Growth Plate Injuries

• Read original article here

When a child has a bone fracture at the growth plate, it is of extra concern when deciding how to treat the broken bone. The growth plates at the ends of the long bones are where new bone is added as children grow. The treatment of a growth plate injury depends on several important factors including:

The specific growth plate injured
The skeletal age of the patient (how much bone growth is remaining)
The severity of the injury

Growth plate injuries that are less severe, and occur closer to the time of closure of the growth plate have the best prognosis. More severe injuries occurring in younger patients require observation and possibly treatment to prevent problems. When a growth plate is damaged, and deformity results, there are several treatment options.
Casting

Bones that are not out of position, or minimally displaced, can often be treated with a cast alone. In fact, the most common treatment of fractures in children is a simple cast. The most common type of broken bone treated in a cast is called a buckle fracture.
Closed Reduction and Casting

When a growth plate has displaced or is no longer properly aligned, your doctor may realign the broken bones by applying pressure to the injured area. This procedure requires anesthesia. In younger kids, sedation is usually necessary, while older kids and adolescents may tolerate a local anesthetic.
Closed Reduction With Pinning

Often the bones can be realigned without surgery but may need added stabilization during the healing process. In these cases, pins may be placed through the skin to hold the broken bones in alignment. The pins are then removed, usually in the office, several weeks later after healing has started. A typical injury that is pinned is a supracondylar humerus fracture.
Open Reduction

Open reduction is another way of saying traditional surgery – an incision is made over the broken bone, and the bones are directly realigned. If needed, screws, plates, or rods may be used to hold the bone in the proper position.

Open reduction is often needed in children when a fracture occurs, and soft tissue surrounding the fracture becomes trapped between the bones. In this situation, no amount of pulling or pushing can restore the proper alignment of the bones.
Growth Plate Arrest

A growth arrest is a procedure performed most commonly in the non-injured extremity. A scenario would be if the growth plate were injured in the left shin bone causing the growth plate to close too soon, the right shin bone may undergo a procedure to stop growth in the right shin bone. This procedure is called an epiphysiodesis. A growth arrest is usually performed long after the initial injury, only when a limb length discrepancy is an issue.
Bar Resection

If a portion of the growth plate has prematurely closed because of growth plate injury, but the remainder of the growth plate is healthy, the area that is prematurely closing can be removed. This procedure removes the closed portion of the growth plate, allowing the limb to continue growing.
Osteotomy/Lengthening

If growth plate damage has caused the extremity to become angled, or if there is significant growth remaining, a procedure may be recommended to correct the angulation (osteotomy) or lengthen the extremity.
Which Is Best?

The best treatment for a growth plate injury depends on the individual situation. Obviously, less treatment is ideal for the patient, but if simple treatments are not sufficient to restore adequate alignment of the bone, then more invasive treatments may be recommended.