Growth Plate Injuries

By Aaron Galpert, MS, ATC

One area that athletic trainers, who work with the adolescent population, deal with is growth plate injuries. Why the concern with growth plates? They are responsible for bone growth. Children can experience a growth plate fracture with a traumatic injury; any disruption of the growth plate due to injury can affect the layer of growing tissue near the ends of a child's bones. Every long bone in the body has a growth plate which is the area where bones get longer. After children reach skeletal maturity, their growth plates close and no more vertical growth occurs.

The growth plate itself is made up of an area of cartilage with rapid turnover. This area turns cartilage into bone and allows the bone to elongate. Most long bones in the body have two growth plates. There's one plate at the top of the bone and one at the bottom. Long bones like the femur (the thigh bone), the humerus (the upper bone in the arm), and the tibia (the shin bone) all have two growth plates. However, growth rates aren't equal in all areas of the body. For instance, the greatest area of growth in the leg occurs through the growth plate in the femur closest to the knee joint.

Growth plates also close earlier or later in different parts of the body. For example, one of the last growth plates to close is in the collar bone, while the first to close is in the elbow. Additionally, girls' growth plates tend to close around age 12-14 years of age while boys' growth plates close between 16-17 years of age. The hormones that are primarily responsible for signaling growth plate closure differ; estrogen for girls and testosterone for boys.

Unfortunately, the growth plate can fracture in adolescent athletes due to a traumatic event which can cause the growth plate to partially or completely close prematurely. If part of the growth plate partially closes due to trauma, the remaining portion of the bone can grow crooked. If the growth plate completely closes early, the bone can actually end up being shorter than the corresponding bone on the other side of the body.

It's not just trauma that can impede a growth plate, repetitive use injuries can also cause damage to growth plates. Typically, though, this type of injury does not cause permanent damage to a growth plate. An adolescent athlete that may have an injury to the area of a growth plate should see a physician as soon as possible. It is very important to make sure the growth plate is lined up in an anatomical position. This will improve the chances that the growth plate will not prematurely close from the fracture. As cartilage is softer than bone so it breaks more easily, therefore only children and adolescents get growth plate fractures—adults have bone where the growth plates used to be.

A growth plate fracture hurts and swells just like any broken bone. Usually these injuries are treated with a cast or splint along with rest. Rarely, do these types of injuries need to be surgically repaired, especially if caught early, which is why it is important for an early orthopedic assessment and treatment plan to be created.