Growth Plate Fractures: Symptoms, Types, Causes and Treatment

Growth plate fractures are injuries unique to children and adolescents, affecting the soft regions of cartilage near the ends of long bones—known as the growth plates or physes. These areas are responsible for bone growth and lengthening during childhood and adolescence, making them crucial to proper skeletal development. When a growth plate is fractured, prompt recognition and management are vital to prevent long-term complications, such as limb-length discrepancies or angular deformities. In this article, we delve into the symptoms, types, causes, and latest treatment options for growth plate fractures, synthesizing the most current research findings and clinical guidelines.

Symptoms of Growth Plate Fractures

Growth plate fractures can be subtle or dramatic in presentation, often depending on the mechanism and severity of injury. Recognizing the telltale symptoms early is essential for timely intervention and to minimize the risk of complications.

Symptom	Description	Common Locations	Source(s)
Pain	Localized at injury site	Long bones (arm, leg)	2 3 8
Swelling	Around joint or bone	Knee, ankle, wrist	2 3 8
Tenderness	Point-specific over growth plate	Distal femur, tibia	2 3
Deformity	Visible angulation or shortening	Severe fractures	1 2 7
Limited movement	Reduced joint/bone mobility	Any affected joint	2 3
Inability to bear weight	Especially lower limbs	Knee, ankle	2 3

Table 1: Key Symptoms

Recognizing Growth Plate Fracture Symptoms

Growth plate fractures often mimic other musculoskeletal injuries but have distinctive features due to the involvement of developing cartilage.

Localized Pain and Swelling

• Pain is usually sharp and focused right over the growth plate region, intensifying with movement or pressure.
• Swelling develops rapidly, particularly around major joints like the knee, ankle, or wrist, following trauma or overuse 2 3 8.

Tenderness and Deformity

• Point tenderness is often present directly over the growth plate; pressing the area elicits discomfort.
• Deformity may be obvious in severe cases, manifesting as visible angulation, limb shortening, or abnormal alignment—especially with displaced fractures or those involving the joint surface 1 2 7.

Functional Impairment

• Limited movement of the affected joint or bone is common, with children often refusing to move the limb.
• Inability to bear weight is a key sign in lower limb fractures, with children often limping or refusing to stand 2 3.

Less Obvious Presentations

• In some cases, especially with chronic or less severe injuries, symptoms may be subtle:
  • Persistent pain with activity (not always linked to acute trauma)
  • Mild swelling or discomfort in athletic children 3
  • Nonspecific pain that may be confused with sprains or overuse injuries

Importance of Early Detection

Rapid and accurate identification of these symptoms is crucial. Delayed recognition can lead to missed diagnosis, increasing the risk of long-term growth disturbance or deformity 2 8.

Types of Growth Plate Fractures

Growth plate fractures are categorized by their anatomical pattern, which influences prognosis and management. The Salter-Harris classification is the most widely used system, helping clinicians predict the risk of growth disturbance and tailor treatment accordingly.

Type	Description	Risk of Complications	Source(s)
Type I	Through the growth plate only	Lowest	5 1
Type II	Through growth plate + metaphysis	Moderate	5 1
Type III	Through growth plate + epiphysis	Moderate-High	5 1 4 7
Type IV	Through growth plate, metaphysis + epiphysis	Highest	5 1 4 7
Type V	Crush injury to growth plate	Highest	5

Table 2: Salter-Harris Classification Overview

The Salter-Harris Classification Explained

The Salter-Harris (SH) system organizes growth plate fractures into five main types based on the path the fracture takes through the bone and cartilage.

Type I: Pure Physeal Separation

• Fracture runs straight across the growth plate, separating the epiphysis from the metaphysis.
• Generally has the best prognosis due to minimal damage to bone-forming cells 5.
• Growth disturbance is comparatively low (36% in distal femur) 1.

Type II: Physeal and Metaphyseal Involvement

• Involves the growth plate and extends into the metaphysis but not the epiphysis.
• Most common type of growth plate fracture.
• Moderate risk of growth disturbance (58% in distal femur) 1 5.

Type III: Physeal and Epiphyseal Involvement

• Fracture passes through the growth plate and into the epiphysis, potentially affecting the joint surface.
• Higher risk of complications, including joint deformity and premature growth plate closure (49% growth disturbance in distal femur) 1 4 5 7.

Type IV: Involving Metaphysis, Growth Plate, and Epiphysis

• Crosses all three regions, often causing significant disruption to the growth plate and adjacent bone.
• Highest risk of growth arrest, angular deformity, and limb-length discrepancy (64% in distal femur) 1 4 5 7.

Type V: Compression Injury

• Crushes the growth plate without visible separation.
• Rare but carries a high risk for growth arrest due to destruction of growth plate cells 5.

Additional Types and Complexities

Some locations, like the distal tibia, can also exhibit "triplane" fractures in adolescents, combining features of SH Types II, III, and IV 4.

Prognostic Implications

• Displacement, involvement of the joint surface, and fracture type all impact the risk of growth disturbance.
• SH IV and V, and displaced fractures, are most likely to result in significant complications, including limb-length discrepancies and angular deformity 1 4 7.

Causes of Growth Plate Fractures

Understanding what causes growth plate fractures is vital for prevention and early diagnosis. These injuries result from a combination of acute trauma, chronic stress, and unique vulnerabilities of the growing skeleton.

