Growth Plate Injury: What Causes It, and Can It Lead to Deformity?

What is a growth plate, and why does it matter?

A growth plate, also called a physis, is a layer of cartilage near each end of a child's long bones. It is the area where new bone forms, allowing the limb to lengthen as the child grows. Because the physis is made of softer cartilage rather than solid bone, it is structurally weaker than the surrounding ligaments and bone. That makes it the part most likely to give way under force.

Once a child finishes growing, the growth plates harden into solid bone and are no longer at risk. Until then, any injury to a physis has the potential to disrupt how that bone continues to develop.

What are the long-term signs of growth plate damage?

The initial fracture itself is usually treated at the time of injury. The real concern is what happens over the months and years that follow. If part or all of the growth plate stops working, the bone on that side may grow more slowly, or at an angle compared to the healthy side. The signs are often subtle at first and become more obvious as the child grows taller.

What causes growth plate injuries and physeal arrest?

Most growth plate fractures happen during sport, play, or accidental falls. The severity depends on how the fracture runs through the physis. Orthopaedic surgeons classify these injuries using the Salter-Harris system, which groups them into types based on the fracture pattern. Higher types carry a greater risk of long-term growth disturbance.

Not every growth plate fracture leads to physeal arrest. Many heal completely and the child's growth continues normally. The challenge is that arrest can develop silently over many months, which is why ongoing follow-up imaging is so important.

How is a growth plate injury monitored over time?

Monitoring involves periodic imaging of both limbs so the treating team can compare growth on the injured side with the healthy side. The child's orthopaedic surgeon will typically request scans at intervals until the growth plates have fully closed. This can mean years of follow-up, particularly if the injury happened when the child was young and has a lot of growing still to do.

The key measurements taken at each follow-up are limb length and joint alignment. Even small differences, when spotted early, can guide the surgeon's decisions. If a significant discrepancy or angular change is developing, options such as guided growth or, in some cases, corrective surgery can be considered at the right time. Waiting until the problem is obvious can make it harder to treat.

Why is standing imaging better for growth plate follow-up?

Standing, weight-bearing imaging captures the skeleton as it actually works. When a child lies down for a scan, gravity is removed, muscles relax, and subtle alignment differences can be masked. A standing full-length image of both legs, from hips to ankles, shows the true picture: any developing tilt, bow, or length difference becomes visible in a single exposure.

EOS technology is particularly well suited to this kind of repeated follow-up. It uses about 90% less radiation than a standard X-ray, around ten times less. For a child who may need imaging every six to twelve months over several years, keeping cumulative radiation as low as possible matters a great deal.

At ScanAlign, low dose standing imaging, each scan produces a full-length, weight-bearing image of both limbs on a single exposure. This gives the orthopaedic team everything they need to track alignment and length accurately. Learn more about paediatric imaging at ScanAlign.

What can be done if a growth plate injury causes deformity?

If monitoring reveals that a significant angular deformity or limb length difference is developing, the child's orthopaedic surgeon has several options. The right approach depends on how much growing the child has left and how large the problem is.

• Guided growth. A small plate is placed near a healthy growth plate to slow one side temporarily, allowing the limb to straighten as it grows. This works best when there is still meaningful growth remaining.
• Epiphysiodesis. The growth plate on the longer or unaffected leg is deliberately closed at a carefully timed point, allowing the shorter side to catch up.
• Corrective surgery. In more severe cases, the bone may be cut and realigned, or lengthened surgically.

The common thread is timing. All of these decisions depend on accurate, up-to-date measurements of how each limb is growing. That is why consistent follow-up imaging matters so much.

Frequently asked questions about growth plate injuries