Surgery for Growth Plate Injuries
Although most growth plate injuries respond to immobilizing the affected area for a few weeks, surgery may be needed if the injury is more severe or has the potential to affect a child’s or teen’s growth and development. Doctors at Hassenfeld Children’s Hospital at NYU Langone perform several types of surgery to correct growth plate injuries and ensure that bones continue to develop properly.
Many of these can be performed as outpatient procedures, meaning a child can have surgery and then go home the same day. For overnight stays, our doctors can arrange for a parent or guardian to spend the night at the hospital alongside the child.
Closed or Open Reduction
If a growth plate fracture has caused the growth plate—and the bone on either side of it—to separate into two sections, or if the injury has otherwise caused the bone to move out of alignment, your child’s doctor may recommend a closed reduction. During a closed reduction, a surgeon uses his or her hands to move the sections of bone back into proper alignment by pressing on them through the skin, without performing a surgical procedure.
In a closed reduction, local anesthetic is used to numb the affected area, though the doctor may recommend using sedation so that your child can sleep through the procedure. Afterward, your child may wear a cast or splint and be back to normal activities within two to three months.
Sometimes, a surgeon may recommend placing pins in the bone to keep it in place while it heals. In this case, a surgery called open reduction internal fixation may be necessary. A surgeon connects the fragments of bone using small surgical pins, which stay in place for about four weeks. The pins often protrude slightly from the skin, so that a doctor can remove them without performing another surgical procedure.
Depending on the kind of fracture your child has, the surgeon may recommend leaving these pins in the bone and under the skin permanently.
Open Corrective Surgery
An injury to a growth plate can cause it to harden and “close” prematurely, meaning it stops producing new bone before your child has stopped growing. An injury to a growth plate may also cause only a part of the growth plate to stop producing new bone while the rest of the growth plate continues to function normally. A growth plate that has partially closed can lead to complications, such as a bone that curves as it grows or limbs that are not the same length. With open corrective surgery, a surgeon may be able to remove the deactivated section of the growth plate so that it no longer affects growth in the bone.
Open corrective surgery is usually performed using general anesthesia. After making an incision over the growth plate, a surgeon removes the part of the growth plate that has started to harden into bone. This allows the rest of the growth plate to grow around that area. If the surgeon is concerned that this area of the growth plate may harden prematurely again, he or she can replace the removed section of the growth plate with fat or synthetic materials. This helps to keep cartilage from moving in and hardening into bone.
Your child wears a cast to immobilize the area for a short time after the operation and should return to normal activities in about three months.
If after an injury a growth plate in one of your child’s legs has “closed,” or stopped producing new bone tissue, and your child is almost done growing, our surgeons may recommend surgically “closing” the growth plate in his or her other leg—a procedure known as epiphysiodesis. This prevents the legs from being different lengths, which can lead to complications such as difficulty walking and early development of arthritis. This type of surgery may also be used to stop a growth plate that has started growing too quickly as a result of an injury.
Epiphysiodesis is performed using general anesthesia, in one of two ways. A surgeon may remove the growth plate in the leg not affected by the injury, so that the bone stops growing. Or the surgeon may temporarily attach a surgical staple or a flexible plate to the bone on either side of a growth plate to act as a lock. The lock keeps the bone on either side of the growth plate in place and prevents further growth. A second surgery is required to remove the surgical staple or plate.
Bone Lengthening or Shortening Surgeries
If a growth plate injury in a child’s leg is not identified and treated while the child is still growing, the affected leg could grow longer, or remain shorter, than the leg on the opposite side. When this happens, our doctors may recommend a bone lengthening or shortening surgery. This surgery is most often recommended when a teen has reached maturity and stopped growing or is expected to stop growing soon.
Depending on your child’s symptoms, a surgeon can operate to make a leg bone longer or shorter. During bone-lengthening surgery, a surgeon cuts a bone in the shorter leg into two segments. The segments are then spaced out using surgical pins. As the bone heals, new bone grows to connect the segments. The result is a strong, longer bone.
During bone-shortening surgery, a surgeon removes a section from the middle of a bone in the longer leg and joins the two pieces with a plate or rod so that they heal into a strong, shorter bone. Children can usually go home a few days after the surgery and are back to normal activities in 6 to 12 months, often without needing to wear a cast.
Both types of surgery require general anesthesia. If a growth plate in one of the child’s legs has not yet stopped growing at the time of the surgery, the surgeon may use epiphysiodesis to keep it from growing further.