Physeal Injuries, Growth Plate Injuries

The growth plate (physis) is a cartilage-like structure near the end of long bones in individuals who are not skeletally mature. The physis is where bones grow in length during maturation. The typical age at which growth plates close is 14 to 16 years old for females and 16 to 18 years old for males. However the growth plates may remain open as late as 25 years of age.

The physes (plural of physis) are more susceptible to injury than the bones, muscles, and ligaments around them. Not only are physes more susceptible to injury than other tissues, but injury to a physis is also a more severe condition.

Fractures of the growth plate frequently involve the neighboring areas of bone. If an injury occurs to ligament or tendon near the growth plate, then the growth plate may become inflamed or a more serious avulsion fracture (a piece of bone is pulled off by a tendon or ligament) may occur.

SYMPTOMS

  • Pain, tenderness, bleeding, bruising, and swelling at the fracture site.

  • Weakness and inability to bear weight on the injured extremity.

  • Weakness or inability to use the injured extremity in athletic activities.

  • Paleness and deformity (sometimes).

  • Loss of pulse, numbness, tingling, or paralysis below the fracture site (usually an extremity). These are signs of a medical emergency.

CAUSES

  • An acute incidence of trauma may cause a physeal injury if the force placed on the growth plate is greater than it can withstand.

  • Repetitive stress and/or strain to or overuse of muscles and tendons may cause injury to a physis.

  • Sudden increase in amount or intensity of activity.

  • Muscle imbalance or weakness.

RISK INCREASES WITH:

  • Contact sports (football, rugby, hockey, or lacrosse).

  • Falls from heights.

  • Endurance sports activities.

  • Poor balance.

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Cardiovascular fitness.

  • Muscle strength.

  • Flexibility and endurance.

  • Wear properly fitted and padded protective equipment.

  • Learn and use proper technique.

PROGNOSIS

Physeal injuries are usually curable if treated correctly. The time to recovery will vary depending on the type and severity of injury.

RELATED COMPLICATIONS

  • Failure to heal (nonunion).

  • Healing in a poor position (malunion).

  • Shock from blood loss (hypovolemic shock). This is rare.

  • Death of bone cells due to lack of the blood supply.

  • Obstruction of nearby arteries.

  • Recurrence of symptoms or increasing symptoms if not given adequate time to heal or if sports are resumed too soon. Treating the problem the first time reduces the likelihood of recurrence.

  • Arthritic joint due to death of bone or repeated injury.

  • Weakness of muscle force if the muscle-tendon attachment is pulled off and not replaced in proper position.

  • Shortening or deformity of the fractured bone.

  • Complete or partial arrest of bone growth. This results in a short bone or growth at an abnormal angle.

  • Prolonged healing time if not treated right or not given adequate time to heal.

  • Untreated, inflammation of the growth plate progressing to a complete fracture of the growth plate.

TREATMENT

Treatment for physeal fractures requires immediate realigning of the bones (reduction) if they are displaced. Reduction should only be performed by someone who is medically trained. After reduction or if reduction is not necessary, ice and medication can be used to reduce pain and inflammation. The injury is usually immobilized for a period of time to allow for healing. If the bones cannot be reduced manually, then surgery may be necessary to reposition and hold them in place with screws and pins. After surgery the injury is usually immobilized.

If a long bone is immobilized for a long period of time, the certain complications may occur. These include:

  • Loss of muscle mass.

  • Stiffness of joints.

  • Fluid accumulation the tissues (edema).

Physical therapy may be necessary after immobilization to regain strength and a full range of motion. Recovery is complete when there is no bone motion at the fracture site and x-rays show complete healing.

MEDICATION

  • General anesthesia, sedation, or muscle relaxants may be necessary to allow for reduction of a displaced fracture.

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if necessary. Use only as directed and only as much as you need.

SEEK IMMEDIATE MEDICAL CARE IF:

The following occur after immobilization or surgery (report any of these signs immediately):

  • Swelling above or below the fracture site.

  • Severe, persistent pain.

  • Blue or gray skin below the fracture site, especially under the nails, or numbness or loss of feeling below the fracture site.