Growth Plate Injuries: Causes, Symptoms, & Treatment Options

Updated 12/7/2023
Growth Plate Injuries, University Foot and Ankle Institute

What are Growth Plates?


Growth plates, also known as epiphyseal plates, are soft points on the end of a child's bone that will eventually form solid bone as your child matures. Growing bones each have one growth plate at either end. The cartilaginous cells transform into hardened bone cells, extending the bone: this is how bones grow.


A possible injury to the growth plate needs to be evaluated by a specialist right away. The growth plate is the weakest point in the bone, and if it is fractured and left untreated, a growth plate injury could stunt bone growth.

What is a Growth Plate Injury?

Most growth plate injuries result from acute trauma, such as a fall, car accident, or twisted ankle. Many occur in younger children and teens who participate in competitive sports. But some injuries are caused by repetitive stress to the joint – a chronic injury common to young athletes. Although most injuries occur in the long bones of the fingers and outer bone of the forearm, they’re also fairly common in the tibia and fibula (the shin bones), and the bones in the foot and ankle.


In addition to acute injuries, growth plates can be damaged by other events, such as a bone infection, frostbite, or radiation therapy as a treatment for certain cancers. Children who have certain neurological or musculoskeletal disorders are also more prone to growth plate injuries.


Growth plate fractures are fairly common and makeup 15 - 30% of all childhood fractures. 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.



How Common are Growth Plate Injuries?

Children and adolescents who have not yet reached physical maturity are susceptible to growth plate injuries, occurring especially at the joints. The growth plate is even more vulnerable to injury than the joints’ connective tissue. A trauma that may have caused a sprain in an adult body could actually do more harm to a child’s growth plate than to the tendons and ligaments.


About 15% of fractures in children are growth plate injuries. Because boys’ bodies tend to mature at a later age than girls, boys have a higher incidence rate of growth plate injuries, and they tend to get them between the ages of 14 and 16. Girls, on the other hand, are most likely to injure their growth plates between 11-13 years of age.


Symptoms of a Growth Plate Injury

Keep a close eye on your child’s growing body and play habits. They may offer clues to a cause for concern. Your child or teen may have a growth plate injury if they:

  • Have sustained an acute injury to one of their limbs
  • Complain of severe pain as a result of an injury
  • Can no longer play or have a worsening ability to play recreational activities after sustaining an injury
  • Have a visible deformity at the injured area
  • Complain of persistent pain and soreness at a joint or in the heel, regardless of injury, especially if they are very physically active


Injuries to the growth plate can be difficult to catch. In adults, an x-ray can easily detect a fracture, but in children, a growth plate fracture takes a specially trained eye.



Diagnosing Your Child's Growth Plate Injury 

Your foot and ankle specialist can check for a growth plate injury and bone fractures by conducting an X-ray. Although there may not appear to be a fracture, a growth plate injury might be diagnosed by comparing the differences between an X-ray image of the injured limb and an image of the (healthy) opposite limb. An MRI (magnetic resonance imaging), CT (computed tomography) scan, or ultrasound can also aid in the diagnosis.



Common Types of Growth Plate Fractures


Type I: Type 1 (also know as Salter-Harris fractures) often occur in younger children. The injury goes across the growth plate and surrounding bones are not affected. They often occur in younger children and are likely to appear normal on an x-ray. Type 1 fractures are treated with a cast and healing is often fast and without complications. 


Type II: This type of fracture goes across the growth plate and up the shaft of the bone. Type two is a common type of growth plate fracture and often affects older children. The broken bone often needs to be repositioned and recovery is without complications. 


Type III: The fracture goes across the growth plate through the end of the bone and into the adjacent joint. These injuries usually affect older children and may involve cartilage damage. Proper positioning of the broken bone is extremely important following this type of fracture. 


Type IV: The fractures go across the growth plate and through the joint cartilage. Type four fractures may involve joint cartilage and impair growth. Proper positioning is also extremely important and surgery can be required to hold the bones in the proper position.


Type V: In this type of fracture the growth plate is crushed. Because bone alignment and length can be affected, Type 5 growth plate fractures are the most concerning. Unless the growth plate is aligned perfectly and maintained during recovery, the prognosis for growth is poor.



Treating a Growth Plate Injury

If there’s a chance your child or teen has injured a growth plate, make an appointment with your foot and ankle specialist. Proper treatment is critical and under no circumstances should your child keep running or playing while injured. Many young athletes try to minimize their injury or “play through the pain,” but if teens and children do not give their growing bodies time to heal, they may be setting themselves up for a more serious condition in the future.


Depending on the severity of the injury, your foot and ankle specialist may recommend one of these courses of treatment.

  • Immobilization of the joint. The joint will typically be immobilized in a cast or boot for 2-4 weeks to give the area time to heal. In the meantime, your child should limit their physical activities and refrain from bearing weight on the injured foot.
  • Manipulation. In some cases, the doctor can manipulate the joint using his or her hands to place the bones back into their correct position. Afterward, the joint will be set in a cast for 2-4 weeks until it has healed completely.
  • Surgery. For severe growth plate fractures, a surgical correction (open reduction) may be required. The surgical site will then be placed in a cast or boot for 4-6 weeks while the bones and soft tissues heal.


Recovery from a Growth Plate Injury

After the growth plate fracture has healed, your foot and ankle specialist will recommend exercises to strengthen the muscles and improve the joint’s range of motion. The greatest risk of a growth plate injury is the stunted growth of the bone (also known as growth arrest), and the younger your child is at the time of the injury, the greater the risk of severe stunting. Your child’s doctor will schedule follow-up visits, including physical exams and X-rays, about 2-3 times per year for two years after successful treatment.



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