Growth Plate Injury: What Causes It, and Can It Lead to Deformity?

What is a growth plate, and why does it matter?

A growth plate, also called a physis, is a layer of cartilage near each end of a child's long bones. It is the area where new bone forms. This lets the limb get longer as the child grows. The physis is made of softer cartilage, not solid bone. So it is structurally weaker than the ligaments and bone around it. That makes it the part most likely to give way under force.

Once a child finishes growing, the growth plates harden into solid bone and are no longer at risk. Until then, any injury to a physis could disrupt how that bone carries on developing.

What are the long-term signs of growth plate damage?

The fracture itself is usually treated at the time of the injury. The real concern is what happens over the months and years after. If part or all of the growth plate stops working, the bone on that side may grow more slowly. Or it may grow at an angle compared to the healthy side. The signs are often subtle at first. They become clearer as the child grows taller.

What causes growth plate injuries and physeal arrest?

Most growth plate fractures happen during sport, play or accidental falls. How serious they are depends on how the fracture runs through the physis. Orthopaedic surgeons classify these injuries using the Salter-Harris system. It groups them into types based on the fracture pattern. Higher types carry a greater risk of long-term growth disturbance.

Not every growth plate fracture leads to physeal arrest. Many heal completely, and the child's growth carries on normally. The challenge is that arrest can develop silently over many months. That is why ongoing follow-up imaging is so important.

How is a growth plate injury monitored over time?

Monitoring means imaging both limbs from time to time. This lets the treating team compare growth on the injured side with the healthy side. The child's orthopaedic surgeon will usually ask for scans at set intervals until the growth plates have fully closed. This can mean years of follow-up. This is especially true if the injury happened when the child was young and still has a lot of growing to do.

The key measurements at each follow-up are limb length and joint alignment. Even small differences, when spotted early, can guide the surgeon's decisions. If a significant difference or angular change is developing, options such as guided growth or, in some cases, corrective surgery can be considered at the right time. Waiting until the problem is obvious can make it harder to treat.

Why is standing imaging better for growth plate follow-up?

Standing, weight-bearing imaging captures the skeleton as it actually works. When a child lies down for a scan, gravity is removed and muscles relax. Subtle differences in alignment can then be hidden. A standing full-length image of both legs, from hips to ankles, shows the true picture. Any developing tilt, bow or length difference becomes visible in a single exposure.

EOS technology is especially well suited to this kind of repeated follow-up. It uses about 90% less radiation than a standard X-ray, around ten times less. A child may need imaging every six to twelve months over several years. So keeping the total radiation as low as possible matters a great deal.

At ScanAlign, low dose standing imaging, each scan produces a full-length, weight-bearing image of both limbs in a single exposure. This gives the orthopaedic team everything they need to track alignment and length accurately. Read more about paediatric imaging at ScanAlign.

What can be done if a growth plate injury causes deformity?

Monitoring may show that a significant angular deformity or limb length difference is developing. If so, the child's orthopaedic surgeon has several options. The right approach depends on how much growing the child has left and how large the problem is.

• Guided growth. A small plate is placed near a healthy growth plate to slow one side for a time. This lets the limb straighten as it grows. It works best when there is still meaningful growth left.
• Epiphysiodesis. The growth plate on the longer or unaffected leg is closed on purpose at a carefully timed point. This lets the shorter side catch up.
• Corrective surgery. In more severe cases, the bone may be cut and realigned, or lengthened with surgery.

What links all of these is timing. Every one of these decisions depends on accurate, up-to-date measurements of how each limb is growing. That is why regular follow-up imaging matters so much.

Before your child starts a treatment, or changes the one they are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help.

Frequently asked questions about growth plate injuries