How Are Growth Plate Injuries Treated in Children?

Our fellowship-trained surgeon, Dr. Charles Ruotolo, restores proper bone alignment to ensure successful healing after growth plate injuries. He recommends treatment based on the fracture’s severity, the child’s age, and the affected bone. For example, mild growth plate fractures often heal with a cast or splint.

However, severe injuries often require surgery to realign the affected bone and protect the growth plate. After treatment, Dr. Charles Ruotolo closely monitors healing through regular follow-up visits. During these appointments, he examines bone growth problems and the healing of the affected limb. Contact us to schedule your appointment with our surgeon at Total Orthopedics & Sports Medicine in East Meadow.

What Is the Best Treatment Approach for Growth Plate Injuries?

Doctors treat growth plate injuries with immobilization, closed reduction (manual bone realignment), or surgery based on the severity of the fracture. In fact, the American Academy of Orthopedic Surgeons reports that most growth plate fractures heal successfully with immobilization. For example, a cast or splint can keep the injured limb in the correct position and support proper bone healing. However, if the affected bone shifts out of alignment, doctors may perform a closed reduction to restore its normal position.

During a closed reduction, a surgeon gently repositions the bone without making an incision. They may also use a cast or metal pins to hold the bone in place while it heals. In severe cases, the surgeon secures the bone with pins, screws, wires, or plates to protect the growth plate and support future bone growth.

In addition, orthopedic surgeons may recommend the following advanced treatments if growth plate damage affects long-term bone growth:

Growth Plate Bridge Removal

In some cases, scar tissue can form a bony bridge across the growth plate (epiphyseal plate). This bridge may interfere with normal bone growth and affect limb length. To address this problem, surgeons may remove the bony bridge through a procedure called bar resection. Then they may fill the space with fat or other materials to help prevent the bridge from reforming.

Limb Length Correction

Some growth plate injuries can affect normal bone growth after healing. As a result, a child may develop a difference in arm or leg length over time. In these cases, surgeons may perform epiphysiodesis (controlled growth plate closure) on the opposite limb. This approach helps both limbs reach a more equal length as the child grows.

Regenerative Medicine Treatments

According to Frontiers in Biotechnology and Bioengineering, regenerative medicine treatments aim to improve cartilage repair and support healthy growth plate healing. These therapies may use stem cells to help generate new cartilage in the injured area before the tissue develops into mature bone. They may also use growth factors (healing proteins) to promote cell growth and reduce abnormal bone bridge formation. As a result, these treatments may support more natural tissue repair and long-term bone growth.

Here are common regenerative medicine approaches used to support growth plate healing:

• Mesenchymal Stem Cells (MSCs): Help regenerate bone and cartilage tissue and support the healing process.
• Chondrocyte Therapy: Uses cartilage cells to repair damaged cartilage and improve tissue regeneration.
• Growth Factor Therapy: Uses proteins such as BMPs, VEGF, TGF-β, and IGFs to stimulate cell growth and tissue repair.
• Natural Scaffolds: Materials such as collagen and gelatin provide support for the formation of new tissue.
• Synthetic Scaffolds: Engineered materials provide structural support and guide cartilage regeneration.
• Adipose and Umbilical Cord Stem Cells: Alternative stem cell sources that may support future growth plate repair.

How Do Doctors Confirm A Growth Plate Injury?

Our surgeon, Dr. Charles Ruotolo, performs a detailed physical examination and reviews your symptoms, such as pain, swelling, or visible deformity related to the injury. During the assessment, he also asks how the injury occurred and compares the injured limb with the opposite limb. If needed, he may order X-rays to identify fractures and evaluate the position of the affected bone. However, if a more severe injury is suspected, Dr. Charles Ruotolo may recommend additional imaging tests, such as:

• Magnetic Resonance Imaging (MRI): Provides detailed images of growth plates and soft tissues to detect injuries not visible on X-rays.
• Ultrasound Imaging: Uses sound waves to assess growth plate injuries and surrounding soft tissues without radiation.
• Computed Tomography (CT) Scan: Creates detailed bone images to evaluate complex fractures and guide treatment.

How Does The Severity Of The Injury Affect Treatment?

Mild growth plate fractures often heal with a cast or splint that keeps the injured area stable for several weeks. However, displaced fractures usually require open reduction and internal fixation (ORIF) to restore proper alignment. In severe cases, a crushed growth plate may affect future bone growth and require long-term orthopedic monitoring. Because treatment varies with injury severity, doctors use the following Salter-Harris classification system to guide treatment decisions:

Type I and Type II Injuries

Type I and Type II fractures account for most growth plate injuries in children. These are the most common types of fractures, usually affecting the growth plate without causing significant joint damage. In many cases, doctors treat them with a cast, splint, or brace for 4 to 6 weeks. However, if the bone shifts out of place, doctors may perform a reduction (bone realignment) before immobilization.

