Growth plate injuries and management

The growth plate, or physis, is the name given to the area of cartilaginous tissue found between the epiphysis and metaphysis of skeletally immature bone. The developing growth plate is weaker than surrounding ossified bone and, therefore, at risk of injury before its closure. Previous studies have shown that fractures account for 10–25% of all paediatric injuries, with growth plate injuries accounting for 15–30% of all paediatric bony injury. The upper limb is most likely to be affected, with the distal radius found to be the most common site of fractures in children.The Salter–Harris classification describes growth plate injuries based upon location and likelihood of growth arrest. In addition to growth arrest, injury to the growth plate often stimulates bone repair, which can lead to limb length discrepancy, bone bridge formation between the metaphysis and epiphysis, and angulation of the bone. The treatment of growth plate fractures ranges from conservative management to operative fixation and bone grafting. Outcome is varied and dependent upon site and grade of the fracture as well as the age of the patient. Regardless of Salter–Harris classification, an important component of management is counselling the parents about the potential risk of future growth arrest and associated sequelae.