Fractures and Growth Plate Injuries

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What are fractures and growth plate injuries?

Fractures

Fractures are cracks or breaks in bones. Because children are flexible, their bones may bend after a break. They may straighten out as they heal. This process is called remodeling.

Because of remodeling, a young person’s broken bone will heal better and with less treatment than a similar break in an adult. But some fractures that look simple to treat can cause serious problems for children or teens because their  have been damaged.

The first treatment your child receives for a fracture is the most important, so get care as soon as possible after their injury.

Growth plate injuries

Children and teens have patches of growing tissue near the end of their long bones. These points where growth happens are called growth plates or growth centers. Growth plates determine how long children’s bones will be once they are mature.

When children or teens break bones, they may damage their growth plates at the same time. (Other injuries, such as , can also damage growth plates.)

If a fracture or other injury damages the growth plate, the bone may stop growing. This serious problem is called growth arrest. Growth arrest can permanently stop a bone’s development and change how it functions. If only part of the growth plate is damaged and stops working, the bone may grow in an uneven way.

When is a fracture an emergency?

Call 911 or take your child to our Emergency Department if you think they may have broken a bone and the body part looks bent, curved or deformed. Other reasons to get emergency care for a fracture include:

Blood flow to the area seems lower than normal. One sign of this is a change in skin color. Your child’s skin may look paler than usual. In those with light skin tone, the area may look white. In those with brown skin tone, it may look yellow-brown. In those with dark skin tone, it may look ashen or gray. Another sign of lower blood flow to an arm or leg is that the hands and fingers or feet and toes may feel cold to the touch compared to an area above the break.
Not being able to put any weight at all on an injured leg, even to limp.

For fractures that aren’t an emergency, call your child’s doctor, Orthopedics and Sports Medicine at 206-987-2109 or an urgent care clinic.

Types of fractures

The most common places for fractures in children and teens are the elbow, forearm and thigh (femur).

Fractures can be simple or open:

Simple fractures are breaks or cracks in the bone that do not break through the skin.
Open fractures are breaks in which the bone sticks through the skin.

What causes fractures?

Fractures can have several causes:

Traumatic fractures happen due to injury, such as falling while running or riding a bicycle or skateboard. These types of injuries happen to healthy children with healthy bones. The bone breaks because it gets more force than it can handle. Most fractures are traumatic. Trauma that causes a fracture is a common reason for growth plate injuries.
Stress fractures can happen when a child repeats the same position or motion over and over for a long time. Repeated motions can also injure growth plates. Stress fractures are not common.
Pathologic fractures happen because the bone is weaker than normal. A pathologic fracture is usually due to holes in the bone (bone cysts) or certain bone conditions, such as brittle bone disorder (), in which bones break easily. This is not a common cause of fractures.

Fracture Treatment at Seattle Children's

The team in Seattle Children’s Fracture Program is specially trained to diagnose and treat broken bones and other serious injuries, such as skin wounds or concussions, in children and teens.

What are the symptoms of fractures and growth plate injuries?

When your child or teen breaks a bone, they will have pain at the site of the break. It will be hard for them to move the body part that is broken. This pain and loss of movement are your cues to take them to the doctor, an urgent care clinic or the Emergency Department.

Signs of broken bones
Some signs of broken bones are clear — for example, when the bone breaks through the skin in an open fracture. Other signs that a bone may be broken and a growth plate may be injured include:
- Severe pain
- Swelling, bruising or bleeding
- Limb or joint looks out of place or the wrong shape
- Numbness and tingling
- Unable to move the affected part of the body

How are fractures and growth plate injuries diagnosed?

To diagnose fractures, doctors first examine your child and take of the affected bone or bones. This helps us know how to treat your child. Simpler breaks can be treated with a sling or a cast. More complex breaks may require surgery. Knowing when a child’s fracture needs surgery requires special education and experience.

If the bone is broken at or near a growth plate, the doctor may suspect the growth plate is injured. The growth plate itself can’t be seen on an X-ray, but some signs of damage may show up. Sometimes children need an  or other scan to check for growth plate damage.

How are fractures and growth plate injuries treated?

Our fracture team is led by pediatric who specialize in the treatment of children’s bones, muscles and joints. This team also includes , , nurses, certified , and trained in sports medicine. Your child may be treated in the Emergency Department, operating room, urgent care clinic or orthopedic clinic.

Splints and slings
- If your child’s X-ray shows a fracture but the bone is straight and in a good position, we may give them a splint or sling to keep the bone in place while it heals.
- Sometimes this splint or sling is all that your child needs while the bone heals.
Casts
- Depending on the bone and how serious the break is, we may need to put a cast on once swelling is under control. We apply casts if we think the bone may not heal in the best way unless it stays securely in 1 position.
- We also use casts if they can make your child more comfortable by keeping the broken bone still. This reduces the pain that may come if your child bumps or moves the broken body part.
Surgery for fractures

Flexible rod used to stabilize the thigh while it heals.

