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Growth plate injuries (physeal arrest)
Kids and teens have unique needs when it comes to caring for a broken bone because of their growing bodies. Not only are kids’ bones more flexible, but kids and teens have growth plates at the end of their bones which can also be injured during a fracture, and those injuries require specialized care from a pediatric expert.
About hand and upper extremity growth plate injuries
Growth plates play a vital role in kids’ physical development. Made of rubbery cartilage at the end of bones, growth plates determine the length and shape of the mature bone and harden into solid bone after teens are finished growing. Growth plates are found only on long bones, which includes the radius and ulna in the forearm and metacarpal bones in the fingers.
Kids have open growth plates until about age 16, though there’s some variability — adolescent boys are much more likely to get growth plate injuries because adolescent girls stop growing earlier. Because open growth plates are weaker than mature bone, an injury that might cause a sprain in an adult could cause a fracture in a child. Nearly one-third of childhood fractures involve the growth plate. Growth plate fractures are classified as Type I, II, III, IV or V, depending on the severity and fracture pattern.
Video: Learn more about growth plates
Experts in hand and upper extremity growth plate injuries
As the only comprehensive pediatric hand and upper extremity program in the state, Children’s Wisconsin provides expert care to kids and teens with a wide range of common and rare conditions affecting the shoulder, arm, elbow, wrist and hand. With our team’s specialized training, vast experience and deep knowledge of the unique challenges of children’s growing bodies, we can ensure the best possible outcomes for your child’s recovery after a growth plate injury. Our child-centered environment and wraparound services are designed to support the whole family and provide comfort when your child is stressed and in pain. If your child has already been diagnosed at another center, we invite you to get a second opinion at Children’s Wisconsin.
Why are growth plate injuries a concern?
If not properly managed by a pediatric expert, these injuries could get worse and cause long-term problems. A damaged growth plate can cause a child’s bone to stop growing (a condition known as physeal arrest) or to grow too much or at an abnormal angle, resulting in a limb that is permanently shorter, longer or crooked.
What are the symptoms of growth plate injuries?
Signs of a growth plate fracture may include:
- A snapping noise at the time of injury
- Pain
- Swelling, heat and tenderness near the bone’s end
- Numbness/weakness in the affected area
- The bone no longer looks straight, is bent the wrong way or is visible through the skin
If you suspect your child might have a fracture of any type, seek medical assistance right away. Even if you think it’s just a sprain, it’s a good idea to see a doctor to have the injury assessed and rule out a broken bone and growth plate injury.
How are growth plate injuries diagnosed?
The physician will evaluate your child’s injury through a physical examination and imaging. At Children’s Wisconsin, we use imaging procedures that ensure your child is exposed to the smallest amount of radiation possible. Imaging procedures may include:
X-rays – Uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film
Magnetic resonance imaging (MRI) – Uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body
Computed tomography scan (CT scan) – Uses a combination of X-rays and computer technology to produce detailed, cross-sectional images of the body, including the bones, muscles, fat and organs
Treatment for hand and upper extremity growth plate injuries
Treatment will vary depending on the type and severity of your child’s injury. Your child’s treatment plan may include:
Closed reduction – If the bone is not in the right place, your child’s doctor will numb the area and move the bones back into place, a procedure called a closed reduction. More commonly known as “setting” the bone, this procedure does not involve cutting open the skin.
Surgical repair – In rare cases, your child might need a procedure called an open reduction to treat a severe or complicated fracture. Our highly skilled pediatric orthopedic surgeon will surgically repair the bones, tendons and soft tissue in a precise and delicate manner to preserve your child’s movement and function in the future. The surgeon might use screws, wires or metal plates to hold the bone fragments in place.
Sling/splint/cast – Once your child’s bone is in the right place, they will need to wear a sling, splint or cast (depending on the area injured) to immobilize and protect the area so the bone can heal.
Medical management – Anti-inflammatory medications can relieve your child’s pain immediately after the injury and as they recover.
Hand therapy – Hand therapy is a critical part of the postsurgical and nonsurgical process to promote healing, increase range of motion and maximize functional use of your child’s hand/arm. Our certified hand therapist offers serial casting, custom splinting, paraffin wax treatments, scar massage and more.
Rest – Your child will need to take a break from athletics or other activities that worsen their discomfort until they heal.
Long-term outlook for growth plate injuries
Recovery from growth plate injuries in the hand and upper extremity can take time, but with proper treatment, most children heal well with no complications. In rare cases, a child might develop a bony bridge across the fracture site that can affect the future growth and shape of the bone, which can be repaired with a small surgical procedure. More severe deformities in the bone might also require surgical repair. Your child may need several follow-up appointments so that the orthopedic specialist can monitor their recovery and growth.