Growth Plate Injuries: Sever’s Disease and Fractures

Growth plates are present in the bones of every growing child. Growth plates are areas of developing cartilage near the ends of bones. Once the growth of the bone is complete, the growth plates close and are replaced with solid bone. Because growth plates are the weakest area in a growing skeleton, they are vulnerable to injury.

Repetitive stress is a common cause of growth plate injuries. This minor injury can occur in any bone with a growth plate and often results in inflammation. This commonly affects the growth plates in the heel bone, this condition is called Sever’s disease. Thisfrequently occurs when the child is undergoing a growth spurt and whilethese injuries can be painful, they do not have any long-term effects. We often manage these injuries with physical therapy, supportive shoes and orthotics to reduce stress on the affected growth plate.

Another cause of growth plateinjuriesis through a direct injury – often causing a fracture at or through a growth plate. An x-ray is taken to visualize the fracture pattern. Growth plate fractures are evaluated through the Salter-Harris classification system.

In this classification system, the fracture is classified based on where the fracture is in relation to the growth plate. The fracture pattern will give us clues as to how well the fracture will heal and if growth in the bone will be impeded. In looking at the fracture patterns, we predominantly look at where the fracture is in relation to the growth plate, if the fracture is displaced from its normal anatomic position and if there is any compression injury to the growth plate. Fractures that cause compression of the growth plate or are displaced have a poorer prognosis than those that do not.

These growth plate injuries are often treated with immobilization in a cast or boot. If the fracture is displaced, the doctor may need to reduce the fracture back into its anatomical position with surgery or manipulation.

Growth plate injuries are fairly common in children. Less severe injuries do not often lead to complications, but certain growth plate fractures can lead to a loss of bone growth. It is important to have the injury evaluated by a doctor to determine the best course of action for the injury.

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