Acute and chronic growth plate injuries

Abstract

Growth plate injuries are common fractures experienced by children, and recognizing the various types of acute and chronic physeal injuries is essential for the pediatrician. The Salter-Harris classification, the most commonly used classification for growth plate injuries, is a 5-part system based on premature growth plate closure and functional outcomes, with higher numbers correlating with increased likelihood of premature closure and poor outcome. Basedprimarilyonconsensusduetoalackofrelevantclinicalstudies,the patient history, physical examination results, and radiologic evidence are key to establishing the correct diagnosis and appropriate management strategy for growth plate injuries to obtain the best possible outcome that minimizes growth disturbance and poor functionality. Based primarily on consensus due to lack of relevant clinical studies, chronic growth plate injuries are principally due to a combination of inflexibility, overuse, and improper technique, and the hallmark of management isrest while correctingtheunderlyingpathophysiology. Based primarily on consensus due to lack of relevant clinical studies, patients with Salter-Harris type III or higher fractures as well as those withrepeatinjuries,injuriesduetohigh-energymechanisms,unstable fractures, or chronic physeal injuries require referral to a specialist for prompt evaluation to determine the need for surgical management.