Learn about growth plate fractures and injuries in children. Growth plates are areas of growing tissues that cause the long bones in children and teens to grow. Bone adjacent to the physis on the opposite side of the epiphysis. The fingers dont finish growing until around age 17. The growth plate, also known as the epiphyseal plate is a thin layer of cartilage that lies between the epiphyses and metaphyses, and is where the growth of long bones takes place. Fractures tend to propagate along the weakest zone. Sometimes, a growth plate fracture can also cause the bone to grow more, but this has the same result.
The age at occurrence documents peak incidences of female fractures. Fractures involving the epiphyseal plate, or physis, are common musculoskeletal injuries occurring in children with open growth plates. Unlike type i, has a small metaphysis triangle fracture fracture exit site bony fracture triangular fragment known as thurstonholland fragment. Morphology and physiology of the epiphyseal growth plate. Foot fractures involve the talus, calcaneus, metatarsal, and phalanges. Aug 24, 2018 when growth of a person is completed, the growth plates are replaced by solid bone. The growth plates in the body are cartilage plates located on each end of the long bones. The growth plate, also known as epiphysealphyseal plate or physis, is weaker than the nearby tendons, ligaments or joint capsule, and obviously weaker than bone. It develops in the bone bud, secondary to presence of the primary ossification centers and is responsible for bone elongation. In one large population based study of growth plate injuries, the largest single group of physeal fractures occurred as a result of a fall, usually while running or playing around furniture or playground equipment. The bone grows from the growth plate and is weakest at this point. Thus, knowl edge of the prognosis for a given injury to the epiphyseal plate in a particular child.
Injuries to the growth plate happen when a break or fracture develops near or at the end of a long bone. Compression fractures of the epiphyseal plate are rare and generally involve crushing of the end of the bone and the growth plate. Design and in vitro evaluation of five epiphyseal plate. Throughout childhood and adolescence, there remains a thin plate of hyaline cartilage between the diaphysis and epiphysis known as the growth or epiphyseal plate figure 6. All such these fractures, by definition, involve or extend through the epiphyseal plate so that all such fractures occur in children before the epiphyseal plate closes.
Growth disturbance after distal femoral growth plate fractures in children. This textbook is an guished from adult orthopedics in many ways. Epiphyseal growth plates definition of epiphyseal growth. Growth plate injuries orthopaedic trauma association ota.
Pdf on jan 1, 2008, gunnar hagglund and others published epiphyseal growth plate fractures find, read and cite all the research you need on. Most kids recover from growth plate fractures without any longterm problems. The classification system used to grade fractures according to the. Growth plate injuries happen to children and teens. The topic epiphyseal plate fractures you are seeking is a synonym, or alternative name, or is closely related to the medical condition growth plate fractures. The treatment for growth plate fractures depends on the injury location, the type of fracture sustained, and the childs age and health status. For instance, the sh type i fracture now becomes peterson type iii, and the sh type v fracture is dropped.
Epiphyseal injuries account for an estimated 15% of childhood fractures. A less common problem is when a ridge develops along. Epiphyseal growth plate fractureseparations describe the relationship of these injuries to possible growth deformities. The author depends heavily on his work with the olmsted county physeal plate fracture registry peterson ha, et al. The physis, or growth plate, is a weak part of cartilage present in the developing bone. These areas of growing tissue, known as epiphyseal plates, harden as a child matures to adulthood. Apr 26, 2020 compression fractures of the epiphyseal plate are rare and generally involve crushing of the end of the bone and the growth plate. Growth plate stress fractures most commonly occur in teenage climbers at the time of the pubertal growth spurt, often around the timing of breast growth for girls and pubic hair in boys. The dread complication of serious disturbance of growth is usually predictable and, in certain circumstances, can be prevented. Physeal fractures of the distal tibia and fibula salter harris type i, ii, iii and iv fractures.