Cause	Mechanism	Typical Age/Group	Source(s)
Acute Trauma	Fall, direct blow, collision	Children, teens	2 3 8
Sports Injury	Twisting, impact, overuse	Young athletes	3 8
Repetitive Stress	Chronic microtrauma	Athletes	2 3
High-Energy Injury	Car accidents, severe falls	Adolescents	2 3 8
Neuromuscular Disorders	Weak bones, abnormal stress	Underlying conditions	3

Table 3: Principal Causes

Acute Traumatic Events

• Falls are the leading cause, especially from playground equipment or while running and jumping.
• Direct blows—such as those from sports collisions or vehicular accidents—can transmit force to the growth plate, causing a fracture 2 3 8.

Sports and Overuse Injuries

• Young athletes are particularly vulnerable due to the repetitive and high-impact nature of many sports.
• Activities like football, basketball, gymnastics, and rugby see higher rates of growth plate injuries, often in shoulders, knees, or ankles 3 8.
• Chronic, repetitive microtrauma (e.g., from throwing or running) can slowly damage the growth plate, leading to stress injuries that may be harder to detect but still result in growth disturbance 2 3.

Mechanisms of Injury

• Growth plates are made of cartilage, which is softer and weaker than bone. This makes them a weak link during trauma—forces that would sprain a ligament in an adult can instead fracture a child's growth plate 2 8.
• Twisting injuries can cause the bone to shift on either side of the growth plate, resulting in a fracture.

Age, Sex, and Other Risk Factors

• Growth plate fractures are most common during periods of rapid growth (childhood through adolescence), when the physes are most active and vulnerable 2.
• Boys tend to sustain more growth plate injuries, likely due to later closure of their growth plates and higher rates of risky activities.

Underlying Conditions

• Children with neuromuscular disorders or other conditions affecting bone strength are at increased risk, even with minor trauma 3.

Less Common Causes

• Compression injuries (SH V) can result from severe forces, such as car accidents or falling from significant heights 5.
• Rarely, growth plate injury can occur due to underlying disease or infection.

Treatment of Growth Plate Fractures

Early and appropriate management of growth plate fractures is essential to maximize healing and minimize the risk of long-term complications. Treatment varies by fracture type, location, displacement, and the child’s age.

Treatment	Approach	Indications	Source(s)
Immobilization	Casting, splinting	Non-displaced, SH I-II	2 7
Closed Reduction	Manual realignment + casting	Displaced but stable	2 7
Surgical Fixation	Pins, screws, open reduction	SH III-IV, severe/displaced	1 4 7
Bar Resection	Remove bony bar, insert graft	Growth disturbance, arrest	9 12
Regenerative Therapies	Scaffolds, hydrogels, tissue engineering	Experimental, complex cases	10 11 12 13

Table 4: Treatment Modalities

Non-Surgical Management

• Immobilization with a cast or splint is standard for non-displaced or minimally displaced SH I and II fractures.
• Regular monitoring with X-rays is necessary to ensure proper alignment and healing 2 7.

Reduction Techniques

• Closed reduction is used for displaced fractures that can be realigned without surgery. After realignment, casting maintains the position during healing 2.
• Frequent follow-up is needed to detect any loss of alignment or early growth disturbance.

When Surgery Is Needed

• Surgical fixation—using pins, screws, or plates—is often required for:
  • SH III and IV fractures (which involve the joint surface)
  • Severely displaced fractures
  • Injuries where closed reduction fails to maintain alignment 1 4 7
• Surgery aims to restore normal anatomy and prevent joint deformity or growth disturbance.

Management of Complications

• Growth plate fractures can lead to bony bar formation, resulting in growth arrest or angular deformities 9.
• Bar resection (surgical removal of the bony bridge) may be attempted, often with placement of a fat graft or synthetic spacer to prevent recurrence 9 12.
• Unfortunately, bony bar reformation remains a significant challenge, and not all patients regain normal growth 12.

Innovative and Experimental Treatments

• Tissue engineering and biomaterials are being explored to regenerate growth plate cartilage and prevent bony bar formation:
  • PLGA (poly-lactic-co-glycolic acid) scaffolds, sometimes loaded with growth factors like IGF-I and stem cells, have shown promise in animal studies for increasing cartilage regeneration and reducing bony bar recurrence 10 11 12.
  • Hydrogels and 3D printed composites offer new avenues for promoting chondrogenesis and restoring normal growth plate function, though these remain experimental 11 13.
• These regenerative strategies aim to improve long-term outcomes beyond what current surgical techniques can achieve.

Long-term Monitoring and Follow-up

• Regular clinical and radiological follow-up is essential for months to years after a growth plate fracture, especially in high-risk types (SH III-V) or locations (distal femur, distal tibia).
• Early detection of growth disturbance allows for timely interventions to correct or minimize limb deformities 1 7.

Conclusion

Growth plate fractures are complex injuries with unique risks and management challenges distinct from adult fractures. Early recognition and appropriate treatment are key to preventing lifelong complications. Ongoing research into tissue engineering and regenerative medicine may offer hope for improved outcomes in the future.

Key Takeaways:

• Growth plate fractures present with pain, swelling, tenderness, and sometimes visible deformity.
• The Salter-Harris classification guides prognosis and treatment, with Types IV and V carrying the greatest risk of growth disturbance.
• Causes include acute trauma, sports injuries, repetitive stress, and underlying medical conditions.
• Treatment ranges from casting and closed reduction to surgery, with emerging regenerative therapies under investigation.
• Long-term follow-up is crucial to detect and address any growth disturbances early.

Prompt, expert care gives children the best chance for healthy bone growth and function, supporting an active and fulfilling childhood.