Bones & Muscles

About ACL Injuries

Knee injuries can happen in active kids, especially athletes, and a torn anterior cruciate ligament (ACL) — a ligament that helps give the knee its stability — is one of the most serious types of knee injuries.

Kids who get ACL injuries tend to play contact sports (like football and basketball) or so-called “cutting” sports (like soccer and baseball that feature swift, abrupt movements such as pivoting, stopping, or turning on a dime).

The injury can also happen with certain movements, like when a child jumps and lands hard on his or her feet. If the quadriceps muscles aren’t strong enough, a movement an athlete is used to doing can suddenly put too much pressure on the knee joint, causing the ACL, a rope-like band of tissue, to tear or break apart.

Teenage girls are 2 to 10 times more likely than boys to tear an ACL. That’s because girls have different risk factors that make ACL injuries more likely, such as body shape, limb alignment, neuromuscular control, and hormones that might loosen the ligament.

ACL injuries can be very painful, especially during cutting and pivoting movements. Depending on the age of the child and the severity of the injury, a torn ACL often benefits best from surgery as well as 6 to 12 months of rehabilitation. This treatment can help prevent a player from getting arthritis or further knee damage.

What an ACL Does

The ACL is one of the four main ligaments in the knee joint that connect it to the shinbone (tibia) and thighbone (femur). It is located deep within the joint, behind the kneecap (patella), above the shinbone, and below the thighbone.

Together with the PCL (posterior cruciate ligament), which crosses over it to form an “X,” the ACL helps keep the knee stable while rotating.

Specifically, the ACL keeps the shinbone in place and prevents it from moving too far forward and away from the knee and thighbone. It also provides stability when rotating the shinbone.

Signs and Symptoms

Kids with a partially or completely torn ACL will definitely feel pain when the ACL tear happens. Afterward, they may or may not have symptoms, depending on the severity of the injury.

Most will have no problems with walking. But if they return to their sport, they may have some instability, feeling “wobbly” or unable to bear weight on the affected leg. Oftentimes there is pain, which can be very intense, and swelling of the knee joint, which can happen within 24 hours of the tear.

When the injury is happening, many kids report hearing a “pop” sound — the sound of the shinbone popping out of and back into place. Others also report the knee feels “less tight” or less compact than it was before.

A child who has injured a knee — whether out on the field or at home — should stop all activity (to prevent further injury) and seek immediate medical care. In the meantime, keep the area iced — place the ice in a plastic bag, wrap the bag in a cloth, and hold it to the knee for up to 20 minutes at a time. Also, keep the knee elevated as much as possible to reduce swelling. If putting weight on the knee is painful, a child should not bear weight on the knee.

Diagnosis

At the doctor’s office or emergency room, doctors will perform physical exams and imaging tests to determine if there is a knee injury and, if so, how severe it is.

These tests can help diagnose an ACL injury:

• Lachman test. During this exam, a child will lie down flat on his or her back with the affected knee lifted and flexed at a 20- to 30-degree angle. The doctor then places one hand on the calf and the other on the top of the thigh, applying pressure to move the shin forward. If it moves too far forward, it can signal a torn ACL.
• Anterior drawer test. During this test, the hip is flexed at 45 degrees and the knee at 90 degrees. The examiner grasps the back of the shin, just below the knee, placing index fingers on hamstring tendons and thumbs on the side of the kneecaps to feel any shift of the knee joint and surrounding areas while attempting to pull the tibia forward.

To properly diagnose ACL injuries, doctors usually perform these tests in combination with or in addition to other physical exams.

While X-rays might be taken to determine the extent of the injury, they only image bone and, therefore, can only confirm the presence of bone fractures in the knee. An MRI, which images tissue (like ligaments and muscles), can confirm a partial or complete ACL tear so some doctors will order one to confirm a diagnosis.

