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Fractured Growth Plate In Ankle

What Is The Long

Growth Plate Injuries of the Ankle

A growth plate injury may affect the angle of bone growth and overall height of a child. When a body part with two parallel bones, like the wrist, experiences growth arrest, each bone needs to be examined separately. If one bone stops growing, there is risk that the parallel bone might continue to grow and surpass it, making the wrist grow at an angle.

If one leg were to stop growing because of a growth arrest, the legs could end up being different lengths. Since height is determined by multiple growth plates in the hips, knees, and ankles, a growth plate injury in just one of these areas may not impact your childs height significantly. Orthopedic surgeons can usually prevent angled bone growth or unequal bone growth with early treatment.

An orthopedic specialist can usually determine whether a childs bones have stopped growing within the first three to six months after a growth plate injury. If the bone has stopped growing, your childs doctor may recommend stunting the bone that matches it so the two limbs will be the same length.

If the bone has continued to heal and grow after treatment, then your child may not require more follow-up care.

  • Older children have already done most of their growing, so the consequences can be less substantial.
  • Younger childrens bones have more growing to do, so if a bone stops growing, the consequences could be more serious.

What Are Possible Complications Of Growth Plate Fractures

The most serious complication is early closure of the growth plate.

  • Complete closure means the entire growth plate of the affected bone has stopped expanding. This results in the affected bone not growing as long as the opposite side.
  • Partial closure means the damaged part of the growth plate has stopped working. In the meantime, the undamaged portion continues to produce new bone. This results in the bone growing at an abnormal angle.

The severity of and need for treatment of growth plate closures depend on the location of the fracture and the age of the patient. Treatment options include:

  • Surgically shutting down the growth plate on the opposite side.
  • Surgical lengthening of the injured bone.
  • Shortening of the normal bone.

Other complications of growth plate fractures include delayed healing of the bone, nonhealing, infection and loss of blood flow to the area, causing death of part of the bone.

How Is A Growth Plate Injury Diagnosed

The doctor will take a medical history and examine your child, checking for warmth or swelling near the joint, and by pressing on the injured area to check for tenderness or pain. The doctor will want to know about any changes in your childs ability to bend or move a limb and may ask about such symptoms as persistent pain.

Because growth plates are not solid bone, both the growth plates and potential fractures will not always show up on X-rays. They do, however, show up as gaps between the shaft and the end of the bone. As a result, the doctor may order an X-ray of the injured limb and the opposite limb, and look for differences between the two, Dr. Socci says.

Your doctor may also order other imaging tests, including a magnetic resonance imaging or a computed tomography scan, but he or she may simply make a diagnosis based on the tenderness of the growth plate area.

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How Does A Salter

A Salter-Harris I fracture of the distal fibula typically occurs when a child rolls or twists the ankle. This injury is most likely to occur in basketball, football, soccer and volleyball. A Salter-Harris I fracture of the distal fibula can be easily confused with an ankle sprain. In an adult, twisting the ankle most often results in a sprain of the ankle ligaments. However, in a growing child, the growth plate is much weaker than the surrounding ligaments, which means the same twisting injury is more likely to cause a growth plate fracture than an ankle sprain.

Growth Plate Fracture Treatment

Ankle Fractures

Growth plate fractures are generally treated with splints or casts. Sometimes, the bone may need to be put back in place to allow it to heal in the correct position. This may be done before or after the cast is placed and is called a closed reduction. The length of time your child needs to be in a cast or splint depends on the location and severity of the fracture. Your childs age also matters: younger patients heal faster than older patients.

If the fracture was manipulated , you will need to follow up with your childs orthopaedic specialist more frequently. The fracture must be closely monitored after its healed to make sure the bone continues to grow normally.

Some growth plate fractures require surgery to ensure the growth plate is optimally aligned for normal growth of that bone. The surgery is called open reduction and internal fixation. It consists of exposing the bone to put it in place with screws and plates.

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Treating A Growth Plate Injury

If theres a chance your child or teen has injured a growth plate, make an appointment with your foot and ankle specialist. Proper treatment is critical and under no circumstances should your child keep running or playing while injured. Many young athletes try to minimize their injury or play through the pain, but if teens and children do not give their growing bodies time to heal, they may be setting themselves up for a more serious condition in the future.

Depending on the type of fracture and severity of the injury, your foot and ankle specialist may recommend one of these courses of treatment.

Depending on the severity of the injury, your foot and ankle specialist may recommend one of these courses of treatment.

  • Immobilization of the joint. The joint will typically be immobilized in a cast or boot for 2-4 weeks to give the area time to heal. In the meantime, your child should limit their physical activities and refrain from bearing weight on the injured foot.
  • Manipulation. In some cases, the doctor can manipulate the joint using his or her hands to place the bones back into their correct position. Afterward, the joint will be set in a cast for 2-4 weeks until it has healed completely.
  • Surgery. For severe growth plate fractures, a surgical correction may be required. The surgical site will then be placed in a cast or boot for 4-6 weeks while the bones and soft tissues heal.

