Growth Plate Fractures Part 2


In Part 1, we learned the anatomy of the growth plate, a fibrous cartilage center from which bone grows in the adolescent. After learning about the fracture types in our first article, which type do you think this athlete has? This is the case of a 14-year old male. Presented to my office with a not-so-common climbing related injury, this is the perfect learning situation for athletes, their coaches, and our families alike.

How common are these fractures? They aren’t! 15-30% of the fractures that occur in adolescents/children, they are relatively rare. Most commonly, if a growth plate fracture were to occur, it would most likely be a male and in athletes between the age of 15-17 (males) and 13-15 (females). The closer the athlete to this age range, the more susceptible they are to this injury. Over 15 for a female or 17 for a male? Lucky you, your growth plates are most likely closed and you are not susceptible to this injury in almost all cases.

What Happened to this Athlete?

This athlete didn’t have a fall or any major trauma. His parents said he began talking more and more about finger pain until they finally took him in to see his MD. After begin sent to his orthopedic surgeon, this young climber was told to stop climbing, at least for a few years and was sent home with the diagnosis of growth plate fractures in both 3rd knuckles. Let’s discuss diagnosis, treatment and rehab for this unlucky young climber.

Diagnosis:

First, which fracture type (from Part 1) do you think he has? And I say HE because this injury occurs 2:1 in males as they reach skeletal maturity later and are often climbing harder at that time. To refresh your memory, for the fracture types, here are our options…

A type 2 fracture of the metaphysics and growth plate itself….

A type 3 fracture of the growth plate and the epiphysis or end of the bone…

OR would it be Type 4: The bone above and below the growth plate fractured.

Well, which is it?! Any doctor worth their beans would tell you they need to see a second and/or a third view to be able to tell what type of a fracture this truly is.

The biggest issue that is visible is the displacement of the bone (metaphysis) down into the cartilaginous space of the growth plate. This fracture definitely includes two regions, the metaphysis and the physis or the growth plate itself. The injury could possibly include the epiphysis as well however (and much to your unhappiness) we will not be able to tell on this view alone.

What we CAN see from this view, is that the joint space itself appears to be smooth and relatively unaffected. There appear to be no floating bodies (of the bony debris variety) in the joint space. If the patient has locking or clicking after recovery, we might recommend a follow-up examination with his doctor to rule them out.

Most likely a Type 2 fracture this could also be a Type 4 if we visualize derangement (or changes) to the bone in the second film on the joint’s side of the growth plate. We will post the second view as soon as it arrives so we can discuss treatment at length!

Other Possible Diagnoses:

Keep in mind that without x-ray, this injury can also be confused with other common climbing injuries. Don’t freak out if you are reading this and are a young adolescent with joint pain… Your medical doctor will this rare injury out as he or she does their exam.

More Common Injuries Include the Following:

-Capsular Sprains

-Jammed Joints

-Tendonitis/overuse injuries

-Joint infections

-Joint Mice (ca