Pediatric Growth Plate Injuries

Pediatric Orthopedic Surgery, Hospital for Special Surgery

Causes

Young patient with a leg limb length discrepancy

In children with growth deformities other than bowleg or knock knees, growth plate injuries constitute a major cause, with the most common fractures affecting the proximal tibia and distal femur.

Because the growth plate is the area where new bone develops (adding length to the bone), injury to this area can result in growth arrest and subsequent limb length discrepancy, in which one leg is longer than the other.

Diagnosis

Growth plate injuries are generally clear on an X-ray [See Figures 1&2], but advanced imagery, specifically MRI, is sometimes required to assess the damage. Researchers at HSS are currently studying the application of MRI in these injuries. The advantages of MRI imaging include earlier diagnosis of growth arrest and three-dimensional localization of the area.

X-ray image of growth plate injury X-ray image of normal pediatric knee
Figure 1: (left) X-ray image of growth plate injury
Figure 2: (right) X-ray image of normal pediatric knee

Treatment

Fractures involving growth plate injuries usually require setting the bone, technically referred to as "anatomic reduction, alignment and fixation." Most children respond well to these procedures, but for a small percentage, the bone or a portion of the bone will cease growing, referred to as partial or complete growth arrest.

Since there is no way to regenerate the growth plate cartilage after a partial growth arrest, additional interventions may include resection of the partial growth arrest (also known as the physeal bar) or sequential lengthening procedures during childhood. For more information on limb lengthening, please read Limb Lengthening for the Pediatric Patient.

X-ray image of limb length discrepancy due to growth plate injury X-ray mage following post-surgery
Figure 3: (left) X-ray image of limb length discrepancy due to growth plate injury
Figure 4: (right) X-ray mage following post-surgery

 

In children near the end of growth with complete growth arrest on one side, the pediatric orthopedic surgeon may recommend closing the growth plate on the other side in order to ensure that the length of the healthy limb matches that of the affected one.

 

 

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