Treatment

Treatment  of ACL injuries depends on the age of the child and the type of injury, but most often involves some type of surgery. If a child is still growing, surgeons make sure not to touch the growth plates. Growth plates are the developing tissue on the ends of long bones, like the tibia and femur. Kids who are still growing have “open” growth plates, while those who have reached skeletal maturity have “closed” growth plates.

When a child stops growing, the growth plate hardens (ossifies) along with the rest of the bone. Girls tend to stop growing earlier than boys; their growth plates usually close around ages 14 to 15, while boys’ growth plates close later, at around ages 16 to 17.

If a child has reached skeletal maturity, the surgeon will drill a small tunnel down through the femur to reach the inside of the knee joint. Surgeons replace the torn ACL with tissue from the patient’s own body (usually tissue from the main patellar tendon or hamstring) or with tissue donated from someone else (called an allograft). The new ACL tissue is put into the body through the tunnels created in the tibia and femur and is secured in the proper area with screws or other fixtures.

If a child is young, surgeons will use a technique that spares the growth plate. One example is iliotibial (IT) band reconstruction. The IT band is a thick band of tissue that spans the leg from the lower pelvis to the bottom of the shinbone. Tightening this tissue over the kneecap helps to stabilize the knee and prevent the tibia from moving too far forward.

After surgery, a child will need to walk with the assistance of crutches, limit physical activity, and wear a full-leg brace for 4 to 6 weeks, depending on what the surgeon advises.

Rehab and Recovery

Recovery from ACL surgery is a lengthy process that can take from 6 months to a year. Rehabilitation (“rehab”) therapy is needed to help heal the knee and to:

• restore range of motion
• regain strength in the knee, thigh, and shin muscles (and prevent atrophy, the breakdown of muscle tissue)
• reduce pain and swelling
• improve balance

Most kids undergo rehab at a center three times a week, with daily exercises they practice at home. Accelerated rehab programs involve more frequent therapy, but they won’t necessarily speed recovery.

In the early stages of recovery, a child may receive a leg brace and subsequent knee brace, depending on the surgeon’s recommendations. Keeping the knee iced and elevated can help to reduce swelling. Doctors may prescribe prescription painkillers and anti-inflammatory medicine to help kids deal with the pain and feel more comfortable. In some cases, doctors may give people steroid injections to ease pain and help reduce swelling.

While most sports are off limits — especially the activity that caused the injury in the first place — kids can do some low-impact activities that may be fun and even therapeutic, like swimming, bike riding, or protected running. Talk to your doctor about what activities might benefit your child.

Helping Your Child Cope

Being told that you can’t do the things you love — like running or playing football, field hockey, or softball — can be a devastating blow to any child. Kids recovering from an ACL injury may feel angry, frustrated, or even depressed, especially if they’re no longer participating in team sports with their friends.

But in the meantime, there are ways to still feel like part of the team. Keeping score, being a coach’s assistant, or bringing water to the games may help. If your child doesn’t want to do these, suggest starting a hobby, like playing the guitar, painting, drawing, or another activity that won’t put too much strain on the knee. Low-impact activities, like swimming, are another option.

In time, kids can return to the things they love. But if your child continues to feel angry or depressed during recovery, encourage him or her to talk to a school psychologist or counselor, who can help your child cope and look ahead to better days.

Blount disease is a growth disorder that affects the bones of the lower leg, causing them to bow outward. In younger kids, just the tibia (shin bone) is affected. In teens, it’s usually both the tibia and the femur (thigh bone).

Many babies are born with slightly bowed legs from being in the small space of the womb. Their legs usually straighten out as they grow and start walking.

Blount disease is different. The curve gets worse if it’s not treated, so early diagnosis is very important.

Risks Factors

Most kids who get Blount disease are overweight or gained weight very quickly. It’s also more common in people of African heritage, kids who started walking at an early age, and those with a family member who had it.