What Causes Growth Plate Fractures

Fractures occur in the growth plate because it has not fully hardened into bone yet. The main causes of growth plate fractures are falls, accidents, or other types of trauma to the body. Repetitive or constant use of a jointfor instance, when a child is overworking the limb or joint when practicing sports such as pitching or gymnasticscan also cause growth plate fractures.

Other issues may cause a fracture of the growth plate include:

  • Inherited medical problems

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Treating A Growth Plate Fracture

Most growth plate fractures heal properly and when treated appropriately have no long term complications moving forward.

Most growth plate fractures may be addressed through non-surgical treatment methods such as bracing or a cast to immobilize the injured area. It will be important for your child to adhere to the activity-restriction provided by your orthopedic physician during the recovery process.

A more serious growth plate fracture may require surgery. Orthopedic surgeons typically utilize open reduction and internal fixation surgical procedures to promote growth plate fracture healing. This allows the surgeon to reposition bone fragments and reinforce them with screws, wires, or mental plates when needed.

How Long Does it Take to Heal a Growth Plate Fracture?

Growth plate fracture healing time varies based on the type and location of the fracture. Typically, it takes several weeks for a growth plate to fully heal. Your orthopedic physician or physical therapist will likely recommend special physical therapy exercises and stretches to promote further healing. And, our EmergeOrtho Orthopedic doctors will want to keep an eye on the healed injury following recovery to ensure growth is proceeding as it should.

Our ultimate goal is to provide our Triangle-area patients with the best in personalized, compassionate orthopedic care. We will do all we can to help your child Emerge Stronger. Healthier. Better.

Symptoms Of A Growth Plate Injury

Fractured growth plate in ankle

Keep a close eye on your childs growing body and play habits. They may offer clues to a cause for concern. Your child or teen may have a growth plate injury if they:

  • Have sustained an acute injury to one of their limbs
  • Complain of severe pain as a result of an injury
  • Can no longer play or have a worsening ability to play recreational activities after sustaining an injury
  • Have a visible deformity at the injured area
  • Complain of persistent pain and soreness at a joint or in the heel, regardless of injury, especially if they are very physically active

Injuries to the growth plate can be difficult to catch. In adults, an x-ray can easily detect a fracture, but in children, a growth plate fracture takes a specially trained eye.

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Recovery From A Growth Plate Injury

After the growth plate fracture has healed, your foot and ankle specialist will recommend exercises to strengthen the muscles and improve the joints range of motion. The greatest risk of a growth plate injury is the stunted growth of the bone , and the younger your child is at the time of the injury, the greater the risk of severe stunting. Your childs doctor will schedule follow-up visits, including physical exams and X-rays, about 2-3 times per year for two years after successful treatment.

Our nationally recognized team of foot and ankle experts has been providing advanced, comprehensive, and compassionate care to pediatric patients for over 20 years. They understand the unique circumstances involving the treatment of children and their developing and growing bones, joints, and tendons.

Growth Plate Fractures In Childrens Ankle Injuries Are Much Rarer Than Previously Thought

Posted on January 25, 2016

Topics:All articles on Research


A new study led by SickKids found that lateral ankle injuries in children without X-ray evidence of a fracture are most often sprains that can be easily treated with a removable splint.

A new study led by The Hospital for Sick Children found that lateral ankle injuries in children without X-ray evidence of a fracture are most often sprains that can be easily treated with a removable splint.

The study looked at 135 children with lateral ankle injuries and normal X-rays of these, only four cases showed evidence of a growth plate fracture with magnetic resonance imaging , two of which only had partial growth plate injuries. The majority of children in the study had ankle sprain injuries. This study was published on January 4 in JAMA Pediatrics.

According to current standards, the most commonly presumed lateral ankle injury for children is a Salter-Harris I fracture of the distal fibula , a type of growth plate fracture. This fracture can only be seen using MRI since the growth plate is a layer of soft growing tissue not visible on X-rays. The growth plate is traditionally thought to be the weakest part of a childs musculoskeletal system, so when a child twists an ankle, the injury is more likely to result in a growth plate fracture rather than a sprained ligament like adults.

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Why It Is Important To Do This Review

Suboptimal management of ankle fractures, especially where they involve the growth plate or joint surface, can have significant longterm complications that include leglength discrepancy, deformity, pain, abnormal gait and secondary osteoarthrosis . Several questions regarding the management of paediatric ankle fractures remain to be answered:

  • What is the most effective and appropriate nonsurgical immobilisation for a given type of fracture ?
  • What is the optimal duration of immobilisation for a given intervention and fracture type?
  • Should the leg be immobilised in an above or belowknee cast?
  • How long, if at all, should a leg remain nonweightbearing?
  • What are the indications for surgical versus nonsurgical treatment?
  • If surgery is indicated, what is the safest and most effective surgical intervention for a given fracture pattern?

