Growth Plate Fractures:
Growth plate fractures are injuries that occur in growing children and adolescents. These injuries occur in the area of the bone responsible for growth--the growth plate. When this part of the bone is damaged, there is concern about possible problems with future growth of the bone. Appropriate treatment of a growth plate injury is essential to ensure proper growth of the child.
The prognosis of growth plate fractures depends on several factors, including the type of injury. Orthopedic surgeons classify growth plate fractures according to the Salter-Harris classification system. This classification helps to distinguish different types of fractures and provides prognostic information as well.
Type 1 Growth Plate Fracture:
Type 1 Salter-Harris fractures tend to occur in younger children. These injuries go directly across the growth plate, and the surrounding bone is not involved. Often, x-rays of a child with a type 1 growth plate fracture will appear normal. Healing of type 1 fractures tends to be rapid and complications are rare. Most type 1 growth plate injuries are treated with a cast.
Type 2 Growth Plate Fracture:
A type 2 growth plate fracture starts across the growth plate, but the fracture then continues up through the shaft of the bone (away from the joint). This is the most common type of growth plate fracture, and tends to occur in older children. Often type 2 growth plate fractures must be repositioned under anesthesia, but healing is usually quick and complications are uncommon.
Type 3 Growth Plate Fracture:
A type 3 fracture also starts through the growth plate, but turns and exits through the end of the bone, and into the adjacent joint. These injuries can be concerning because the joint cartilage is disrupted by the fracture. Proper positioning is essential after a type 3 growth plate fracture. These injuries also tend to affect older children.
Type 4 Growth Plate Fracture:
Type 4 growth plate fractures start above the growth plate, cross the growth plate, and exit through the joint cartilage. These injuries can affect the joint cartilage, and may impair normal growth. Proper positioning is also essential with type 4 growth plate fractures, and surgery may be needed to hold the bone fragments in proper position.
Type 5 Growth Plate Fracture:
Type 5 growth plate injuries occur with the growth plate is crushed. Type 5 growth plate fractures carry the most concerning prognosis as bone alignment and length can be affected. These types of fractures may permanently injure the growth plate, requiring later treatment to restore alignment of the limb.
Treatment of Growth Plate Fractures:
Treatment of growth plate fractures depends on several factors including the type of injury, the severity of the injury and the age of the child. Many childhood fractures are well treated with a cast, but all require medical attention and follow-up care to ensure adequate treatment and healing.
American Academy of Orthopaedic Surgeons "Growth Plate Fractures May 2009.