We are New York personal injury lawyers. We get accident cases involving fractured or broken bones all the time. But there is a term within the fracture category that only applies to children and teens, and that is called a “growth plate injury” and they can be highly problematic, so parents should take them seriously.
Don’t panic – I am not trying to scare you. I am trying to educate you, so you get your child the very best medical care.
So, let’s start with the definition of a growth plate (also referred to as an epiphyseal plate). It is a section of soft cartilage (it is actually not bone – yet) located at the ends of the long bones of children and teenagers – and because they are soft, they are easily injured. This is the part of the bone where new bone develops and adds length as the child grows. At maturity (when the child is finished growing), these plates are permanently close to form solid bone.
How Does a Growth Plate Injury Effect my Child
Let’s use the shin bone, called the tibia, to show how the injury might affect your child – in a minute you’ll see why I’m using this bone as an example. A child steps in a hole awkwardly and breaks the bone somewhere in the middle of the leg. This is not a growth plate injury and, if it’s a small fracture, the child will only require a cast. If it’s a larger fracture, he might need a pin or screws to set it and with good medical treatment and time, it should heal and the child will go on to be a full functioning adult.
But, what happens when the fracture happens at the end of the bone – what I’ve identified as “the growth plate”? Well, that is a different ball game. Injury to this area can cause the plate to close prematurely and stop bone growth. It doesn’t take long to figure out what happens if the child’s right leg stops growing and the left leg continues to grow at its original pace. Absent the proper treatment, one leg will end up being longer than the other as the child grows up, resulting in pain and difficulty walking.
Sometimes, a growth plate fracture can also cause the bone to grow more – this has the same result – where one limb ends up longer than the other. A less common problem is when a ridge develops along the fracture line. This can also interfere with the bone’s growth or cause it to curve.
If the accident happened when the child was almost fully grown (the age varies, but usually around age 20), this problem might be able to be cured with a small lift in a shoe. But, if the injury happens when the child was only 8 years old and 4 feet tall and his full adult size will be 6 feet tall, well then you have a huge deformity.
The Most Common Bones for Growth Plate Injuries
The most common growth plate fractures take place in the proximal tibia (top of the shin bone) and the distal femur (bottom of the thighbone). They are also common in the long bones of the fingers and can occur in joints in the shoulder, wrist, ankle, or elbow.
A decent-sized fracture will always be clearly found by taking an X-ray – because the most common purpose of an x-ray is to detect bone fractures. But remember what I said earlier – the growth plate is actually cartilage (not bone), so the damage can be harder to detect. Advanced imagery is usually required to fully assess the extent of the damage. It is often recommended that children or teenagers who break an arm or leg get a CT exam. If the CT demonstrates a growth plate injury, then an MRI may also be useful to determine precisely where the plate has begun to close prematurely.
Many things go into designing a treatment plan for a child with a growth plate injury. A doctor will take into account the child’s age, health, and fracture severity. If the fracture isn’t severe and the broken parts of the bone still line up right, the doctor might be able to cast, splint, or brace the leg, which will prevent movement and weight bearing and give the growth plate time to heal.
If the fracture pieces don’t seem to line up in a straight line in the x-ray, then the doctor may need to perform a “closed reduction”, where he manipulates the leg with his hands back into proper alignment (don’t worry, your child is given pain medication and shouldn’t feel too much pain). If the doctor can’t manipulate the bones with his hands, he may have to perform an “open” surgery, where he cuts into the leg and shifts the bones back into place with screws, pins, wires, and/or plates to hold the pieces together. Either way, in most cases, the child should respond well.
But, in a small percentage of these patients, the bone or a portion of the bone will stop growing. This is called “partial growth arrest” or “physeal bar.”
Since there is no way to regenerate the growth plate cartilage after a physeal bar, additional treatments are required. These treatments may include resection (removal) of the partial growth arrest or a limb lengthening procedure (in this process the doctor stimulates the injured area by surgically cutting the bone and attaching a device that slowly moves the two ends of the bone apart. As space opens up between these two ends, new bone grows to fill in the gap).
Another problem that might develop is that a ridge forms at the fracture line. In that case, the doctor would perform surgery to remove the ridge and pad the area with fat or another material to keep it from growing back.
If a child is almost fully grown and experiences a complete growth stoppage in a limb on one side of the body, a pediatric orthopedic surgeon may recommend closing the growth plate in the limb on the other side so that both limbs remain the same length.
The Healing Process
After the injury has healed, your child’s doctor may suggest exercises to strengthen the injured area and make sure their limb moves like it’s supposed to. Other children might require additional surgery.
Make sure to schedule a couple of follow-up appointments – perhaps at 6 months and a year so your doctor can make sure all is well.
Why You Need an Experienced Child Injury Lawyer
Growth plate injuries are a big deal. An inexperienced lawyer can’t explain to an insurance company the severity of the injury or may not get the expert reports required to demonstrate the serious problems that could await. Children are at the beginning of their lives. If they have problems walking, can’t play sports, or end up with psychological injuries such as lack of self-esteem or embarrassment because one leg or arm is shorter than the other, then those physical and psychological injuries have substantial value. The injury may result in the child not being able to do certain jobs when he or she gets older and that creates an economic element to the case.
If your child suffers a growth plate injury, please call the award-winning team at Sakkas, Cahn & Weiss for a free consultation.