The bones of children and adults are at the same risk of fractures. However, children’s bones, due to their normal development, are subject to a particular type of injury called growth plate fracture (epiphyseal plate). Growth plates are areas of cartilage that are found near the ends of the bones and are particularly vulnerable because they form the last stage of osteogenesis.
About 15 to 30% of childhood fractures are related to the growth plate and the fact that it determines the future shape and length of bone, such fractures require a great deal of attention. If not treated properly, they can lead to distortion and inequality. Fortunately, in most cases the growth plate fractures are not complicated.
ANATOMY
Epiphyseal plates are found on the long bones of the human body. Examples of long bones include the femur, the radius and ulna, as well as the metacarpal bones in the hands. Most long bones of the body have at least two growth plates, one at each end. In particular, the plates are found between the part of the bone that is increased in size (metaphysis) and its terminal end (epiphysis). Bone growth takes place at each end of the bone around the growth plate. When a child’s development is complete, the plates harden and are completely transformed into bone.
DESCRIPTION
Most fractures involve the long bones of the fingers while they are also often in the forearm (radius and ulna) and in the tibia.
CLASSIFICATION OF EPIPHYSEAL PLATE FRACTURES
Several grading systems have been used for the different types of fractures in the epiphyseal plate. The most widely used classification system by the medical community is that of Salter-Harris, described below:
TYPE I:
In this type of fractures, the fracture line passes through the epiphyseal plate separating the metaphysis from the epiphysis.
TYPE II:
In these fractures, the fracture line passes through the epiphyseal plate but also includes part of the metaphysis. This is the most common type of epiphyseal plate fracture.
TYPE III:
In these fractures, the fracture line passes through a part of the epithelial plate and a part of the epiphysis. This type of injury affects older children.
TYPE IV:
These fractures include the epiphyseal plate, the epiphysis and the metaphysis.
TYPE V:
These fractures include a crushing injury to the entire plaque. They are rare fractures.
CAUSES
Fractures of the epiphyseal plate are mainly due to a single event, such as a fall from height or a car accident. However, they can occur gradually as a result of repeated pressure and bone loading during intense athletic activity of young people.
Children are at risk of injury to the epiphyseal plate throughout their development, but there are some factors that increase the risk of injury:
- Fractures of the epiphyseal plate occur twice as often in boys, because girls complete their development earlier.
- 1/3 of these fractures occur during participation in sports such as football, basketball or gymnastics.
- 1/5 of epiphyseal plate fractures occur while engaging in recreational activities such as cycling, skiing or skateboarding.
- The incidence increases during adolescence.
SYMPTOMS
Fractures of the epiphyseal plate cause persistent and intense pain. Other common symptoms include:
- Visible deformation of the limb
- Inability to move the limb
- Edema, redness and tenderness of the fractured anatomical region (bone ends).
EXAMINATION
Given that children’s bones can heal more quickly, any injury to the epiphyseal plate should be examined as soon as possible, ideally within 5-7 days. It is important for the child to receive appropriate treatment before the healing process begins.
After receiving a detailed medical history, the Orthopedist should carefully examine the injured area. He/she will probably need to study the area in question with a radiograph. In the majority of cases, radiological imaging of the lesion is sufficient to diagnose and classify the fracture. Imaging may also include a CT or a MRI Scan.
TREATMENT
The management of epiphyseal plate fractures depends on several factors, including:
- Identification of the fracture
- The type of fracture (Salter-Harris Classification)
- Displacement of the fracture
- The age and general condition of the patient
- Concomitant injuries-fractures
CONSERVATIVE TREATMENT (NON-SURGICAL TREATMENT)
Most fractures of the epiphyseal plate are successfully treated with simple immobilization. By applying a plaster splint, the injured area is immobilized and the child restricts their activities. The orthopedist uses the plaster splints when the fractures are not displaced. The splint will hold the bones in the correct position and the fracture will heal.
SURGICAL TREATMENT
If the fractures are displaced or unstable, then surgery is required (open reduction internal fixation – ORIF). During the procedure, the bones are rearranged (repositioned in the correct anatomical position). They are then fixed with special implants or osteosynthesis materials such as screws or wires, or by placing metallic plates on the bone surface.
Often, a splint is applied to protect the fracture.
COMPLICATIONS
In most cases, fractures are healed without any problems. However, some complications may occur.
Rarely, a bone bridge can form through the growth plate, preventing proper bone growth and causing permanent deformation. In this case, the orthopedist is urged to intervene by surgically removing the bone bridge, and by placing fat or other materials to prevent deformation. Sometimes, a fracture of the growth plate may cause growth to accelerate relative to healthy limb development. And in this case, the Orthopedist must intervene to ensure the proper development of the child.
RECOVERY
Bone fractures in children are healed quickly, but fractures of the growth plate may require several weeks to heal. The length of immobilization time varies depending on the severity of the fracture.
After healing, the Orthopedist may recommend specific exercises to strengthen and improve the range of motion of the joints involved.
LONG-TERM RESULTS
Fractures of the growth plate should be carefully monitored to ensure good long-term results. Regular follow-up by the orthopedist should continue for at least one year after the injury so as to exclude the possibility of any complication. More complex fractures may require monitoring until the child reaches skeletal maturity.