In Blount disease, a lot of pressure is put on the growth plate (an area of growing bone tissue) at the top of the tibia. As a result, the bone can’t grow normally. The lateral (outer) side of the tibia keeps growing but the medial (inner) side of the bone does not.

This uneven bone growth causes the tibia to bend outward instead of grow straight. One leg may also become slightly shorter than the other.

Signs and Symptoms

The most obvious symptom of Blount disease is a bowing of the leg below the knee. In young kids, it’s usually not painful, though it can affect the way they walk. For preteens and teens, Blount disease may cause knee pain that gets worse with activity.

The tibia can be rotated as well as bowed, causing a condition called in-toeing (when the feet point inward instead of straight out).

Over time, Blount disease can lead to arthritis of the knee joint and, in severe cases, trouble walking.

Diagnosis

When doctors suspect Blount disease, they may recommend taking a child to an orthopedic doctor (bone specialist) for leg X-rays and further examination.

Mild bone changes can be hard to spot in kids younger than 2 because their bowed legs might be normal and straighten out on their own. It’s easier for doctors to diagnose Blount disease in kids after age 2.

Treatment

Treatment of Blount disease depends on a child’s age and how curved the bone is.

Usually, doctors will just keep a close eye on the condition in children younger than 2. Kids 2 to 4 years old and those with severe bowing might need leg braces, called KAFOs (knee-ankle-foot orthotics). KAFOs, which go from the thigh to the toes, are created for kids using a mold of their leg. The hope is that the braces gradually shift leg bones to a straighter position over time. However, doctors have differing opinions on KAFOs. If you have questions about them, talk to your doctor.

Older kids and teens, or kids who don’t get better wearing KAFOs, might need surgery:

• The surgeon can cut the bone, straighten it, and fasten it with plates and screws. This is called an osteotomy.
• Another procedure can slow or stop the growth of half of the growth plate to allow the other side to catch up and straighten the leg.
• A device called an external fixator can be put on the outside of the leg and attached to the bones after they are cut. It holds the bones in place while gradually straightening the leg.

If surgery is necessary, it will be done under general anesthesia. This means your child will be sedated and asleep and won’t feel anything. Afterward, your child might wear a cast or use crutches and a wheelchair for a while. Physical therapy also might be needed.

Outlook

Most kids who are treated for Blount disease get better and have active lives.

If being overweight caused the Blount disease, it’s important for parents to help their child reach and maintain a healthy weight. This can reduce stress on the bones and joints and prevent other long-term problems from weight gain (like type 2 diabetes and heart disease).

If you need help getting your child to adopt a healthier lifestyle that includes a balanced diet and exercise, talk to your doctor.

Hard falls and collisions are a reality of sports, and they often lead to injuries. Taking a spill and falling on a shoulder or with arms outstretched puts tremendous stress on the shoulder and on a small bone called the clavicle, or collarbone. If the stress is too great, the collarbone can break.

Broken collarbones are one of the most common sports injuries among kids and teens.

About Broken Collarbones

The collarbone runs between the top of the breastbone (sternum) and the shoulder blade (scapula) and helps connect the arm to the rest of the body. You can feel your collarbone by touching the area between your neck and your shoulder. Most people can see their collarbones sticking out beneath the skin when they look in the mirror.

A broken collarbone typically is the result of a direct blow to the shoulder or a fall onto an outstretched arm. Collarbone breaks (fractures) are common in contact sports (like football, lacrosse, and hockey) and in sports where there is a chance of a hard fall (such as biking, skiing, snowboarding, and skateboarding). They also can follow direct trauma to the collarbone during a car collision or other accident.

Most collarbone fractures will heal on their own if the arm is properly immobilized in a sling and the injury is treated with ice and physical therapy. Sometimes, however, if the collarbone is significantly displaced or the break is severe, surgery may be needed to realign the bone, with screws and plates inserted to hold the collarbone in place as it heals.

