Bone, Joint and Muscle Conditions

Fractures and Growth Plate Injuries

What are fractures and growth plate injuries?

Fractures

Fractures are cracks or breaks in bones. Because children are flexible, their bones may bend after a break. They may straighten out as they heal. This process is called remodeling.

Because of remodeling, a young person’s broken bone will heal better and with less treatment than a similar break in an adult. But some fractures that look simple to treat can cause serious problems for children or teens because their growth plateshave been damaged.

The first treatment your child receives for a fracture is the most important, so call the doctor as soon as possible after their injury.

Growth plate injuries

Children and teens have patches of growing tissue near the end of their long bones. These points where growth occurs are called growth centers or growth plates. Growth plates determine how long children’s bones will be once they are mature.

When children or teens break bones, they may damage their growth plates at the same time. (Other injuries, such as sprains, can also damage growth plates.)

If the growth plate is damaged by a fracture or another injury, the bone may stop growing. This serious problem is called a growth arrest. Growth arrest can permanently stop a bone’s development and change how it functions. If only part of the growth plate is damaged and stops working, the bone may grow in an uneven way.

Types of Fractures

Fractures can be simple or open:

  • Simple fractures are breaks or cracks in the bone that do not break through the skin.
  • Open fractures are breaks in which the bone sticks through the skin.

Fractures can have several causes:

  • Traumatic fractures occur due to injury, such as falling while running, pedaling a bicycle or riding a skateboard. These types of injuries happen to healthy children with healthy bones. The bone gets more force than it is able to handle and breaks. Most fractures are traumatic. Trauma that causes a fracture is a common reason for growth plate injuries.
  • Stress fractures can happen when a child repeats the same position or motion over and over for long periods of time. Repeated motions can also injure growth plates. Stress fractures are not common.
  • Pathologic fractures occur because the bone is weaker than normal. A pathologic fracture is usually due to holes in the bone (bone cysts) or certain bone conditions, such as brittle bone disorder (osteogenesis imperfecta), in which bones break easily. This is not a common cause of fractures.

Fractures and Growth Plate Injuries at Seattle Children’s

  • Seattle Children’s Fracture Program specializes in fractures and growth plate injuries in children and adolescents. We are part of Orthopedics and Sports Medicine, a team of pediatricians, pediatric orthopedic surgeonsnurse practitioners, physician assistants, nurses, athletic trainers, certified medical assistants, registered orthopedic technologists and sports physical therapists.

    We have the knowledge and experience to give your child expert fracture care, from a splint or cast, to complex surgery, to rehabilitation. We treat about 2,000 children and teens with fractures each year. Many kids we see were hurt in sports or other active play. In the summer, when kids play the hardest, we see 10 fractures on our busiest days.

    Many of the patients we treat are referred to us from other doctors and hospitals throughout the Pacific Northwest.

  • Kids are still growing well into their teens. Their bodies can be damaged in ways that an adult body can’t. At Seattle Children’s, we specialize in knowing which treatments are most likely to have the best results for kids whose bones are still growing. The treatment we give your child will take possible growth plate injury into account.

    All the caregivers on our team have special training in the medical, surgical, emotional and social needs of young people.

  • Seattle Children’s has the largest group of board-certified pediatric radiologists in the Northwest. We keep your child’s safety in mind at all times. If your child needs imaging that uses radiation, we use the lowest amount possible to produce the best image.

    We also have a 3D low-dose radiation X-ray machine, called the EOS, for safer full-body 3D images.

    • Children, teens and young adults who need surgery get expert care at our hospital campus in Seattle.
    • Our Orthopedics and Sports Medicine doctors see patients at Seattle Children’s locations in Seattle, Bellevue, Everett, Federal Way, Olympia, the Tri-Cities, Wenatchee, Yakima and Alaska.
    • The Fracture Program offers a Friday Fracture Clinic on the Seattle campus. The clinic provides dedicated, quick access for children or teens who need evaluation, treatment or follow-up care.
    • See our locations and contact information.

Symptoms of Fractures and Growth Plate Injuries

When your child or teen breaks a bone, they will have pain at the site of the break. It will be hard for them to move the body part that is broken. This pain and loss of movement are your cues to take them to the doctor or the emergency room.

  • Some signs of broken bones are clear – for example, when the bone breaks through the skin in an open fracture. Other signs that a bone may be broken and a growth plate may be injured include:

    • Severe pain
    • Swelling, bruising or bleeding
    • Limb or joint looks out of place or the wrong shape
    • Numbness and tingling
    • Unable to move the affected part of the body
  • The most common locations for fractures in children and teens are:

    • Elbow
    • Forearm
    • Thigh (femur)

Diagnosing Fractures and Growth Plate Injuries

  • Doctors first examine your child and take X-rays of the affected bone or bones. This helps us know how to treat your child.

    Simpler breaks can be treated with a sling or a cast. More complex breaks may require surgery. Knowing when a child’s fracture needs surgery requires special education and experience.

  • If the bone is broken at or near a growth plate, the doctor may suspect the growth plate is injured. The growth plate itself can’t be seen on an X-ray, but some signs of damage may show up. Sometimes children need an MRI (magnetic resonance imaging) or other scan to check for growth plate damage.

Treating Fractures and Growth Plate Injuries

Our fracture team is led by surgeons who specialize in the treatment of bones, muscles and joints (orthopedists). This team also includes physician assistants, orthopedic technologists, nurses and pediatricians trained in sports medicine. Your child may be treated in the emergency room, operating room or orthopedic clinic.

  • If your child’s X-ray shows a fracture but the bone is straight and in a good position, we may give them a splint or sling to keep the bone in place while it heals.

    Sometimes this splint or sling is all that your child needs while the bone heals.

  • Depending on which bone they have broken and the severity of the break, we may need to put a cast on once swelling is under control. We apply casts if we think the bone may not heal correctly unless it stays securely in 1 position.

    We also use casts if they can make your child more comfortable by keeping the broken bone still. This reduces the pain that comes if the broken body part is bumped or moved.

  • Flexible rod stabilization. Courtesy of 'Fundamentals of Pediatric Orthopedics,' © 2003 Lippincott Williams & Wilkins

    Flexible rod used to stabilize the thigh while it heals.

    If your child’s X-ray shows that the broken bone is at an angle and in a bad position, we may need to do a surgical procedure called a fracture reduction. In this operation, we usually are able to bend the fracture into a better position.

    If that is not successful, we will make a cut (incision) so we can see the fracture and move it (open reduction). In some cases, we use surgical screws, rods or other devices to keep the bone in place so it can heal correctly.

    About 20% of the children we treat for broken bones need surgery. If your child does need an operation, our surgical staff can ensure that they receive the most appropriate surgery for their injury.

  • Most growth plate injuries will heal without affecting growth. The risk of problems depends on many factors, such as how serious the injury is, how old your child is and which bone they broke.

    If your child has or might have a growth plate injury, the doctor will ask you to watch for signs of growth problems. The doctor will also want your child to come back from time to time in the first 1 to 2 years after the injury. The doctor will examine your child, and your child may have X-rays to check for growth problems. For example, the leg that was broken may not be growing as fast as the other leg or it may not be growing straight.

    Some children who develop growth problems may need surgery, such as to adjust the length of a bone, or other care.

Contact Us

Contact Orthopedics and Sports Medicine at 206-987-2109 for an appointment, a second opinion or more information.

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