plates, such as those in the region of the knee, are more involved in extensive bone growth than others.
- Type of fracture. Of the six fracture types described earlier, types IV, V, and VI are the most serious.
If your child experiences an arrest in bone growth, they could have one limb shorter than the uninjured limb. If only part of the growth plate is injured, growth may be lopsided and the limb may become crooked.
Growth plate injuries at the knee have the greatest risk of complications. Nerve and blood vessel damage occurs most frequently there. Injuries to the knee have a much higher incidence of premature growth arrest and crooked growth.