Symptoms

If your child has a broken collarbone, the most obvious symptoms will be pain in the affected area and difficulty moving the affected arm. Other symptoms include:

• swelling, tenderness, and bruising along the collarbone
• increased pain when your child tries to move the shoulder or arm
• feeling a grinding or crackling sensation if trying to raise the arm
• a bulge or deformity above the break (in rare cases, the broken end of the bone may even penetrate the skin and be exposed)
• slumping or sagging of your child’s shoulder down and forward

Diagnosis

To diagnose a collarbone fracture, a doctor will ask about the injury and what symptoms your child has. The doctor will examine your child’s shoulder and may press gently on the collarbone to see if it is tender, determine where the fracture is, and make sure no nerves or blood vessels are damaged. The doctor might check the feeling and strength in your child’s arm, hand, and fingers to see if there is nerve damage.

If a broken collarbone seems likely, the doctor will order X-rays of the shoulder and the affected area to pinpoint the location of the break and check its severity. X-rays also show if any other bones are broken. In some cases, if other bones are broken or if the doctor needs to see the fracture in greater detail, a computerized tomography (CT) scan will be performed.

Causes

Most collarbone fractures are due to a fall onto the shoulder, but they can also follow a fall onto an outstretched hand or a direct blow to the collarbone itself (as from a sports-related injury or car accident). Newborns also can incur a broken collarbone as they pass through the birth canal.

In a collarbone fracture, the break can happen in three areas of the collarbone:

1. Most occur in the middle third of the bone, generally from a hard fall or direct impact to the middle of the collarbone.
2. A fall or impact that transmits force to the outside or top of the shoulder can cause a fracture on the outer third of the collarbone, the part closest to the shoulder itself.
3. The rarest type of collarbone fracture happens on the inner third of the collarbone. These are almost always the result of a direct blow to the front of the chest, such as from an impact with a steering wheel during a car collision.

Risk factors that can increase the chances of a collarbone fracture include:

• Participating in sports that involve contact or the possibility of a hard fall. Injuries related to sports are perhaps the most common cause of collarbone fractures. There’s a risk of hard falls in sports from skiing to soccer and wrestling, and from contact sports like football, hockey, rugby, and lacrosse.
• Age. Bones that are still growing are more susceptible to injury. Collarbones typically don’t harden completely until someone is about 20 years old, putting those who are younger at greater risk of a fracture. The risk goes down after the teen years but increases again as people age and their bones begin to lose strength.
• High birth weight. Having a high birth weight can make a baby more at risk for a collarbone fracture during labor and delivery.

Prevention

Because they happen suddenly and unexpectedly, collarbone fractures can be hard to prevent, but a few precautions can help kids decrease their risk:

• Make sure your kids wear all the recommended protective gear needed for sports, and help them to learn the proper techniques. Knowing the right way to play decreases the chances of an awkward fall or unexpected blow.
• Keep your kids’ bones strong by offering a diet rich in calcium and vitamin D. Foods like milk, cheese, and yogurt can help build strong bones that are less likely to break during an impact.
• Encourage strength training and stretching to build strong, flexible muscles. Muscles that are strong and flexible help support bones better and keep kids agile and less likely to take a hard fall.
• Take steps to prevent falls. Make sure your kids wear supportive footwear, teach them to use handrails when coming down stairs, and keep your home well lit.

Treatment

Treatment for a collarbone fracture depends upon the type of fracture and how severe it is. Most fractures can be treated with simple comfort measures until they heal.

But fractures where bone fragments on each side of the break are severely shifted (displaced fractures) or where the bone is broken into several pieces (comminuted fractures) may require surgery for proper healing. Compound fractures, where the broken bone pierces the skin, require immediate, aggressive treatment to reduce the risk of an infection.