If your child’s X-ray shows that the broken bone is at an angle and in a bad position for healing, we may need to do a procedure called a fracture reduction. Usually, in this procedure we can bend the fracture into a better position.

If that is not successful, we will make a cut (incision) so we can see the fracture and move it (open reduction). Sometimes, we use surgical screws, rods or other devices to keep the bone in place so it can heal well.

About 2 in 10 of the children we treat for broken bones need surgery. If your child needs an operation, our surgical staff will carefully choose the best surgery for their injury.
Dealing with growth plate injuries

Most growth plate injuries will heal without affecting growth. The risk of problems depends on many factors, such as how serious the injury is, how old your child is and which bone they broke.

If your child has or might have a growth plate injury, the doctor will ask you to watch for signs of growth problems. The doctor will also want your child to come back from time to time in the first 1 to 2 years after the injury. The doctor will examine your child, and your child may have X-rays to check for growth problems. For example, the leg that was broken may not be growing as fast as the other leg or it may not be growing straight.

Some children who develop growth problems may need surgery, such as to adjust the length of a bone, or other care.

Why choose Seattle Children’s for treatment of fractures and growth plate injuries?

Seattle Children’s Fracture Program specializes in fractures and growth plate injuries in children and teens. The program is part of Orthopedics and Sports Medicine.

The fracture experts you need are here
- At Seattle Children’s, your child’s team includes , pediatric ,, , nurses, , certified , registered and .
- We have the knowledge and experience to give your child expert fracture care, from a splint or cast, to complex surgery, to rehabilitation. Many of the children we treat are referred to us from other doctors and hospitals throughout the Pacific Northwest.
- We treat about 5,800 children and teens with fractures each year and see 20 fractures on our busiest days. Many kids we see were hurt in sports or other active play.
Injury care for growing bodies
- Kids are still growing well into their teens. This means their bodies can be damaged in ways that an adult body can’t. At Seattle Children’s, we specialize in knowing which treatments are most likely to have the best results for kids whose bones are still growing. The treatment we give your child will take their growth plates into account.
- All the caregivers on our team have special training in the physical, emotional and social needs of young people.
- Seattle Children’s has the largest group of  pediatric radiologists in the Northwest. We keep your child’s safety in mind at all times. If your child needs imaging that uses radiation, we use the lowest amount possible (PDF) to make the best image. We have a 3D low-dose radiation X-ray machine, called the EOS. It makes safer full-body 3D images.
- We see your child to check their progress as their fracture heals to help prevent, watch for and deal with problems that can develop later.
Our approach to surgery aims to get the best results for your child
- We can treat most fractures successfully without surgery, but your child might need surgery if the broken bone is at an angle and in a bad position for healing.
- Before we recommend surgery, we look at your child as a whole person. Your child’s team will take many factors into account. These include where their fracture is, how serious it is, whether their growth plate was injured and what results you can expect from treatment.
- We recommend surgery only when we believe it will give your child the best results. If your child needs surgery, our pediatric have many years of experience in treating children with fractures. Many have expanded fellowship training in areas like sports medicine, hip preservation, upper extremity surgery and foot and ankle conditions.
Here when and where you need us
- Seattle Children’s Emergency Department and urgent care clinics see children with broken bones.
- Our Orthopedics and Sports Medicine doctors also see patients with fractures in clinic at Seattle Children’s locations in Seattle, Bellevue, Everett, Federal Way, Olympia, the Tri-Cities, Wenatchee, Yakima and Alaska.
- Children, teens and young adults who need surgery get expert care at our hospital campus in Seattle or in Bellevue.
Support for your whole family
- Having a child with a fracture can be stressful for the whole family. From the first visit to follow-up, our team will work to give your child seamless care and make your experience here as easy on you as we can.
- Your child’s team does more than plan and provide care for your child. We also make sure you and your child understand your child’s injury and treatment options. We support you in making choices that are right for your family.
- Seattle Children’s supports your family with a range of resources. Our Child Life specialists, Family Resource Center and Guest Services are here to help.
Research and advances to improve care
- Seattle Children’s pediatric are part of CORTICES, a national group of experts working together to promote care for children with fractures and other bone, muscle and joint conditions. CORTICES stands for Children’s Orthopedic Trauma and Infection Consortium for Evidence-Based Studies.
- Our surgeons have led research to reduce your child’s exposure to radiation from imaging tests, like and .
- As part of our constant work to improve results for kids, we developed standard plans (called protocols) to help your child recover after surgery.
- Learn more about current orthopedics research at Seattle Children’s.