Childhood and Adolescent Pathology Series Part 1 – Growth Plate Fractures
Over the next couple of weeks, we’ll be looking at some pathologies and injuries that occur in the younger age groups. The growing body undergoes an incredible amount of change over a short period of time as the young person matures. This usually occurs without any issues; however the growth process doesn’t always go perfectly to plan. Factors such as a body weight, activity level and speed of growth can play a role in the development of the pathologies we will cover in this series.
Before we get to the different pathologies, lets go through some of the important physiological changes that happen within bones as children and adolescents go through growth periods.
Most people have heard of a growth plate. What is it? And why is it important?
A growth plate is a thin strip of cartilage in between the middle and the end of a bone that is the ‘active’ bone lengthening area. Cartilage cells (called chondrocytes) within this growth plate multiplyand act as scaffolding for bone building cells (called Osteoblasts) to lay down new ‘hard bone’. This process is continued at varying rates throughout the growth period until the plate fuses completely. This generally occurs in the early to mid teens for females and mid to late teens for males.
Although this is a normal process, the thin strip of cartilage creates a slightly weaker zone in the bone leaving it more susceptible to injury. Fracture involving the growth plate can happen in various ways and the type of fracture is classified using the Salter-Harris classification (see below). Initial management may be slightly different depending on the classification of the fracture itself, although the principles will stay the same.
Most fractures through this area will heal without any further issues. In a small amount of cases, complications can arise via disturbance to the growth plate which can cause growth arrest and consequently a difference in limb length or shape. Those who do end up with a degree of growth arrest can pursue surgical options to address the disparity.
However the fracture is initially managed, physiotherapy treatment aims to reduce any stiffness or restriction that occurs as a result of the casting, as well as strengthening exercises to get the affected area back to one hundred percent.
So in this blog we’ve gone through some background on bone building physiology and why that’s important, along with some common fracture types seen in young people. That’s only part of the picture though, we can’t forget about everything else. Along with bones getting longer and stronger, muscles and tendons need to do the same in order to keep up! In the blogs coming up, we will look at some further bony issues seen in young people, with some of those also being related to muscle and tendon growth.