For fractures where the bone fragments stay aligned, these treatments are recommended:

• Ice. To help control the pain and swelling associated with a collarbone fracture, apply wrapped ice packs to the affected area for the first 2-3 days after the injury. Be careful not to apply ice directly to the skin, though, as this can injure it.
• Arm support. Following a collarbone fracture, it’s important to keep the arm immobilized by using a sling or wrap. This will help control the pain and keep the bone in position as it heals.
• Medication. Talk with the doctor about which medicines (such as ibuprofen or acetaminophen) your child can take to help manage pain.
• Physical therapy. While your child’s arm is immobilized, it’s likely to lose muscle strength and range of motion in the shoulder will decrease. Once the bones have started to heal, your child should begin gentle motion exercises to reduce stiffness while still wearing the sling. When the bone has healed completely, the doctor may recommend a more strenuous rehabilitation program to help rebuild the shoulder’s strength and flexibility.

The special screws and metal plates used when a significantly displaced, compound, or comminuted fracture requires surgery won’t need to be removed once the bone has healed unless they cause irritation.

After surgery, doctors will often prescribe a therapy routine to help restore movement and strengthen the shoulder. Usually, therapy will start with gentle motion exercises, and strengthening exercises will be added as the bone heals.

For younger children, healing time can be as fast as 3-4 weeks. For teens, healing time is usually about 6-8 weeks. During this time, your child should take it easy to reduce the risk of reinjuring the bone. After that, follow up with the doctor about when your child can return to normal activities.

As time passes, you may notice that your child’s growth isn’t completely on the straight and narrow. Many young kids have flatfeet, toe walking, pigeon toes, bowlegs, and knock-knees.

As kids grow, some of these conditions correct themselves without treatment. Others don’t or become more severe because of other medical conditions. But many orthopedic (bone) conditions, just like dimples or cleft chins, are just normal variations of human anatomy that don’t need to be treated.

Flatfeet

Most babies are born with flatfeet and develop arches as they grow. But in some kids the arch never fully develops. Parents often first notice this because their child has what they describe as “weak ankles” (which appear to turn inward because of the way the feet are planted).

Flatfeet usually don’t cause problems. Doctors only consider treatment if it becomes painful. They also don’t recommend any special footwear, such as high-top shoes, because these don’t affect the development of the arch.

Parents sometimes worry that flatfeet will make their kids clumsier than other kids, but doctors say that being flatfooted isn’t a cause for concern and shouldn’t interfere with playing sports. Sometimes, doctors will recommend inserting arch supports into shoes to reduce foot pain.

Toe Walking

Toe walking is common among toddlers as they learn to walk, especially during the second year of life. The tendency often goes away by age 3, although it lasts in some kids.

Occasional toe walking should not be cause for concern, but kids who walk on their toes almost all the time and continue to do so after age 3 should see a doctor. Persistent toe walking in older kids or toe walking only on one leg might be linked to other conditions, such as cerebral palsy, muscle weakness disorders, autism, or other nervous system problems.

If an otherwise healthy child has persistent toe walking, the doctor might recommend a few visits with a physical therapists to learn stretching exercises. Once a child is around age 4 or 5, casting the foot and ankle for about 6 weeks may be needed to help stretch the calf muscles.

In-Toeing (Pigeon Toes)

Babies may have a natural turning in of the legs at about 8 to 15 months of age, when they begin standing. As they get older, parents may notice their children walking with feet turn inward, also called in-toeing, or walking pigeon-toed. Intoeing can have a few different causes that are normal variations in the way the legs and feet line up.

Children who intoe and trip often may have internal tibial torsion, in which the lower part of the leg is rotated inward. Children over the age of 3 or 4 with intoeing may have femoral anteversion, in which there is a greater-than-normal bend in the upper part of the leg, which causes the upper leg to rotate inward. In some children, intoeing can be related to existing medical problems such as cerebral palsy.

Doctors rarely have to treat pigeon-toed feet. Special shoes and braces commonly used in the past were never proved to speed up the natural slow improvement of this condition. In-toeing usually doesn’t interfere with walking, running, or sports, and ends on its own as kids grow into teens and develop better muscle control and coordination.

