Growth Plate Fractures (Physeal Fractures) Clinical Presentation

Updated: Dec 13, 2021
  • Author: Steven I Rabin, MD, FAAOS; Chief Editor: Jeffrey D Thomson, MD  more...
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Presentation

History

Patients with acute growth plate fracture typically complain of what seems to be localized joint pain, often following a traumatic event (eg, fall or collision). Swelling near a joint with focal tenderness over the physis is usually present (see the image below). Lower-extremity injuries present as an inability to bear weight on the injured side; upper-extremity injuries present with complaints of impaired function and reduced range of motion (ROM), quite similar to ligamentous injury. 

Growth plate (physeal) fractures. Clinical appeara Growth plate (physeal) fractures. Clinical appearance of knee of patient with minimally displaced Salter-Harris I fracture of distal femur. Impressive swelling was noted adjacent to joint, but no evidence of intra-articular swelling was present. Patient was markedly tender to palpation about distal femoral physis.

Most acute injuries to the growth plates are from a fall. It is essential to obtain a history of sports involvement, in that 33% of acute injuries occur during sports. Hockey, football, and baseball are the activities most often involved; biking, skiing, and snowboarding are the next most common activities causing acute growth plate injury. [4]  Little League shoulder, gymnast wrist, Little League elbow, Osgood-Schlatter disease, Sever disease, and Sinding-Larsen-Johansson disease are examples of physeal injuries commonly associated with sports that involve overuse at specific apophyses. [3]  

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Physical Examination

The main differential in a pediatric patient who has pain and swelling at the distal end of a long bone with normal radiographs is a sprain. If the patient has tenderness specifically directly over the bone/growth plate, the injury is most likely a Salter-Harris (SH) type I physeal injury. If the tenderness is more over the ligaments, then the injury could be a sprain. Because the ligaments are five times stronger than the physis, most "sprains" in children are actually SH I growth plate injuries.

Ligamentous laxity tests of the joints of the injured side may elicit pain and positive findings similar to those indicative of joint injury. (An SH III or SH IV fracture of the distal femur is the classic example.) Positive joint laxity test findings must not be dismissed as only involving the related joint tissues.

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