Children's Fractures and Growth Plate Injuries

Patient information — Dr Christopher Spelman, Orthopaedic Surgeon

Overview

Children’s bones are different from adults’, so their fractures behave differently. Children’s bones are more flexible and heal faster, and – uniquely – they have growth plates (physes), the areas of soft, growing cartilage near the ends of the bones. Understanding these differences explains why many children’s fractures can be treated simply, and why some need particular care.

How children's fractures differ

●      They heal quickly – children’s fractures unite faster than adults’, so casts are needed for shorter periods.

●      They remodel – a growing bone can straighten out a fracture that has healed in a slightly imperfect position, particularly in younger children and when the bend is near a growth plate and in the plane of movement. This means some fractures that would need surgery in an adult can be treated in a cast in a child.

●      They have growth plates – fractures can involve the growth plate, which needs careful assessment because of the potential effect on growth.

●      They have unique patterns – such as buckle (torus) fractures and greenstick fractures, where the flexible bone bends and cracks rather than breaking completely.

Growth plate (Salter-Harris) injuries

Fractures involving the growth plate are described using the Salter-Harris system (types 1 to 5), according to how the fracture line runs through or around the plate. Most heal well without affecting growth. However, some – particularly higher-grade injuries or those involving the joint surface – carry a risk that part of the growth plate stops growing, which can lead over time to a limb that is slightly shorter or grows at an angle. For this reason, growth-plate injuries are followed up until it is clear that growth is continuing normally.

Treatment

Many children’s fractures are treated without surgery, in a cast or splint, sometimes after gently realigning the bone (reduction). Surgery is used when a fracture is unstable, significantly displaced, involves the joint surface or growth plate in a way that needs precise repositioning, or is open (through the skin). Where fixation is used, it is often with smooth wires or flexible nails designed to respect the growth plate, which are usually removed later.

Complications

Most children’s fractures heal very well. Points to be aware of include:

●      Growth disturbance – a growth-plate injury can occasionally cause part of the bone to stop growing, leading to a length difference or angular deformity that may need later treatment.

●      Malunion – healing in a poor position; though remodelling corrects much of this in young children, a significant malposition may need correction.

●      Stiffness, and the small general risks of any surgery (infection, further procedures such as removal of wires).

●      Re-displacement in a cast – which is why children are reviewed with repeat x-rays during healing.

Summary

Children’s fractures heal quickly and often remodel, so many are treated simply in a cast. Growth-plate injuries need particular attention and follow-up because of their potential effect on growth. Dr Spelman treats upper and lower limb fractures in children of all ages and will explain the specific pattern of your child’s injury and its treatment.