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Almost every bone in your body has a physis. The physis (or growth plate) is made of cartilage and is near the ends of the long bones. Physis helps bone grow in both length and width. When a child stops growing, the physis hardens into solid bone.
Physeal fractures are very common; the most common types of fractures are found in the fingers, wrists and lower leg, mostly from overuse and in playing sports. The physis can fracture and although physis can heal very quickly, it’s important to bring your child to an orthopedic specialist as soon as possible after an injury occurring.
The Salter-Harris classification describes the different patterns of physeal fracture:
Type I fractures
This could just be a crack in the physis that is still perfectly aligned, or the physis may be disrupted and the bone separated.
Type II fractures
A fracture that is partly through the physis and then out the shaft of the bone away from the joint.
Type III fractures
A partial fracture through the physis and then exits the end of the bone into the joint. The joint surface may be disrupted.
Type IV fractures
A fracture that goes through the shaft of the bone, also through the physis, then exits out the end of the bone at the joint.
Type V fractures
Part of the physis is crushed but not displaced; these can be very difficult to see on X-rays.
Swelling, pain, bruising, and a crooked limb with the inability to move are the most obvious signs that a physeal fracture has occurred.
A doctor will need to test the joints and force some gentle movement to diagnose the problem. They will then conduct X-rays, MRI or CT, which can help to correctly identify a physeal fracture.
Treatment will depend on the specific injury. Treatment options include a cast or surgery using metal pins or screws.
Physeal stress fractures can often heal with rest, although a splint or cast may be used to help with the pain. Following healing, it’s important to reduce stress on the affected area and avoid any activity that could cause further injury or stop the healing process. Your surgeon will give you guidelines on this.
Surgery may be needed if:
Implants can be used in surgery to keep the bones aligned properly. This can include plates, pins or screws to help keep the bones aligned while healing.
Growth plate fractures, especially in the femur (upper part of the knee), must be monitored for 9 to 12 months after injury to ensure the bone grows properly. X-rays are needed to monitor progress.
If a hard-bony area forms across the physis, it may stop growing properly or grow in a crooked form. This is very rare, but if it does happen, there are different techniques for removing the bony bridge, including inserting some fat into the area, or cutting the bone to adjust its growth pattern. Your doctor may suggest surgery to prevent this from happening.