Surgery: Physeal Fractures & Growth Plate Injuries

Treatment of physeal fractures and epiphyseal separations: surgical techniques, recovery and growth monitoring. Dr. Priano, Milan.

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Growth plate injuries

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Surgical Techniques

Closed Reduction and Casting

For displaced but reducible injuries, reduction maneuver followed by cast immobilization. The technique respects the delicate nature of the growth plate.

Indication

Epiphyseal separations with moderate displacement, without soft tissue interposition.

Recovery

Cast for 3-6 weeks depending on location. Serial X-ray checks. Spontaneous mobilization in children.

Percutaneous Fixation (Kirschner wires)

Minimally invasive stabilization with thin metal wires inserted through the skin. Wires are positioned avoiding crossing the growth plate when possible.

Indication

Unstable injuries after reduction, high risk of secondary displacement.

Recovery

Cast for 3-4 weeks. Wire removal in clinic. Return to activity in 6-8 weeks.

Open Reduction and Internal Fixation

Surgical procedure with direct exposure of the fracture for anatomical reduction under direct vision, followed by fixation with appropriate hardware.

Indication

Injuries irreducible by closed manipulation, periosteal interposition, displaced articular fractures.

Recovery

Immobilization for 4-6 weeks. Prolonged follow-up to monitor growth.

Postoperative Overview

Treatment of physeal injuries depends on injury type, location and displacement. The goal is to restore growth plate anatomy to minimize growth disturbance. Follow-up is always longer than for diaphyseal fractures.

Detailed Recovery Timeline

Note: The timeline below is a general baseline. The actual postoperative course varies depending on the specific surgical technique chosen (see procedures above).

Closed reduction: often day-surgery. Open reduction: 1-2 nights.

Weeks 1-4: Cast immobilization. X-ray check at 7-10 days to verify maintained reduction.

Weeks 4-6: Cast removal. Wire removal in clinic if applicable. Start gradual mobilization.

Months 2-3: Spontaneous functional recovery. Physical therapy rarely needed in children.

Return to Sport

Return to sport: 8-12 weeks depending on location and healing stability.

Follow-up Schedule

Checks at 1, 3, 6 weeks, then at 3, 6 and 12 months. Prolonged follow-up (1-2 years) to exclude growth disturbance.

Possible Complications

Growth disturbances (more common in crush injuries or those irregularly crossing the physis). Secondary displacement. Most heal without sequelae with correct treatment.

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