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Growth Plate Fractures

(Physeal Fractures)


Danielle Campagne

, MD, University of California, San Francisco

Reviewed/Revised Dec 2022
Topic Resources

Growth plate fractures occur in areas at the ends of bones. These areas (called growth plates) are what enable children to grow. Growth plate fractures occur only in children and adolescents.

  • A growth plate may be fractured when repeated stress is put on a bone or when children are injured.

  • If a growth plate is fractured, the area over it is painful and swollen, and children have trouble moving the affected limb.

  • The bone may stop growing or grow crookedly.

  • Doctors suspect this fracture based on symptoms and can usually diagnose it based on x-rays.

  • Some growth plate fractures are treated with a cast or splint, but if the fracture is more severe, the broken pieces of bone are put back in place (reduced) with or without surgery, and then a cast is applied.

Growth plates are areas of cartilage in long bones (such as the arm and leg bones). They enable bones to lengthen until children reach their full height. When growth is completed, growth plates are replaced with bone. When growth stops varies by bone, but all growth plates are replaced with bone by age 20.

Locating Growth Plates

Growth plates (indicated by the pink lines) are areas of cartilage near the ends of long bones, such as the arm and leg bones. They enable bones to lengthen until children reach their full height.

Locating Growth Plates

Because cartilage is more fragile than bone, growth plates are particularly vulnerable to fracture. When a growth plate is fractured, the bone may stop growing or grow crookedly. If a joint is involved, it may be permanently damaged, resulting in arthritis.

Did You Know...

  • In children, some bones have areas of cartilage that are more fragile than bone and that do not become solid bone until children have finished growing.

A fracture may occur straight across a growth plate, separating the bone from the cartilage. Or a fracture may extend above or below the growth plate, sometimes all the way through the end of the bone and into the joint. The most serious type of fracture is a compression fracture (when the growth plate is crushed).

Causes of Growth Plate Fractures

Growth plate fractures may result from

  • Being in an accident such as a fall or car crash

  • Putting repeated stress on bones

Bones may be stressed by repeating the same motion over and over, as when children or adolescents train as gymnasts, pitchers, or long-distance runners.

Symptoms of Growth Plate Fractures

The area over the growth plate is painful, particularly when it is touched. This area is also swollen and may feel warm. Children have trouble moving the affected limb or putting weight or pressure on it.

Diagnosis of Growth Plate Fractures

  • X-rays

If children have symptoms that suggest a growth plate fracture, they should be taken to a doctor or to an emergency department.

Doctors suspect a growth plate fracture based on symptoms.

X-rays can detect most growth plate fractures. However, certain types of growth plate fractures may not be detected. So sometimes children are assumed to have a fracture and are treated accordingly (with a cast or splint). Then they are reexamined in a few days. If the area is still tender and painful, they probably have a growth plate fracture.

Treatment of Growth Plate Fractures

  • A cast or splint

  • Realignment of the broken bones done with or without surgery

Some growth plate fractures are treated by immobilizing the affected area—for example, with a cast or splint. If broken pieces of bone are widely separated or the fracture extends into a joint, the broken pieces are realigned or put back in place (called reduction).

Depending on the type of growth fracture, reduction may or may not involve surgery. When possible, doctors move the pieces of bone back in place from outside the body—without making an incision. Then a cast or splint is used to hold the bones in place.

Sometimes reduction requires surgery, typically open reduction and internal fixation Surgery Surgery (ORIF). When ORIF is done, the broken bones are put back in place and held in place using a combination of metal wires, pins, screws, rods, and plates.

If the growth plate is crushed, children are referred to a pediatric orthopedist because such injuries almost always result in abnormal growth.

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