The purpose of this review was to collate and appraise highlevel evidence from randomised controlled trials in order to explore the variations and reduce uncertainty in, and to assess the appropriateness of, current clinical practice in treating different types of paediatric ankle fractures . In doing so, we hope to inform patient, parent and clinician decisions in the treatment of ankle fractures in children and also to highlight where there is insufficient evidence to endorse or inform changes to practice.

How Do Growth Plate Fractures Happen

Growth Plate Fracture

Growth plate fractures commonly result from falls or sports, bike and motor vehicle accidents. In some cases, a growth plate may fracture due to an overuse of a joint. An example is growth plate fractures that may occur in Little League pitchers because of excessive throwing.

Your child should be treated at your local emergency room or urgent care clinic immediately after the injury. The medical staff will be able to tell you whether surgery is needed. For fractures that do not require surgery, you should still make an appointment with your physician for follow-up care.

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Special Distal Tibial Fractures

The growth plate at the ankle end of the tibia matures and goes away in girls at about 14 years of age, and in boys at about age 16. This occurs over an 18-month transitional period. During this time, the growth plate first begins to close and harden in the center of the bone, then outward toward the front, then toward the back, and finally all around the outside of the bone.

It is during this period that “transitional fractures” of the maturing growth plate can occur. Two common transitional fractures of the distal tibia are triplane fractures and Tillaux fractures.

Triplane fractures. If the fracture extends away from the growth plate in both directions it is a triplane fracture. Triplane fractures extend through the epiphysis, physis , and metaphysis of the bone.

Treatment of triplane fractures depends on the amount of displacement between the broken bones. Minimally displaced fractures and non-displaced fractures can be treated with a long-leg cast.

Tillaux fractures. Ankle fractures occurring in the front and outside area of the distal tibia in adolescents are named after the French surgeon Tillaux. This is a Salter-Harris Type III fracture which extends through the growth plate and joint. Tillaux fractures account for 3% to 5% of pediatric ankle fractures

Boston Medical Center is a 514-bed academic medical center located in Boston’s historic South End, providing medical care for infants, children, teens and adults.

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Diagnosing A Growth Plate Fracture

When our fellowship-trained orthopedic physicians examine and determine a growth plate fracture, the diagnosis will be classified as one of the following five types of fractures:

  • Type I Fracture. The bone end separates from the bone shaft
  • Type II Fracture. As the most common type of growth plate fracture, the fracture breaks through part of the bone at the growth plate and cracks through the bone shaft
  • Type III Fracture. The fracture crosses through a section of the growth plate, breaking off a piece of the bone end.
  • Type IV Fracture. The fracture breaks through the bone shaft, growth plate, and end of the bone.
  • Type V fracture. A more rare type of growth plate fracture, they are caused by a crushing injury.

This hierarchy of fractures is referred to as the Salter-Harris system.

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What You Need To Know

  • Growth plates are areas at the end of certain bones that allow the bones to grow. A child continues to grow while the plates are open.
  • A growth plate may fracture due to a fall or another cause.
  • A physical exam and X-rays are most often used to diagnose a growth plate fracture.
  • Fractures of the growth plate can interrupt normal growth if not treated properly.
  • Casting and splinting are common ways to treat growth plate fractures, but surgery may also be required in certain cases.

What Are The Complications Associated With A Growth Plate Fracture

Growth Plate Fracture Injury

Most growth plate fractures heal quickly and without complications. However, patients who have Type IV and V fractures are at greater risk for further problems. Occasionally, the fracture may cut off the blood supply to the growth plate, which would cause slow healing and stunted growth.

If the growth plate is crushed, or severely injured, it may close and harden too early, before growth has been completed. If this happens, the patient is left with a hardened section of bone over the fracture line that may need to be repaired with surgery.

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Different Types Of Ankle Growth Plate Injuries

While most fractured growth plates in the ankle often heal without complications, some injuries necessitate special attention in order to ensure normal growth continues.

Ankle growth plate injuries most commonly either occur at the end of the fibula or tibia, two of the three bones that compose the ankle joint.

  • Growth plate fractures in the ankle that occur at the end of the fibula, commonly associated with a typical ankle sprain, may not present on an X-ray. These often require about four to six weeks of recovery.
  • A fractured or broken growth plate in the ankle at the end of the tibia may be more severe, and may require more time to heal .

Diagnosing Your Child’s Growth Plate Injury

Your foot and ankle specialist can check for a growth plate injury and bone fractures by conducting an X-ray. Although there may not appear to be a fracture, a growth plate injury might be diagnosed by comparing the differences between an X-ray image of the injured limb and an image of the opposite limb. An MRI , CT scan, or ultrasound can also aid in the diagnosis.

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