Growth Plate Injuries
Ross Hauser, M.D. Marion Hauser, M.S.,R.D.

Classification of Growth Plate Injuries

The Salter and Harris classification of growth plate injuries is commonly used to describe injuries to the growth plate.

The Salter 1 injury is a nondisplaced fracture. The x-ray is often normal, and according to traditional orthopedic teaching this can cause the examining practitioner to miss the diagnosis. The diagnosis should be based on clinical findings of point tenderness over the epiphyseal area.3 The typical treatment for type 1 epiphyseal injuries usually consists of immobilization and gradual return to play.

Types 1 and 2 have excellent prognoses for prompt healing and no residual problems or growth disturbance.

Types 3 and 4 require open reduction and internal fixation (surgery) and have a more guarded prognosis.

Type 5 can go unrecognized and has the potential to lead to major growth disturbances.4

Because of the risk of injury to the epiphyseal growth plates, x-rays are more often utilized in young athletic injuries. Even what appears to be a mild ligament sprain, will probably be x-rayed to make sure a growth plate fracture has not occurred. The traditional orthopedic surgeon's recommendation for a young athlete with a normal x-ray and palpatory tenderness is rest. Rest is tremendously detrimental not only to the ligaments and tendons, but also to articular cartilage. Diminished weight-bearing has been shown to lead to degeneration of the articular cartilage.5 It appears that sufficient loading (weight-bearing) is necessary for maintaining healthy articular cartilage growth.6 Activity and cyclic loading are also necessary to maintain the biochemical and structural integrity of ligaments and tendons.7
 

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