Type III and Type IV Injuries

Complex or intra-articular fractures, specifically Salter-Harris Type III and Type IV, typically require surgical intervention. These fractures extend through the growth plate and require proper alignment. For this reason, orthopedic surgeons often recommend open reduction and internal fixation (ORIF). During surgery, they use pins, screws, or plates to stabilize the bone and protect future growth.

Type V Injuries

Type V fractures occur when a strong force crushes the growth plate. These injuries carry a high risk of growth arrest (premature stopping of bone growth). Because the growth plate may suffer permanent damage, treatment often focuses on preventing future bone deformities. As a result, children with Type V injuries usually require close monitoring and specialized orthopedic care.

Which Growth Plate Injuries Can Be Treated With A Cast?

Salter-Harris Type I and Type II fractures are the most commonly treated growth plate injuries with a cast. Doctors also recommend casting for stable youth stress fractures without significant bone displacement. In these cases, the cast keeps the injured area stable and protects the growth plate during healing. Most children wear a cast for about 4 to 6 weeks after the injury. However, the exact healing time depends on the severity of the fracture and the affected bone.

What Activities Should Be Avoided During Healing?

To ensure a smooth recovery, avoid activities such as running, jumping, and sudden twisting movements that could stress the injured limb. You should also avoid heavy lifting and weight-bearing activities that place extra pressure on the healing growth plate. Beyond this, avoid contact sports or repetitive activities that increase the risk of falls and reinjury. In fact, NIH research found that 15% to 30% of childhood fractures involve growth plate injuries, which occur from both traumatic events and repetitive overuse.

What Can Parents Do To Help Their Child Heal Faster?

Parents can help their child heal faster by keeping the cast or splint clean and limiting activities that stress the injured limb. They should elevate their child’s injured arm or leg to reduce swelling and apply ice as directed by their doctor. Parents should also include calcium-rich foods, vitamin D, and protein in their child’s daily meals to support bone repair and growth. Most importantly, they should attend follow-up appointments and perform the following exercises under their doctor’s guidance to support a full recovery:

• Passive Joint Movements: Gentle bending and straightening exercises to improve joint mobility.
• Supported Leg Lifts: Controlled lifting or sliding movements to improve leg function.
• Stationary Cycling: Low-resistance cycling to restore smooth joint movement.
• Isometric Exercises: Muscle-tightening exercises without moving the joint.
• Resistance Band Exercises: Light pulling or pressing movements to rebuild strength.
• Controlled Squats or Lunges: Supervised movements after weight-bearing clearance.
• Single-Leg Stands: Balance exercises to improve stability and coordination.
• Weight-Shifting Exercises: Gentle side-to-side or forward-and-back weight transfer activities.

When Is Surgery Needed For A Growth Plate Injury?

Our surgeon, Dr. Charles Ruotolo, may recommend surgery when the broken bones are significantly misaligned or damage the joint surface. He may also recommend surgery when part of the growth plate fuses prematurely and disrupts normal bone growth. This condition can lead to limb-length differences or angular deformities as the child grows. In such cases, procedures such as epiphysiodesis (controlled growth plate closure) or limb-length correction may help restore proper bone alignment and growth.

However, before the procedure, Dr. Charles Ruotolo carefully evaluates the following factors that may affect treatment decisions and long-term outcomes:

• Future Growth Risk: Growth plate damage can affect future bone development, especially in younger children.
• Location of the Injury: Fractures near highly active growth plates in the long bones, such as the distal femur or distal radius, carry a higher risk of growth disturbances.
• Blood Vessel and Nerve Health: If the injury affects nearby nerves or blood vessels, surgery may be necessary to prevent further complications.

What Are The Risks And Benefits Of Surgical Repair?

Surgical repair (open reduction and internal fixation) restores proper bone alignment in unstable or displaced fractures. It also helps prevent permanent deformity, limited joint movement, and long-term damage before growth plates harden. However, surgery may cause hardware irritation or premature closure of the growth plate, which can affect future bone growth. Over time, some children may also develop limb-length differences or other potential risks, including:

• Angular Deformity: Uneven growth across the growth plate can cause the limb to grow crooked.
• Infection: Bacteria can enter around surgical pins, screws, or other implants.
• Avascular Necrosis: Poor blood flow may damage the solid bone and affect long-term healing.

Will Younger And Older Children Need Different Treatment?

Yes, younger and older children need different treatments due to differences in healing rates and bone remodeling. For example, younger children often recover with a cast, splint, brace, or closed reduction (manual bone realignment), as their bones can naturally correct minor misalignments over time.

