Distal Radius Fracture with damage to the Physis and partial growth arrest (R)
by Matthew Harris MD, MBA
When a young patient breaks a bone, it's traumatic, not just for them but for the parents as well. Fractures in children deserve special attention for several reasons. Depending on their age, children will often have a significant amount of growth remaining in a bone. The younger your child is at the time of injury, the more potential his/her body will have to remodel the bone. In most cases, your child will show no sign of having ever broken his/her bone after only a few short years if treated properly from the start. But just as with any fracture, we want to get the bone either fixed or lined back up as best we can in order to give your child the best chance possible of never developing a deformity as they grow.
Depending on the location of the fracture(s), we may worry about damage to the growth plate (known as the physis). The growth plate is the area of delicate cartilage that a young person's bone develops and grows from. The Salter-Harris Classification outlines the different ways that a fracture can go through and affect the growth plate, as seen below. Each of the growth plates in the body naturally closes in a predictable pattern, as well as, at a predictable age. After the growth plates are closed, young patients are said to be skeletally mature and their fracture patterns become similar to those seen in adults. This makes many fractures in young patients very unique and different than in adults.
With some fractures, permanent damage to the growth plate is inevitable and this results in some degree of Growth Arrest. If the growth arrest is only partial, meaning only some of the growth plate is closed, then the child is likely to have that bone grow on a strange angle because the other part of the growth plate is still working. Other times, the entire growth plate can close, and this will lead to a shorter bone than on the opposite side of the body. Sometimes, we will not know for weeks, or even months if your child's growth plate was injured. For that reason, we need to closely follow them by repeating XRays periodically. If we detect damage to the growth plate early enough, we may be able to stop it from getting worse. If the damage is minimal, we may simply observe it over time.
Unlike adult bones which are stiff and hard, children's bones tend to be more flexible. This quality often results in what we call a "Greenstick Fracture," which as the name implies, is similar to what you would see if you tried to break a very flexible stick. The bone is less likely to break all the way through, and instead will usually only break on one side. This leaves the bone more or less in place, and sometimes requires only a little bit of bending to line it up better before putting a cast on. The other great thing about children is that they heal much faster than adults. A fracture that might take many months to heal in an adult, may only take several weeks in a child. And while we oftentimes avoid treating adults with casts because bones take longer to heal and adult patients get very stiff, children quickly regain their flexibility very quickly once the cast is removed.
While we always prefer to treat fractures in our young patients as conservatively as possible by bracing or casting, we may need to perform surgery depending on the injury. This is often because certain fractures simply have better results if treated with surgery. Other factors that may determine the type of treatment that your child receives include the severity of the fracture, where it's located, what other injuries your child may also have at the time, and how old your child is, as well as, how skeletally mature he/she may be.
There are many conditions that children sometimes a born with, or develop later on, that cause bones to break more easily. These are discussed in some of the other sections of the site, such as for Rickets and Osteogenesis Imperfecta. If you are concerned that your child may have one of these conditions, or if your child has had multiple fractures at a young age, please make an appointment to meet with Dr. Harris at The Joint Preservation and Limb Reconstruction Center so that this can be further evaluated.