Pediatric Growth Plate Injuries

Pediatric Orthopedic Surgery, Hospital for Special Surgery


Causes

In children with growth deformities other than bow leg or knock knees, growth plate injuries constitute a major cause, with the most common fractures affecting the proximal tibia and distal femur.

Because the growth plate is the area where new bone develops (adding length to the bone), injury to this area can result in growth arrest and subsequent limb length discrepancy, in which one leg is longer than the other.

Diagnosis

Growth plate injuries are generally clear on an x-ray [See Figures 1&2], making advanced imagery, specifically MRI, sometimes required. Researchers at HSS are currently studying its application in these injuries; advantages include earlier diagnosis of growth arrest and three-dimensional localization of the area.

 
Figure 1: (left) x-ray image of growth plate injury
Figure 2: (right) x-ray image of normal pediatric knee

Treatment

Fractures involving growth plate injuries usually require setting the bone, technically referred to as anatomic reduction, alignment and fixation. Most children respond well to these procedures, but for a small percentage, the bone or a portion of the bone will cease growing, referred to as partial or complete growth arrest.

Since there is no way to regenerate the growth plate cartilage after a partial growth arrest, additional interventions may include resection of the partial growth arrest (also known as the physeal bar) or sequential lengthening procedures during childhood. For more information on limb lengthening, please read Limb Lengthening for the Pediatric Patient.

 
Figure 3: (left) X-ray image of limb length discrepancy due to growth plate injury
Figure 4: (right) X-ray mage following post-surgery

In children near the end of growth with complete growth arrest on one side, the pediatric orthopedic surgeon may recommend closing the growth plate on the other side in order to ensure that the length of the healthy limb matches that of the affected one.

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