Treatment of physeal fractures and epiphyseal separations: surgical techniques, recovery and growth monitoring. Dr. Priano, Milan.
Growth plate injuries
Learn about this condition →For displaced but reducible injuries, reduction maneuver followed by cast immobilization. The technique respects the delicate nature of the growth plate.
Epiphyseal separations with moderate displacement, without soft tissue interposition.
Cast for some weeks, with duration related to site and injury pattern. Serial X-ray checks. In children, movement usually recovers spontaneously.
Minimally invasive stabilization with thin metal wires inserted through the skin. Wires are positioned avoiding crossing the growth plate when possible.
Unstable injuries after reduction, high risk of secondary displacement.
Cast for some weeks. Wires are removed with a short procedure, often in an outpatient setting though not at every site. Gradual return to activity on a clinical basis.
Surgical procedure with direct exposure of the fracture for anatomical reduction under direct vision, followed by fixation with appropriate hardware.
Injuries irreducible by closed manipulation, periosteal interposition, displaced articular fractures.
Immobilization for some weeks, with timing related to the site. Prolonged follow-up to monitor growth.
Treatment of physeal injuries depends on the injury type, the site and the displacement. The goal is to restore growth plate anatomy to reduce the risk of growth disturbance. All the times below are orientative windows, to be read together with the radiographs and the child's age.
Note: This is an indicative pathway, personalised after surgery. Some elements are relatively stable (goal of the procedure, approximate hospital stay, presence of a cast or brace); others depend on the individual case (weight bearing, range of motion, imaging, sport, hardware removal, follow-up intervals) and on the surgical technique chosen.
Closed reduction: often day-surgery. Open reduction: usually one or two nights.
Cast immobilization, with an X-ray check in the first days to verify maintained reduction.
Cast removal and, where present, wire removal, once consolidation allows. Start of gradual mobilization.
Functional recovery is usually spontaneous in children. Physical therapy is rarely needed, but may be indicated in selected cases.
Indicative pathway: return to sport generally falls within a window of some weeks to months, depending on the site, the injury type and the stability of healing.
Close checks in the first weeks, then spaced out. The duration of follow-up for growth disturbance risk is not the same for everyone: it is tailored to the site, the type of physeal injury, the specific risk and the remaining growth.
Growth disturbances (more common in crush injuries or those irregularly crossing the physis). Secondary displacement. Most heal without sequelae with correct treatment.
Causes, diagnosis, conservative options and when surgery is considered.
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