Growth Plate Injuries

What is a growth plate? Growth plates are areas of cartilage found near the ends of bones in children and adolescents. For example at the elbow joint, growth plates that are lcoated about an inch above and an inch below the joint. These growth plates contribute to arm length as the young athlete grows and develops. The growth plates remain open until skeletal maturity, and close once the athlete is done growing. Growth plate injuries are most prevalent between the ages of 10 and 16 years old. Before puberty, the growth plate is considered the child’s weakest link, since it is more vulnerable to injury than the ligaments and tendons surrounding the joints. Therefore, the growth plate can be more easily injury than the surrounding soft tissue and supporting ligaments.

Types of growth plates There are two basic types of growth plates, a “physis” and an “apophysis.” A physis is located near the end of a long bone as mentioned above, such as an upper arm bone or thigh bone. This type of growth plate contributes to the growth and length of that bone. It is also known as an epiphyseal plate or disk. Injuries to the physis can potentially cause long-term issues such as growth disturbances, premature closing of the growth plate or angulation.

An apophysis is an area of cartilage near an attachment point for a tendon, such as where the achilles tendon attaches to the heel bone. The apophysis contributes to the shape of the bone, not to the length. The apophysis is vulnerable to injury because the tendons that attach to it are under higher tension during the growing years.

Physis injuries Injuries to the physis can often occur from acute trauma, such as a twisted ankle or a blow to the knee in tackle football. Wrist growth plate injuries from falling on an outstretched hand are common in sports. Since growth plates are considered the young athlete’s “weakest link,” a skeletally immature athlete may damage the growth plate instead of the joint’s supporting ligaments. For example, a twisted ankle sometimes results in damage to the fibular growth plate, just above the outer bony ankle knob. Little League shoulder is another common type of growth plate injury that usually can result excessive throwing. Physis injury severity is graded according to the Salter-Harris Classification System.

Apophyseal injuries Injuries to the apophysis can occur from an acute injury, but are often due to overuse. Little Leaguer's Elbow, Osgood-Schlatter's Disease, and Sever's Disease are common overuse injuries to the apophysis and are called “apophysitis.”