(Disorders of the Growth Plate)
Discussed on this page:
What is a Growth Plate?
What is an Epiphyseal Plate?
Trauma to the Growth Plate
Premature Closure of the
What is an Apophysis?
- Kohler's Disease
- Uhke's Disease
- Sever's Disease
- Osgood Schlatter's Disease
- Osteochondritis Dessicans
- Freiberg's Disease
- Salter Harris Classification
What is a Growth Plate,
and what is an Epiphysis?
When we're born,
our bones are quite small, and they need to grow in order for us to grow.
A growth plate, or epiphyseal plate, is the portion of bone
that grows as we go through childhood. It basically consists of
cartilage that gradually hardens into bone.
To the left is a microscopic view of a growth plate.
The cells are normally white, but have been stained pink to make them more
In this picture, the oval-shaped, pale bluish white coloured, cells
are the cartilagenous cells--the cells within the growth plate that are
You can see that the cartilage cells at the top of the picture are
fading into the surrounding pinkish colour. These are the older
cartilage cells that are hardening and developing into mature
Is it possible to injure a growth plate?
infection and other diseases can cause the growth
plate to become injured, which can cause
arthritis, deform how the bone
grows, and even stop bone growth altogether--something called "premature
closure" of the growth plate.
Usual treatment for a simple injured growth plate is rest, protection and
immobilization, but surgery may be needed to lengthen, shorten, realign or
otherwise correct arrested or abnormal growth plates. Fractured
growth plates are treated based on the classification of the
What is the Salter-Harris
The Salter-Harris Classification is the most commonly used
system to classify growth plate fractures.
A complete separation of the growth plate. No disruption
of growth. Treated with casting and immobilization for about 3
A fracture through the growth plate with a portion of the
fracture extending into the shaft of the bone, creating the
"Thurston-Holland" sign. There is usually no disruption of the
growth plate, and it is usually treated like type I fractures.
A fracture through the growth plate with
a portion of the fracture extending into the joint. Because of the
likelihood of injury to the joint and for growth plate disturbance means that
these fractures are usually treated through surgical repair.
A fracture that is oriented from the
shaft of the bone directly into the joint. It is primarily perpendicular
to the growth plate. This fracture is unstable and requires
A crush injury involving the growth
plate. Growth plate disturbance is common. These injuries are
sually immmobilized for 3-6 weeks.
The creation of a crater in an area of the growth plate.
These are usually treated conservatively, though surgical intervention is
frequently done if premature closure of the growth plate occurs on the injured
A fracture involving the joint, but not
the growth plate. Treatment is made on a case-by-case basis.
Casting is usually done if the fracture is non-displaced. Surgical
intervention is considered primarily then the fracture is displaced, unstable,
What is Avascular Necrosis?
Avascular Necrosis is the name given to the condition where a
portion of bone begins to die from lack of circulation. This may be caused
from severe injury, surgery, or most commonly, from repetitive, low-grade
trauma. When the condition occurs in a growth plate in a child, it is
known as osteochondrosis.
(The plural is "osteochondroses".)
There are many, many locations where this might
occur, but a few
of the most common are:
The Tibia (the front of the shin bone):
Disease Most common in athletic boys 11-15 years of age.
The Navicular Bone (on the inside border of the foot):
The Fifth Metatarsal Base (on the outside border of the
foot): Uhke's Disease
Seen most commonly in children 5-11 years of age.
What is an
An Apophysis is a certain type of growth plate that occurs at the end
of a bone, when there is no other bones on the other side. The
best example of an apophysis is on the heel bone.
The X-ray on the right shows the heel bone (the calcaneus) and the
What is Apophysitis?
is a common inflammation of the apophysis on the heel bone. It
occurs in both girls and boys, usually at about 8-14 years of
Sever's disease is usually treated by rest, protection, and
immobilization, but medications, heel cups, over-the-counter inserts,
prescription orthoses, accommodative orthopaedic devices, taping, padding, casting,
changes may be necessary to control this condition.
What is Osteochondritis
Osteochondritis Dessicans is a condition where a fragment of
cartilage and bone become loose and detached from the underlying joint
surface. This may commonly affect the knee and ankle, or it may be
associated with osteochondroses (the growth plate degeneration described above)
when the joint is near the growth plate.
The most common example of this
is in the ball of the foot, in bones known as the metatarsals. The
most commonly affected metatarsal bone is the
2nd metatarsal, the longest one, and one that undergoes a great deal of stress. Osteochondritis Dessicans in this area is
known as "Freiberg's Disease",
and as the bone degenerates, it is characterized by a flattened appearance on radiograph.
Again, treatment is aimed at protecting the injured bone through
rest, immobilization, orthoses, orthopaedic appliances, taping, padding,
casting, and shoe changes. Surgery is often required,