Leg Growth Plate Fractures
The distal femur refers to the end of the femur bone, near the knee. This growth plate contributes a significant amount to the growth of not only the femur bone, but of the entire lower extremity. This growth area is tethered closely to the bone, and so it takes a significant force in order to break it.
Unfortunately when this area breaks, it almost always requires surgery to realign the bone ends back together. Even if the bones are lined up perfectly, there is still almost a 50% chance that the growth plate will suffer some type of permanent injury. Since it contributes to a large portion of growth, it is very important to follow up with your surgeon regularly.
Depending on where the bone breaks, your surgeon will either repair the fracture with pins or screws. If pins are placed across the bone, they will remain outside the skin for approximately four to six weeks. During that time, the pins will remain protected by a cast and are then removed in the office. Once the pins have been removed, your child will be allowed to start moving their knee.
If the fracture is repaired with screws, then often times, your surgeon will not allow your child to put weight on the leg for the first six weeks to allow the fracture to heal. Most of the time, the screws are not bothersome and can be left in place forever.
The proximal tibia refers to the top portion of the tibia bone, close to the knee. Similar to the distal femur, it contributes a large portion to growth of the limb. It also has a high risk of growth arrest if the fracture occurs through the growth plate.
Often when breaks occur through the physis, the pieces are separated far enough away from each other that it requires surgery to piece them back together. Your surgeon will likely use sterile metal pins that are placed outside the skin and across the bone to hold the fracture in place. The pins typically stay in place for a total of four to six weeks.
Once the fracture heals, then the pins will be removed and your provider will allow your child to begin walking on the leg again. Approximately six months after the fracture has healed, your child will have x-rays taken to determine whether or not the growth plate is permanently injured.
These growth plate fractures occur near the ankle joint. In younger children, the fracture fragments typically are not separated from each other and these go on to heal properly most of the time. There are different types of growth plate fractures that occur in adolescence and the type of fracture that occurs depends on the amount of growth that your child has remaining.
Usually, the fractures through the growth plate exit out through the ankle joint. If the broken pieces are very close to each other, our providers will try and treat the fracture without any surgery.
However, frequent follow-up will be required initially to ensure that the fracture pieces do not move. Initially, your child will remain in a cast above the knee before transitioning into a cast below the knee. Total time in a cast averages about six weeks.
If the fractured fragments are separated too far from each other, your provider will likely recommend surgery to decrease the risk for pain and arthritis in the future.
Similar to the other growth plate fractures, your provider will check via x-ray in six months after the injury to evaluate if the physis has been permanently damaged.