Growth plate fracture fixation
The best treatment and surgery for your child’s growth plate fracture depends on a number of factors, including age, current health, past health history, the severity of the fracture and history with various other medications and treatments. In most cases, growth plate fractures, which are a partial or complete break through the growth plate in children, are the result of a traumatic injury.
Left untreated, a growth plate fracture can cause significant pain and also stunt proper development of a child’s body. If you have any reason to suspect that your child has broken a bone either partially or completely, it is important to see a doctor right away. To diagnose whether a growth plate has been fractured, the doctor will begin by asking questions about the injury, then perform a physical exam, which will consist of one or more of these tests:
- X-ray (radiograph) – This is usually the first test performed as it can tell the approximate location of the breakage. The growth plates are not shown on the X-ray results, as they are not ossified bone. Therefore, the X-ray usually will be not only of the limb in pain, but also of the surrounding limb to ensure the fracture did not spread through the growth plate to another bone.
- Computed tomography scan (CT or CAT scan) – If a more extensive fracture is suspected, a CAT scan may be performed to get more detail in the area of the injury.
- Magnetic resonance imaging (MRI) – Sometimes an MRI may be performed to reduce the amount of radiation to which a child is exposed. This test works by placing the patient in a magnetic tube and using magnetic resonance to create images of the bone and surrounding area.
If the growth plate fracture is minor, simple tactics to immobilize the bone and allow it to heal on its own may be used. This involves placing a cast on the affected area, which can remain on for as long as six weeks. After the cast is removed, the child usually will work with a physical therapist to help regain movement in the joint or area where the bone was broken. In more severe cases, when the bone is misaligned, the doctor may help realign the bone by using pressure prior to casting. This requires local or full anesthesia.
In most cases, growth plate fractures require surgery to help the bone develop correctly. The goal of the surgery is to repair the breakage so bone development is not stunted due to injury. The majority of growth plate fractures are treated using these surgeries:
- Open reduction – This is the traditional surgical approach. It is performed by making an incision and realigning the bone by using screws, pins or rods. This is often used when soft tissue becomes damaged and therefore is trapped in between the growth plate fracture.
- Growth plate arrest – This procedure usually is performed when significant time has passed since the fracture. Sometimes when a growth plate breaks, the injury causes the growth plate to close too soon, and stunts the development of the bone. In the case of growth plate arrest, the bone directly to the side of the injured bone also is operated on to stop its growth so that it does not cause a misalignment in that area of the body.
- Bar resection – When a growth plate fracture causes only a part of the growth plate to close prematurely, this procedure allows the doctor to go in and reopen the growth plate so development can continue as normal.
Most growth plate fracture research involves studying how to allow the body to continue developing normally once this fragile part has been damaged. This includes how to remove the area that blocks the growth plate from operating correctly after a fracture, how drugs can stop the growth plates from being affected during radiation and how to reengineer tissue to redevelop musculoskeletal tissues and help development occur more naturally.
As research on growth plate fractures is ongoing, it is a good idea for conversation with your doctor to be ongoing as well.