Physeal injuries are very common in children, making up 1530% of all bony injuries. This type of fracture is sometimes referred to as a salter fracture or a salter harris fracture. Epiphyseal growth plate fractures article pdf available in acta orthopaedica 792. It is the part of a long bone where new bone growth takes place. The growth plate, or physis, is the translucent, cartilaginous disc separating the epiphysis from the metaphysis and is responsible for longitudinal growth of long bones. The main emphasis is on evaluation diagnosis and management treatment.
Jul 06, 2006 in one large population based study of growth plate injuries, the largest single group of physeal fractures occurred as a result of a fall, usually while running or playing around furniture or playground equipment. Jun 20, 2018 this is found in children and young adults who are still in the stage of growth. Epiphysis plate fracture an overview sciencedirect topics. Growth plate fractures for parents nemours kidshealth. When growth of a person is completed, the growth plates are replaced by solid bone. The plates are formed by numerous cells that rapidly divide and mature. Hence, ligamentous injuries, as well as traumatic dislocation of major joints are less common in childhood. This comprehensive reference work covers all aspects of growth plate fractures and their complications.
Epiphyseal growth plate fractureseparations account for approximately 1520% of major. The hypertrophic zone of the cartilagi nous component is the weakest part of the growth plate. Most growth place injuries occur after a sudden accident, such as falling or having a hard hit to the limb. Thus, knowl edge of the prognosis for a given injury to the epiphyseal plate in. The classification of physeal injuries arc journals. Go to all followup doctor visits to make sure the bones heal well and continue to grow normally. Secondary ossification center the epiphysis is the bone located between the articular surface and the physis.
A growth plate fracture can occur quite unexpectedly due to the sensitive nature of this area of the skeleton, often from injuries that would cause only joint sprains in adults. The text is well organized, well referenced, and easy to follow. The epiphyses and epiphyseal plates are vital structures in the bone development of the growing athlete. Unlike type i, has a small metaphysis triangle fracture fracture exit site bony fracture triangular fragment known as. They are also common in the outer bone of the forearm radius and lower bones of the leg the tibia and fibula. However, the majority of growth plate fractures heal without any complications. Vessel damage leads to uneven growth patterns of response to ischemia of the epiphyseal a, b versus metaphyseal c, d circulatory systems. Growth plate fractures musculoskeletal medicine for medical. The physis is located between the metaphysis and the epiphysis on all long bones fig. Calcaneus fracture due to highenergy direct axial compression. May 29, 2018 however, the majority of growth plate fractures heal without any complications. Physis growth plate rapid longitudinal and diametric growth appreciated by growth of the secondary centre epiphyseal blood vessels penetrate to reach physisfig 2. Teenage children who climb and train intensively are more at risk of epiphyseal growth plate stress fractures of the finger.
These represent the main subset of childhood fractures contributing a major way to limb deformity. Sep 26, 2019 growth plate physeal fractures may be defined as disruptions in the cartilaginous physis of long bones that may or may not involve epiphyseal or metaphyseal bone. Nonsurgical treatment for growth plate fractures may include. Several classification systems have been developed that categorize the different types of growth plate fractures. The growth plate, also known as epiphyseal physeal plate or physis, is weaker than the nearby tendons, ligaments or joint capsule, and obviously weaker than bone. Such longitudinal bone growth occurs here through the mechanism of endochondral ossification, with formation of cartilage and then remodeling into bone tissue fig. Pediatric knee injuries orthopaedic trauma association ota. Fracture through the physis with separation of physis from metaphysis. Salter harris type 1 fracture in a german shepherd dog. Most common overall epiphyseal fracture 75% of epiphyseal fractures similar to type 1. Metatarsal fracture due to direct trauma or twisting force applied to a fixed forefoot. Growth plate injuries orthopaedic trauma association.
