Growth Plate Injuries: An Introduction

The growth plate is a specialized cartilaginous structure situated at the proximal and distal ends of long bones and is responsible for longitudinal growth of bones. As the child is growing, the cartilage on the metaphyseal side is gradually replaced by mineralized tissue that ossifies through the process of endochondral ossification. It is the weakest part of the bone and thus vulnerable to various types of injuries or insults. In this section, 14 cases of growth plate injuries are discussed, most of them caused by trauma, but also other pathologies including infection (case 5; two other cases of proximal femoral destruction are discussed in the hip section), meningococcemia (case 14), curettage of cystic lesion adjacent to the growth plate (case 41), and post ACL repair (case 57). In some cases of fractured femur, a delayed appearance of a proximal tibial deformity (case 304), most often recurvatum deformity, may occur long after the initial trauma, and this is due to an undiagnosed injury to the proximal tibial growth plate. This possibility should be considered when addressing femur fractures. Furthermore, limb deformities can develop in some genetic conditions, like skeletal dysplasias, where one side of the physis is “sick” with slower growth than the other half of the physis, leading to angular (genu valgum/varum) or more complex deformities (this is more extensively discussed in Skeletal Dysplasia section). A “sick” physis is also typically seen in cases of Blount’s disease, where the medial proximal tibial physis grows at a slower rate than the lateral half of the physis (this is discussed in Blount’s section).