Bowlegs

Bowleggedness (also called genu varum) is an exaggerated bending outward of the legs from the knees down that can be inherited. It’s common in infants and, in many cases, corrects itself as a child grows.

Bowleggedness beyond the age of 2 or bowleggedness that only affects one leg can be the sign of a larger problem, such as rickets or Blount disease:

• Rickets, a bone growth problem usually caused by lack of vitamin D or calcium in the body, causes severe bowing of the legs and also can cause muscle pain and enlargement of the spleen and liver. Rickets is much less common today than in the past.

  Rickets and the resulting bowlegs are almost always corrected by adding vitamin D and calcium to the diet. Some types of rickets, however, are due to a genetic condition and may need more specialized treatment by an endocrinologist.

• Blount disease is a condition that affects the tibia bone in the lower leg. Leg bowing from Blount disease is seen when a child is about 2 years old, and can appear suddenly and quickly become worse.

  The cause of Blount disease is unknown, but it causes abnormal growth at the top of the tibia bone by the knee joint. To correct it, kids may need bracing or surgery when they’re between 3 and 4 years old.

You should also take your child to the doctor if bowleggedness is only on one side or gets progressively worse.

Knock-Knees

Most kids show a moderate tendency toward knock-knees (also called genu valgum) between the ages of 3 and 6, as the body goes through a natural alignment shift. Treatment is almost never needed because the legs usually straighten on their own.

Severe knock-knees or knock-knees that are more pronounced on one side sometimes do need treatment. Devices like braces, splints, and shoe inserts aren’t helpful and are no longer used. In rare cases where children have symptoms such as pain or difficulty running, surgery might be considered after age 10.

When a child complains of chest pain, it can be enough to send any parent into a panic: “Could it be a heart attack?”

Fortunately, the answer usually is no. Heart attacks are extremely rare in children. More often than not, chest pain in a child or teen is due to a harmless condition called costochondritis.

About Costochondritis

Costochondritis (kos-tuh-kon-DRY-tis) is a painful inflammation (swelling) of the cartilage that attaches the ribs to the breastbone (sternum). It’s one of the most common causes of chest pain in kids and teens, with girls having it more often than boys.

The breastbone is the hard bone you can feel in the center of your chest, running from the bottom of the neck down toward the stomach. Your ribs are connected to your breastbone by rubbery cartilage at points called costosternal joints. One or more of the costosternal joints can be affected by costochondritis, and it’s in these joints that the pain is felt. Because of this, costochondritis is sometimes referred to as chest wall pain or costosternal syndrome.

Costochondritis can cause a sharp, stabbing pain that might make you think it’s a heart attack or other heart condition, but that’s rarely the case. Usually, it’s harmless and goes away on its own after 2 or 3 days. Sometimes, though, it lasts longer — from several weeks to months.

Causes

Doctors often can’t pinpoint the exact cause of costochondritis, but sometimes it’s linked to:

• an injury to the ribs or breastbone
• physical strain due to heavy lifting or strenuous exercise
• repeated coughing (as can happen with some infections)

Symptoms

The main symptoms of costochondritis are pain and soreness in the chest. A sharp pain is usually felt on the left side of the breastbone, but it’s possible to feel it on both sides of the chest. The pain can get worse when a child takes deep breaths, coughs, moves the upper body or presses on the affected area. It may decrease a little when a child stops moving or takes shallower breaths, but in general it won’t go away entirely.

Although a heart attack is rarely the cause of chest pain in kids, it helps to know how costochondritis pain differs from heart attack pain:

• Heart attack pain is usually more widespread and felt in other body parts, like the arms and neck. It also feels as if it’s coming from under the breastbone.
• Costochondritis pain is usually only felt in a small area of the chest and feels as if it’s coming directly from where the breastbone meets the ribs.

