Epiphyseal fractures occur in growing children when the growth plate is involved. There are five or six types of fractures depending on which parts of the bone are broken. Diagnosis is done through X-rays and further imaging may be needed. Treatment varies depending on the severity of the fracture.
A fracture at one end of a long bone in a growing child that involves his or her growth plate is known as an epiphyseal fracture. Cartilage discs near each end of an immature long bone allow the bone to grow. These areas of growing tissue, known as epiphyseal plates, harden as a child matures to adulthood. The growth plates in the bones are the weakest areas of the skeletal structure and are prone to injuries called fractures. This type of fracture is sometimes referred to as a Salter fracture or Salter Harris fracture.
The shaft of a bone is referred to as the shaft while the rounded portion on each end is called the epiphysis. Between these two areas is a flared portion of the bone at each end called the metaphysis. An epiphyseal plate sits between the epiphysis and metaphysis at each end of a long bone. Depending on which parts of the bone are broken, an epiphyseal fracture can be classified as one of five or six types of fractures.
Type I fractures involve complete separation of the epiphysis from the metaphysis. The rupture passes through the epiphyseal plate, which remains attached to the epiphysis. Such a fracture typically requires immobilization and sometimes requires repositioning of bone pieces if there is significant displacement. Assuming there is no interruption in the blood supply to the epiphyseal plate, the bone is likely to grow normally.
Fractures through the growth plate and metaphysis but not involving the epiphysis are classified as type II fractures. These are the most common type of epiphyseal fracture. With immobilization and rest and, if necessary, repositioning of the bone or growth plate, the fracture typically heals and strengthens over time.
A rarer fracture in which part of the epiphysis and growth plate are separated from the metaphysis is classified as a type III epiphyseal fracture. Teens are more likely to suffer this injury. It usually occurs at the lower end of the tibia, which is one of the long bones located in the lower leg. Sometimes surgery is needed for this more serious type of fracture. However, if the blood supply is maintained to the separated portion of the epiphysis, the chances of normal bone growth are still good.
Type IV fractures traverse the epiphysis, the epiphyseal plate, and into the metaphysis. Surgery is usually required for this very serious injury to align the bone pieces perfectly. If this alignment is not maintained perfectly during recovery, the prospects for proper bone growth are poor.
Compression fractures of the epiphyseal plate are rare and usually involve crushing the end of the bone and the growth plate. This injury, classified as a type V epiphyseal fracture, is associated with a poor prognosis, resulting in premature growth arrest. It is difficult to detect and often remains undiagnosed until a disturbance in normal growth becomes apparent. Such fractures typically require surgical treatment and often also require subsequent corrective surgery.
Some classification systems add a type VI epiphyseal fracture in which part of the epiphysis, epiphyseal plate, and metaphysis are completely missing. Such fractures are usually the result of trauma such as an accident with heavy machinery, a gunshot wound, and so on. As with type V fractures, these fractures usually require surgical treatment and subsequent reconstructive surgery. They also usually result in stunted growth.
Diagnosing an epiphyseal fracture isn’t always straightforward. After examining a patient, a doctor usually orders an X-ray of the affected area. For comparison purposes, a second X-ray of a comparable uninjured area, such as the other elbow, can also be ordered. In cases where the results of these X-rays are insufficient, further imaging such as computed tomography or magnetic resonance imaging may be needed.
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