Fractures in the Young Athlete
By Joseph Rubino, MD
There are significant differences in the ways fractures occur in the pediatric population compared to those seen in adults. The bones in children have unique characteristics that allow them to bend before breaking as well as a physis (commonly referred to as the growth plate) at the end of the bone that is a weak area and is often involved in pediatric fractures.
Bones in children are surrounded by a thick periosteum that allows bone to grow thicker with age and making it more reliable and faster healing. The body will form a mass of bone surrounding the area of the fracture, called fracture callus. This is how the fracture heals, and allows the fractures to remodel over time. This is why fractures in children may appear crooked on x-rays initially, but with continued growth, the bone realigns itself and looks normal. Once a child reaches skeletal maturity, broken bones are treated
essentially the same as in adults.
Another injury pattern seen only in the young population is a growth plate fracture. The growth plate is at the end of the bone and is responsible for bone growth in length. Fractures here are also called Salter-Harris fractures and can be types one through five. The most common type is a Salter 1 fracture. These occur directly through the growth plate and are often not diagnosed on x-rays because there is already a “crack” or lucency through even normal bone. (Image 1) These fractures are diagnosed with a history of injury and pain that lingers and is located directly over the area of the growth plate. These are typically treated with a cast for between three-six weeks, depending on the age of the patient and the location of the injury. It is important to recognize and treat these injuries because damage to the growth plate can cause problems with future growth in the bone involved.
As children are constantly falling and injuring themselves, it is important to realize the majority of these injuries are not serious and may be simple bumps, bruises or sprains. However, if a child continues to complain of pain for 12 to 24 hours, seek medical attention to ensure there is not a more serious problem, such as a growth plate fracture.
Dr. Rubino is certified by the American Board of Orthopaedic Surgery with a subspecialty certification in orthopedic sports medicine. He is an Associate Professor of Orthopaedic Surgery and Sports Medicine at Wright State University School of Medicine. He has been on staff at the University of Dayton since fall 2010 as an Orthopedic Consultant.