Growth Plate Injuries - Dr. Jeffrey Farber

Iowa Ortho's pediatric orthopedic surgeon, Dr. Jeffrey Farber, discusses injuries to the growth plate in adolescents.

What is a growth plate and how is it injured?

Growth plate injuries and fractures (happen) in skeletally immature individuals. As we're growing – we all have growth plates at the end of each long bone. The growth plate is actually made out of cartilage, which is weaker than tendon or bone. So, if I have a ‘weekend’ adult athlete – their injuries happen to be ligamentous or tendon injuries because that's the weak spot. In kids, the weak spot (and it is usually near the joint) is the growth plate because it's made out of cartilage. That's the most common fracture I see because it's the path of least resistance.

The downside is they can grow crooked. The single best thing you can do is to get (the bone) lined up as good as you can. Sometimes even with perfect alignment – growth abnormalities can occur because we don't know what happened to the cells of the time of impact. Once the fracture has healed, then I usually will get an X-ray between 6 and 12 months down the line to make sure they are growing appropriately. Most of them do – it's actually kind of rare to have a growth issue. The good part of growth plate fractures (compared to adult fractures) is they heal quicker. So, a typical wrist fracture in an adult will heal in an eight-year-old in three weeks – with adults maybe six weeks. It's something to be in tune with, but most of the time they turn out fine.

What are symptoms of a growth plate injury and how is it diagnosed?

Growth plate fractures are painful, and they have the same type of pain response as any fracture – they hurt. And so, it's usually pretty obvious. There is a subset of growth plate issues where it's more of like a stress fracture, it's kind of an overuse syndrome – but again, since it's the weak spot, that's where it hurts.

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Where are these kinds of injuries most common?

The most common growth phenomena that I see is in the knee – and there's different names to it. I like to call ‘patellofemoral syndrome,’ some people call it ‘adolescent knee syndrome,’ and there are really three parts of it. Since the muscles are imbalanced, the kneecap is loose. The tendon is irritated and where the tendon attaches to the top of the shin bone there's a growth plate there. There's a couple of doctors who first described an irritation to that growth plate, Osgood and Schlatter. It generally happens in girls about 10 or 11 (years old), the boys get it when they were about 13 or 14 (years old) – and it is an overuse syndrome of that growth plate at the top of the tibia bone.

What are treatment options for a growth plate injury?

For the standard fracture – it's no different than any fracture. If it's not lined up, we'll need to set it. If it's lined up, that's fine. But we'll treat it in a cast or splint, what’s ever appropriate for that patient.

What does the recovery look like from a growth plate injury?

As far as recovering from a growth plate fracture, as I mentioned earlier, they heal in about half the time is an adult. But again, it's mostly common sense in that most growth plate fractures in kids will heal and three to four weeks. I'll usually give them another extra two or three weeks to get used to being in athletics again. And usually by six or seven weeks, most of them are ready to go.