Growth Plate Injuries and Kids

Every pediatrician knows the saying “kids are not little adults” and this applies to broken bones as well. The good news is that when kids get fractures they tend to heal faster than adults. The bad news is that a fracture in the wrong place can interfere with proper growth. This is particularly true for fractures in the knee and hip.

Some basic anatomy

Bones that are still growing have an epiphysis (the part of the bone that interfaces with the joint space), the physis (the growth plate) and the metaphysis which is above the growth plate. Because we love to classify things, there is a classification system for the type of growth plate injury. This is called the Salter classification of growth plate injuries. It goes from 1 to 5. The higher the number the worse the fracture.

Type 1 is the most benign. Type 1 fractures are through the growth plate and can be hard to see on an x-ray. If your child has pain at where the growth plate lies, this is suspicious for a Salter type 1 fracture. These are usually managed by splinting and heal within a few weeks. Type 2 is above the growth plate; type 3 is below the growth plate and into the part of the bone that is in the joint. Type 4 is above and below the growth plate, and type 5 is the most serious which is a crush injury of the growth plate. Type 5 is most worrisome because this can result in growth issues with healing. Types 2-4 are fairly straightforward to see on a plain x-ray. All injuries that involve the growth plate should be followed by a visit to an orthopedist to make sure that the bone heals properly.