Growth Plate Fractures Part 1
Above: A growth plate fracture in a young climber.
This is a two part series on growth plates and young climbers. An uncommon injury, climbers and their coaches need to be aware of this possibility when dealing with bony tenderness near the joint line in the young climber.
Growth Plate Anatomy:
An area of cartilage that forms into bone is called the physis or more commonly the growth plate. Rubbery and flexible, it exists only in those still developing into adulthood. The growth plate is located in the zone between the end of the bone (epiphysis), and the long shaft itself (metaphysis), Where the bone elongates with growth, once adulthood is reached, the growth plate ossifies and hardens into regular bone.
Closing once the region has finished growing, they are prone to fracture as they are made of a softer material than bone itself. With trauma or overuse, fractures do occur in this region. 15-30% of all childhood fractures occur in the growth plate region and most commonly in males as females finish growing earlier than males.
Types of Growth Plate Injuries:
There are now 6 classified types of growth plate fractures, each possibly needing different treatment and recovery strategies. Let’s discuss each one so we understand what we are looking at on this patients films.
Type 1- A complete fracture encompassing the entire growth plate, the bone is fractured at a 90 degree angle across and in line with the growth plate. After this fracture the metaphysis is still touching the epiphysis. Unless the blood supply has been damaged to the end of the bone, surgery is not needed. Relocation of the bone might be needed if the bones do not meet correctly after the fracture. Splinting or casting is recommended to ensure proper healing.
Type 2- The most common type of growth plate fracture, part of the growth plate is fractured as in Type 1 however the fracture continues up into the shaft (metaphysis) of the bone. If displaced, this fracture needs to be reset however the likelihood of healing is quite good, especially in the younger child.
Type 3- A rare fracture, this fracture includes the end of the bone (epiphysis) and runs horizontally across the growth plate. The metaphysis, or long bone is not involved. The end of the bone might need to be realigned for the growth plate to heal correctly. If blood supply is not disrupted and the bone heals in alignment, the healing is ideal and no long term side effects are expected. This fracture could involve joint space damage and is more common in adolescence.
Type 4- This fracture includes the end of the bone (joint affected) and crosses the growth plate to include the shaft of the bone as well. Surgery is commonly needed to ensure alignment of the bony end (which effects the joint space). Unless proper alignment is achieved the healing is poor and improper joint alignment and/or a bony deformity may exist after maximal healing takes place.The epiphysis and metaphysis are fractured as well as part of the growth plate.
Type 5- An impact (crush) injury to the end of the longbone (epiphysis) and growth plate. This injury occurs hitting an object or a fall in which blunt trauma occurs.
A Type 6 also occurs (under the new Peterson classification) but as it rarely occurs with climbing and is most common with major accidents, it is not discussed in this article. For curious minds, it includes Type 4 but the bony fracture debris is missing.
Types 4-6 are the most serious with Type 1-3 healing quite nicely under doctor supervision. Occurring only in those in adolescence or younger, the symptoms of a growth plate fracture are no different than the typical unhappy climbers finger. The main indicator is a young child with a severe unhappy finger or an injury that fails to heal. Trauma is not needed as this fracture can occur with repetitive use in climbing, particularly with hang board, crimps and/or systems walls. If you are even remotely worried about this fracture, timing is everything and you should head in to visit your medical doctor just in case. Please read the Part 2 of this article to gain insight into the care and treatment of the athlete who’s finger is in this x-ray.