In contrast, older children and teenagers have less natural bone remodeling and limited future growth potential. For this reason, displaced or unstable fractures in older children require open reduction and internal fixation (surgical bone realignment) to restore proper alignment. During this procedure, surgeons use pins, screws, or wires to stabilize the bone and support healing.

Are Some Growth Plate Injuries More Difficult To Treat?

Yes, complex growth plate injuries are difficult to treat and often require more advanced treatment. For example, Salter-Harris Type III, IV, and V fractures can extend through the growth plate and nearby bone, making precise alignment essential for proper healing. Similarly, sports-related conditions, such as Little League shoulder, may require specialized evaluation when growth plates are involved. Crush injuries and severe growth plate damage can also lead to growth arrest (premature stopping of bone growth) or limb deformities if left untreated.

In addition, injuries near major joints may require more complex treatment to restore proper bone function, such as:

• Knee Growth Plate Injuries: These injuries can affect highly active growth plates and increase the risk of growth problems.
• Ankle Growth Plate Injuries: Damage near the ankle joint can disrupt normal bone growth and affect walking, balance, and joint alignment.
• Displaced Elbow Fractures: These fractures can affect nearby nerves and blood vessels and are difficult to align properly. They also carry a risk of long-term stiffness and limited forearm movement.

How Do Doctors Monitor Bone Growth After Healing?

Our surgeon, Dr. Charles Ruotolo, monitors bone growth after healing through regular follow-up visits and imaging tests. During these appointments, he uses X-rays to evaluate bone alignment and confirm that the fracture is healing correctly. In some cases, he may recommend CT scans to obtain detailed 3D images of the healing bone and surrounding structures. He may also use DEXA scans to evaluate bone density and strength after recovery.

In addition, our sports medicine specialist, Dr. Charles Ruotolo, performs the following physical examinations to monitor bone growth and recovery in growing children:

• Palpation: Checks the injury site for tenderness, swelling, or warmth.
• Range of Motion (ROM): Evaluates joint flexibility and movement compared to the healthy side.
• Strength & Stability Tests: Assesses muscle strength and the stability of nearby ligaments and tendons.
• Alignment & Length Checks: Ensures the affected limb is growing straight and symmetrically with the rest of the body.
• Neurological & Vascular Checks: Evaluates sensation, blood flow, and nerve function to detect growth-related complications.

After assessing bone growth, our surgeon, Dr. Charles Ruotolo, compares both limbs to identify any differences in length or alignment. This ongoing monitoring helps detect growth-related problems until the child is fully grown and the growth plates have been replaced with bone.

When Can Children Safely Resume Sports Activities?

Children can usually return to sports about 6 to 12 weeks after a growth plate injury, depending on the severity of the fracture and the treatment received. For example, simple injuries often heal after 4 to 6 weeks of immobilization, while displaced fractures may require a longer recovery period. However, before returning to sports, children should meet the following recovery milestones:

• No Pain or Swelling: The injured area should be completely symptom-free.
• Full Range of Motion: The joint should move normally compared to the uninjured side.
• Restored Strength: The injured limb should regain most of its normal strength.
• Medical Clearance: The child’s doctor or orthopedic specialist should approve the return to sports.

What Complications Can Occur If Treatment Is Delayed?

Delayed treatment can lead to premature growth plate closure, limb-length differences, and angular deformities (crooked bone growth). It can also cause joint damage and early arthritis, especially when the fracture extends into the joint. These complications can affect normal bone development and become more noticeable as the child grows. In most cases, untreated growth plate injuries can complicate future treatment and cause long-term complications, including:

• Avascular Necrosis: Loss of blood supply can damage part of the bone.
• Nonunion: The fractured bone fails to heal properly.
• Malunion: The bone heals in the wrong position.
• Longer Limb Growth: In rare cases, the injured limb may grow longer than expected

Consult Dr. Charles Ruotolo for the Diagnosis and Treatment of Growth Plate Injuries in Children! 

Growth plate injuries can affect your child’s bone growth and require prompt medical attention. Without timely treatment, these injuries may lead to long-term complications and affect normal bone development. You may also be concerned about how the injury could affect your child’s physical abilities and participation in sports and other everyday activities.

At Total Orthopedics and Sports Medicine, our surgeon, Dr. Charles Ruotolo, uses advanced diagnostic imaging to accurately diagnose growth plate injuries. From nonsurgical care to complex surgical repair, he develops personalized treatment plans designed to protect your child’s growth plate and support long-term recovery. He also provides clear guidance on recovery, activity restrictions, and safe return-to-sports planning. Call 855-321-6784 or visit our clinic for advanced care.

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