Salter (Growth Plate) Fracture of a Lower Extremity (Child)
A growth plate is an area near each end of the long bones. It exists in children from birth to adolescence. A growth plate allows the bone to grow as the child grows. Once the bone’s growth is complete, the growth plate changes to solid bone. A break (fracture) in the growth plate is known as a physeal, Salter, or Salter-Harris fracture. The bone hasn't yet fully formed in this area in babies and toddlers. So these fractures may look normal on the first X-rays taken.
Some growth plate fractures don’t affect future bone growth at all. Others are more severe. They can result in bone shortening, arthritis, deformity, and chronic disability of the joint in later years.
The doctor will check to see that the broken pieces of bone are in line and not pushed out of place. If the fracture is greatly out of place, it may need to be moved back where it should be. For a severe injury, your child may need surgery to put the bone back in place. This is done by an orthopedic surgeon. This is a surgeon who specializes in treating bone, muscle, joint, and tendon problems.
A splint or cast is then put on the leg or foot. In some cases, the foot may be put in a special boot instead. The splint, cast, or boot must remain in place until the bone heals.
Home care
Your child’s doctor may prescribe medicines for pain. Follow the doctor’s instructions for giving these medicines to your child. Don’t give your child aspirin unless the doctor tells you to do so. If pain medicine was not prescribed, ask the doctor what medicine you should give your child for pain or discomfort.
General care
-
If your child has been given crutches, they should use them to walk. Your child should not walk or put weight on the injured leg or foot until the doctor says it’s OK.
-
Put a cold pack on the injured area to help control the swelling. You can make a cold pack by wrapping a plastic bag of ice cubes in a thin towel. As the ice melts, be careful that the cast or splint doesn’t get wet. Don’t put the ice directly on the skin because this can cause damage.
-
Hold the cold pack on the injured area for up to 20 minutes every 1 to 2 hours the first day. Continue using the cold pack 3 to 4 times a day for the next 2 days, then as needed. You can place the cold pack directly on the splint or cast. If your child has a boot, open it to apply cold, unless told otherwise.
-
Babies and toddlers: It may be hard to use the cold pack because most children don’t like the feel of the cold. Don’t force your child to accept the ice. This could make both of you miserable. Sometimes it helps to make a game of it.
-
Keep the leg or foot elevated to reduce pain and swelling. This is most important during the first 2 days (48 hours) after the injury. For infants and younger children, watch that the pillows don't slip and move near the face.
-
Care for a splint or cast as you’ve been told. Don’t put any powders or lotions inside the splint or cast. Keep your child from sticking objects into the splint or cast.
-
Keep the splint, cast, or boot dry. Unless you’re told otherwise, a boot can be taken off for bathing. A splint or cast should be covered with two plastic bags and kept out of the water when your child bathes. Separately close the top end of the bag with tape or rubber bands. Covering the cast or splint with a plastic bag will not make it completely waterproof. Don't allow water to run directly over the area and don't place the covered cast in water.
-
Encourage the child to wiggle or exercise the toes on the foot of the injured leg. Check that your child's toes are pink and able to wiggle. If there is a change in the movement or color of the toes, contact your doctor immediately.
Follow-up care
Follow up with your child’s doctor within one week, or as advised. Your child may need follow-up X-rays to see how the bone is healing. If your child was given a splint, it may be changed to a cast or boot at the follow-up visit. If you were referred to a specialist, make that appointment as soon as you can.
Special note to parents
Health care providers are trained to recognize injuries like this one in young children as a sign of possible abuse. Several health care providers may ask questions about how your child was injured. Health care providers must, by law, ask you these questions. This is done for the protection of the child. Please try to be patient and not take offense.
Call 911
Call 911 if any of these occur:
When to get medical advice
Contact your child's doctor right away if:
-
The splint or cast becomes wet or soft.
-
The splint or cast is too tight. If the splint is on, loosen it before going for help. It may be on too tight.
-
The splint or cast has a bad smell.
-
Swelling or pain gets worse. If the splint is on, loosen it before going for help. Babies too young to talk may show pain with crying that can't be soothed.
-
Toes of the foot on the injured leg are cold, blue, numb, burning, or tingly. If the splint is on, loosen it before going for help.
-
Your child can’t move the toes on the foot of the injured leg.
-
Your child develops a fever of 100.4°F (38°C) or higher, or as advised by your doctor.
-
Your child has chills.