How Are Growth Plate Fractures Diagnosed?
After learning how the injury occurred and examining the child, the doctor will probably use X rays to determine the type of fracture and decide on a treatment plan. Because growth plates have not yet hardened into solid bone, they don’t show on X rays. Instead, they appear as gaps between the shaft of a long bone, called the metaphysis, and the end of the bone, called the epiphysis. Because injuries to the growth plate may be hard to see on X ray, an X ray of the noninjured side of the body may be taken so the two sides can be compared. In some cases, other diagnostic tests, such as magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound, will be used.
What Kind of Doctor Treats Growth Plate Injuries?
For all but the simplest injuries, the doctor may recommend that the injury be treated by an orthopaedic surgeon, a doctor who specializes in bone and joint problems in children and adults. Some problems may require the services of a pediatric orthopaedic surgeon, who specializes in injuries and musculoskeletal disorders in children.
How Are Growth Plate Injuries Treated?
As indicated in the previous section, treatment depends on the type of fracture. Treatment, which should be started as soon as possible after injury, generally involves a mix of the following:
Immobilization
The affected limb is often put in a cast or splint, and the child is told to limit any activity that puts pressure on the injured area. The doctor may also suggest that ice be applied to the area.
Manipulation or Surgery
In about 1 out of 10 cases, the doctor will have to put the bones or joints back in their correct positions, either by using his or her hands (called manipulation) or by performing surgery. After the procedure, the bone will be set in place so it can heal without moving. This is usually done with a cast that encloses the injured growth plate and the joints on both sides of it. The cast is left in place until the injury heals, which can take anywhere from a few weeks to several months for serious injuries. The need for manipulation or surgery depends on the location and extent of the injury, its effect on nearby nerves and blood vessels, and the child’s age.
Strengthening and Range-of-Motion Exercises
These treatments may also be recommended after the fracture is healed.
Long-Term Followup
Long-term followup is usually necessary to monitor the child’s recuperation and growth. Evaluation may include X rays of matching limbs at 3- to 6-month intervals for at least 2 years. Some fractures require periodic evaluations until the child’s bones have finished growing. Sometimes a growth arrest line may appear as a marker of the injury. Continued bone growth away from that line may mean that there will not be a long-term problem, and the doctor may decide to stop following the patient.
For more information, visit The National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse (NAMSIC) at http://www.nih.gov/niams/.
