More Than Just a Funny Bone: Preventing Growth Plate Injury
Adults and youth face the same risk of bone injuries, but because a child’s bones are still growing, children, unlike adults, are susceptible to growth plate injuries. Growth plate injuries are common in competitive youth athletes and must be quickly and correctly identified to prevent permanent damage.
All parents of growing athletes, as well as coaches and trainers who work with youth athletes, should fully understand the function and importance of growth plates. This article will explain:
- What growth plates are
- Where growth plates are located
- How growth plates become injured
- How to recognize growth plate injuries
- Treatment of growth plate injuries
What Are Growth Plates?
The growth plate determines the future length and shape of the mature bone. Also known as the epiphyseal plate or physis, growth plates are the developing tissues at the end of long bones.
Long bones are bones that are longer than they are wide, such as in the legs, arms, toes, and fingers. Each long bone has at least two growth plates at each end, which sit between the metaphysis (the wider end of the bone) and the epiphysis (the rounded end of the bone). The long, middle part of the bone is the diaphysis.
"Injuries to the growth plate are called fractures and can be caused by a traumatic event, such as a fall, or from repetitive motions and overuse that place stress on the bone."
When a child's bones have completed growing, the growth plates harden and cause the epiphysis to fuse with the metaphysis, forming one complete bone. Contrary to common belief, bone growth occurs at the ends of the bone around the growth plate, rather than from the middle of the bone.
Growth Plate Fractures
According to the Pediatric Orthopaedic Society of North America, approximately fifteen to thirty percent of all childhood fractures involve the growth plate. Because girls tend to reach skeletal maturity earlier than, their growth plates usually close around ages thirteen to fifteen, while boys' growth plates close around ages fifteen to seventeen. As a result, girls’ bones finish growing sooner and their growth plates are replaced by stronger, solid bone. Accordingly, growth plate fractures occur twice as often in boys than in girls.
Growth plates are located at the end of the following bones:
- The long bones of the hand and fingers (metacarpals and phalanges)
- Both bones of the forearm (radius and ulna)
- The bone of the upper leg (femur)
- The lower leg bones (tibia and fibula)
- The foot bones (metatarsals and phalanges)
"One-third of all growth plate fractures occur during participation in competitive sports such as football, basketball, baseball, or gymnastics."
Growth plates are the weakest areas of a child’s growing skeleton and are even more susceptible to injury than nearby tendons and ligaments. Injuries to the growth plate are called fractures and can be caused by a traumatic event, such as a fall, or from repetitive motions and overuse that place stress on the bone. This stress can cause growth plates to become inflamed, producing pain and swelling. If use of the injured area continues, the growth plate may begin to separate from the rest of the bone.
One of the more common repetitive growth plate injuries, medial epicondyle apophysitis, also known as Little League elbow, can actually occur in many different sports, such as volleyball, tennis, or any other sport that significantly stresses the elbow. Little League elbow is aptly named though, as statistics from Nationwide Children’s Hospital state that in the over two million children who participate in Little League activities per year, elbow pain occurs in up to twenty percent. Further studies show that 26% of elbow pain occurs in baseball players between the ages of nine to twelve.
While all children are at risk for growth plate injuries, there are certain factors that put a child at a higher risk:
- One-third of all growth plate fractures occur during participation in competitive sports such as football, basketball, baseball, or gymnastics.
- About twenty percent of all growth plate fractures occur during participation in recreational activities such as biking, sledding, skiing, or skateboarding.
- The incidence of growth plate fractures peaks in adolescence.
Working Through the Pain?
No, not in this case. A child who has pain that affects his/her athletic performance should never be allowed or expected to “work through the pain.” Medical assistance should be sought, whether an injury is acute or due to overuse. This is particularly true if any of these symptoms are present:
- Persistent or severe pain
- Visible deformity (crookedness in the limb)
- An inability to move or put pressure on the limb
- Swelling, warmth, and tenderness in the area around the end of the bone, near the joint
"If not treated properly, growth plate injuries could result in a limb that is crooked or unequal in length."
Touching upon, but not delving into the various classifications of growth plate fractures, the Salter-Harris system is the most commonly used method to describe growth plate fractures. Many growth plate injuries are minor and involve rest and non-weight bearing of the affected area. But, dependent upon the severity of the fracture, more in-depth medical procedures may be needed ranging from a cast, splint, or brace to reduction (manipulating the growth plate back into place) to surgery.
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Take All Reports of Pain Seriously
Growth plate injuries can be scary, but the bottom line is this: complaints of pain in children and adolescents, especially those who have had a recent fall or who play competitive sports, should be taken seriously and be checked by a doctor.
Because the growth plate helps determine the future length and shape of the mature bone, this type of fracture requires prompt attention. If not treated properly, growth plate injuries could result in a limb that is crooked or unequal in length. Fortunately, serious problems are rare, and with proper treatment, most growth plate fractures heal without complications.
1. “Elbow Injuries in Young Throwers.” Nationwide Children's Hospital. Accessed 26 January 2015.
2. “Growth Plate Fractures.” The Pediatric Orthopaedic Society of North America. Reviewed by members of the Pediatric Orthopaedic Society of North America, Oct 2014. Accessed 26 January 2015.
4. “Growth Plate Injuries.” National Institute of Arthritis and Musculoskeletal and Skin Diseases. NIH Publication No. 14–7845, May 2014. Accessed 26 January 2015.
5. “Preventing Musculoskeletal Sports Injuries in Youth: A Guide for Parents.” National Institute of Arthritis and Musculoskeletal and Skin Diseases. NIH Publication No. 12-4821, June 2013. Accessed 25 January 2015.
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