GROWTH PLATE FRACTURES AND INJURIES

Growth plates are structures that are present on both ends of the long bones of the body. This is also known as the epiphyseal plate. Epiphyseal plates can be found on the femur (the largest bone of the body), bones of the lower leg (both tibia and fibula), the paired bones of the forearm (radius and ulna) and the bones of the hands and feet.

The epiphyseal plate is made up of a flexible substance that is rich in collagen. This is the area where new bone growth occurs to match the growing individual. Growth is defined as an increase in both the bone length and diameter, causing a growth in the outward appearance.

As we age, this region of the bone closes and does not permit entry of minerals necessary for bone growth; thus, we stop growing once we reach 21. However, some abnormalities can alter this state, and this includes gigantism wherein there is an excess of overproduction of the growth hormone, thus leading to increased deposition of calcium in the bones, resulting in increased bone mass.

TYPES

Growth plate fractures occur when there is a discontinuity in the structure of the epiphyseal plate. Most commonly found on the areas subjected to weight or weight-bearing areas of the body or areas involved in the mobility of the body. They often heal spontaneously in the setting of adequate nutrition and proper rest of the affected area without any long term disability.

Injuries to the growth plate are brought about by constant use. This type is especially prevalent among growing children who are active most of the time, and athletes who use the same muscle group/set of bones for their activity.  Examples of this type of injury include Osgood-Schlatter disease (characterized by pain on the kneecap coupled with swelling), Jumper’s knee (this condition is brought about by the inflammation on the tendon of the knee resulting from the frequent up and down springing of kids during play.

SYMPTOMS

The most common symptoms of growth plate fracture involve pain that makes the patient immobile, or they sometimes present as a limp favoring the area of injury.

DIAGNOSIS

Diagnosis for fractures on this bone area is quite tricky since there is not enough bone substance present that would make them opaque in the radiograph. The clinician most often requests an x-ray of both extremities and studies them for any differences to consider a fracture on the epiphyseal plate area.

For those with severe pain symptoms, other imaging modalities such as computed tomography scan, magnetic resonance imaging, and ultrasound can provide a better clue on the extent of the injury.

TREATMENT

Treatment of the growth plate fractures is dependent on the extent and severity of the injury. Minor injuries or fractures are supported using casts or splints to immobilize the affected extremity and allow maximal healing temporarily. The cast is usually kept in place for approximately two weeks.

In severe fractures, surgical intervention may be necessary with the placement of pins to keep the bones in their exact axis.

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