Paediatric Fractures and Growth Plate Injuries
Children break bones often — a fall from play equipment, a bike, a tackle at football. Their bones are not simply small versions of adult bones: they are softer and more flexible, wrapped in a thicker outer layer, and still growing from cartilage growth plates near each end. That changes how they break, how they heal and how they should be treated.
Children also heal faster than adults, and they have a capacity adults do not: a bone that heals slightly out of line can straighten itself over the following months as the child grows. This is called remodelling, and it is why many fractures that would need surgery in an adult are treated in a cast in a child.
How children’s fractures are different
Buckle (torus) fractures — the bone compresses and bulges rather than snapping, most often at the wrist. These are stable and heal in a splint or cast in about three weeks.
Greenstick fractures — the bone bends and cracks on one side only, like a green twig. Some need to be straightened before casting.
Complete fractures — through both sides of the bone, as in adults, but healing faster.
Growth plate (physeal) fractures — a break through the cartilage growth plate at the end of the bone. These need particular care, because the growth plate is what the bone grows from.
Because the growth plates are the weakest part of a child’s skeleton, an injury that would sprain a ligament in an adult often fractures the growth plate in a child instead. That is why a child who has “sprained” an ankle and cannot walk on it should be X-rayed.
Common fractures in children
Wrist and forearm — the most common site, usually from a fall onto an outstretched hand
Elbow — including supracondylar fractures, which need prompt specialist assessment because of the nerves and blood vessels nearby
Collarbone (clavicle) — usually treated in a sling
Ankle — growth plate fractures of the shin bone, including the Tillaux and triplane patterns seen in adolescents as the growth plate closes
Shin bone (tibia) — including the toddler’s fracture, a subtle spiral crack in children under three who suddenly refuse to walk
Foot and toes — metatarsal fractures and injuries from objects dropped on the foot
Growth plate injuries
Growth plate fractures are graded by where the fracture line runs: through the plate alone, into the shaft of the bone, into the joint, or crushing the plate itself. The grade guides both treatment and how closely the child needs to be followed.
Most growth plate injuries heal without any effect on growth. In a small number — more often after high-energy injuries, crush injuries and fractures that were displaced — part of the growth plate can stop growing, which over time can leave a bone shorter or angled. This is uncommon, but it is the reason growth plate fractures are followed with X-rays for six to twelve months after the injury, and longer for the higher-risk patterns. Caught early, a growth disturbance can be treated. When can my child return to sport after a growth plate injury?
Treatment
Most children’s fractures are treated in a cast or splint. Casts are generally worn for three to six weeks depending on the bone and the child’s age, with younger children healing faster. A fracture that has moved out of position may need to be straightened (reduced) under sedation or a short anaesthetic before the cast goes on.
Surgery is recommended for the minority of fractures that cannot be held in an acceptable position, for growth plate fractures that run into the joint surface, for some elbow fractures, and for open fractures. Children’s fracture surgery differs from adults’: fixation usually uses smooth wires or flexible rods that avoid the growth plate, and these are often removed once the bone has healed. Adult fractures are covered on the upper and lower limb fractures page.
Recovery
Children are generally back at school within days of a cast being fitted, and return to sport six to twelve weeks after most fractures, once the bone has healed and the limb has regained its movement and strength. Physiotherapy is needed less often than in adults, because children regain movement quickly, but it helps after elbow and ankle injuries and after surgery.
Dr Janan’s approach
Dr Janan Chandrananth completed dedicated international paediatric orthopaedic training at the Shriners Hospital for Children in Portland, USA, and treats children’s fractures and growth plate injuries alongside his adult trauma practice. Where a fracture can safely be treated in a cast, that is what he recommends — surgery is reserved for the injuries that need it. Parents are shown the X-rays and walked through what to expect, including what to watch for at home and when the next check needs to be.
Has your child broken a bone, or hurt a growth plate?
Book a consultation with Dr Janan Chandrananth to have the injury assessed and a clear plan made. Children’s injuries are prioritised.
Request an Appointment
FAQs
How can I tell if my child’s bone is broken?
Young children cannot always say where it hurts. Refusing to use an arm, refusing to walk or limping, swelling, and crying when the limb is touched are the usual signs. Because growth plates fracture more easily than ligaments tear, a “sprain” in a child should be X-rayed rather than assumed.
Will the fracture affect my child’s growth?
Almost always, no. Fractures away from the growth plate do not affect growth at all, and most growth plate fractures heal without any effect. A small number can cause a growth disturbance, which is why those injuries are followed with X-rays for up to a year — and why they are best managed by someone trained to recognise the higher-risk patterns.
Does my child need surgery?
Most children’s fractures do not. Surgery is for fractures that cannot be held in position in a cast, growth plate fractures that involve the joint, certain elbow fractures, and open fractures.
How long will my child be in a cast?
Usually three to six weeks — shorter for buckle fractures and for younger children, longer for the larger bones of the leg. The cast is often changed once during that time as the swelling settles.
When can my child go back to school and sport?
School within a few days, once the pain has settled, with the cast protected. Sport is generally six to twelve weeks after the injury, depending on the bone and the sport — contact and high-impact activity last.
Will the wires or plates need to be removed?
Smooth wires used in children are usually removed once the bone has healed, typically at three to six weeks, either in the rooms or under a short anaesthetic. Flexible rods and plates may also be removed after healing so that they do not interfere with the growing bone.