With the exception of the distal femur, the ends of the long bones in the newborn are completely cartilaginous. The growth plate, also known as the epiphyseal plate or physis, is composed of hyaline cartilage. This is found in children and young adults who are still in the stage of growth. Traumatic conditions, many times resulting in epiphyseal fractures, are the most frequent cause of growth plate injuries. Distal femoral growth plate fracturesymptomscauses. Doctors test for growth plate injuries by asking about the injury, examining your child, and ordering xrays. These fractures, which present similarly to other salterharris growth plate injuries, do not fit neatly into any 1 classification scheme and are not easily evaluated on plain radiographs. The overview of fractures of the physis, and is divided into two most prominent differences are the small size of three parts. The epiphysis is the bone located between the articular surface and the physis. Epiphyseal growth plate present bones are growing heal faster bones are more pliable periosteum thicker and more active abundant blood supply to the bone the younger the child the faster the healing. The salterharris classification is a means of categorizing epiphyseal plate fractures and provides clues to their prognosis.
The commonest of growth plate injuries are fractures and they are more common in boys than girls. Growth plates are areas of cartilage tissue near the ends of long bones that are still growing in children and adolescents. The growth plates in bones are the weakest areas of the skeletal structure and are prone to injuries called fractures. Epiphyseal growthplate fractures is an enormous undertaking by hamlet peterson. Growth plate fractures orthopaedic institute northwell health.
Epiphyseal growth plate fractures of the distal femur are commonly seen in young canines that have not completed full ossification of the growth plate. The epiphyseal plate or epiphysial plate, physis, or growth plate is a hyaline cartilage plate in the metaphysis at each end of a long bone. Injuries involving the epiphyseal plate present special problems in diagnosis and management. All of these chapters are constructed similarly for easy and quick retrieval of. The secondary ossification centres appear during growth in a predictable pattern figure 14 and knowledge of the timing and pattern of appearance is important in assessing fractures around and into the joints. The subspeciality of pediatric orthopedics is distin common of which is fracture. Melissa nebzydoski do, in the sports medicine resource manual, 2008. Causes include overuse injuries, sports, childe abuse, juvenile arthritis, frostbite, radiation, and chemotherapy.
Diagnosis of fractures is based on the history of trauma, clinical signs of swelling, pain and lameness and confirmation on the nature of the fracture by use of imaging modalities such as radiography, computed tomography ct and magnetic resonance imaging mri. The growth plate is the weakest part of the growing skeleton. A guide for parents, coaches, gps and hand surgeons. Growth plate fractures description the growth plate, or physis, is the portion of a. Any sort of injury, which can be considered as serious, to a joint often injures the growth plate, as it is the weakest area of a growing skeleton. Aug 07, 2007 learn about growth plate fractures and injuries in children. All of these chapters are constructed similarly for easy and quick retrieval of the required information.
The growth plate consists of fibrous, cartilaginous, and bony components. The epiphyseal plate is two to five times weaker than the surrounding fibrous tissue in children and adolescents. Pdf epiphyseal growth plate fractures researchgate. The key difference between the childs bone and that of an adult is the presence of a physis. Talus fracture due to a twisting injury, fall, or highenergy impact. They most commonly occur following trauma, although at the hip, a slipped upper femoral epiphysis sufe is a type i fracture that can occur without an acute traumatic event. Mammalian growth plate, also known as epiphyseal plate or physis, is highly specialized mesodermderived cartilaginous structure. In adults, the growth is replaced by an epiphyseal line. Distal humerus growth plate fracturesymptomscauses. Each long bone has at least two growth plates one at each end of the bone. This injury, classified as a type v epiphyseal fracture, is associated with a poor prognosis, most typically resulting in premature stunting of growth.
Most growth plate fractures occur in the long bones of the fingers. The distal humerus growth plate fracture is a medical condition where there is a fracture of distal growth plate that is located at fag end of humerus, which constitutes the superior part of elbow joint. Epiphyseal growth plate fractureseparations springerlink. Physeal fractures are most common in 10to15yearold children ref. Help your child follow the health care providers directions. Current treatment techniques involve the use of crossed kirschner wires and commercial stainless steel plates.
737 943 1184 141 499 712 974 659 992 204 225 1323 616 185 1425 161 92 516 924 1168 1269 206 276 744 1054 532 1353 290 623 684