Diagnosis

If your child has chest pain that doesn’t go away, call your doctor or go to a hospital emergency room. Chest pain is rarely a sign of something serious in kids, but sometimes it can be an emergency that needs immediate medical attention.

To diagnose costochondritis, the doctor will ask your child questions about the symptoms and will feel for tenderness along the area where the breastbone meets the ribs. Although it’s not possible to see costochondritis on a chest X-ray, the doctor may order one to rule out other possible causes of chest pain, such as pneumonia.

Treatment

Costochondritis usually goes away on its own without any treatment within a few days or weeks. If you’re concerned about pain that’s not going away, talk to your doctor.

In the meantime, the doctor will probably recommend giving your child over-the-counter pain medicines like ibuprofen or naproxen to help ease symptoms. Applying a warm compress or a heating pad (set on low) to the sore area also may give some relief.

Until your child feels better, make sure he or she gets plenty of rest and avoids any activities that make the pain worse.

Prevention

Since it’s not always clear what causes costochondritis, it’s not possible to prevent it. But you can help your kids avoid it.

First, identify and correct activities that can cause this kind of pain in kids. Costochondritis often is caused by heavy lifting — such as carrying an overstuffed backpack, especially on just one shoulder, which many kids do. If your child has to carry lots of books to and from school, buy a supportive backpack that spreads weight evenly over both shoulders and make sure it’s worn over both shoulders.

Developmental dysplasia of the hip (DDH) is a problem with the way a baby’s hip joint forms before, during, or after birth — causing an unstable hip. In severe cases, the hip joint can dislocate or cause trouble walking.

Mild cases of DDH usually get better on their own as a baby grows. More severe cases may need treatment with a brace or surgery to reposition the hip and allow for proper healing.

At your baby’s checkups, the doctor will examine the hips to look for DDH. Identifying and treating the problem early will help a child avoid muscle, joint, and skeletal problems down the road.

What Happens in DDH?

The hip is a ball-and-socket joint. The “ball” is the rounded top of the thighbone (the femoral head); the “socket” is a cup-shaped bone that the ball fits into (the acetabulum).

When a child has a mild case of DDH, the ball moves back and forth slightly in the socket, causing an unstable hip. In more serious cases, the ball becomes dislocated and moves completely out of the socket. In the most severe cases, the ball may not even reach the socket where it should be held in place.

Hip dislocations are fairly uncommon, affecting just 1 in 1,000 newborns. However, some degree of hip instability happens in as many as 1 in 3 newborns. Girls are more likely than boys to have hip dislocations.

Causes

The causes of DDH aren’t completely understood, but experts think that many things are involved. A baby can be at risk for DDH due to:

• Bring cramped in the uterus. A fetus can develop DDH when there is less space to move inside the womb. This is more likely to happen in first pregnancies when the uterus is tight, or in pregnancies where there is less amniotic fluid in the womb.
• Breech position. Being in the breech position (buttocks facing the birth canal) can limit movement in the womb, especially when the baby’s knees extend out with the feet near the head (called “frank breech”).
• Other conditions. Babies born with conditions that are caused by their position in the womb, like metatarsus adductus (an inward curving of the foot), torticollis (stiff neck), and flat head syndrome (positional plagiocephaly), are more likely to develop DDH.
• Birth hormones. DDH also may be caused by an infant’s response to the mother’s hormones that relax the ligaments for labor and delivery, causing the baby’s hip to soften and stretch during labor.
• Tight swaddling. After birth, swaddling a newborn too tightly around the hips can sometimes cause DDH. (When swaddled, a baby should still have some wiggle room for the legs, with hips and knees bent slightly and turned out.)

Signs and Symptoms

DDH usually affects only one side of the body, most often the left. Babies usually don’t feel any pain and don’t show any obvious symptoms. To diagnose it, doctors look for these signs:

• at birth, an audible “click” or palpable “clunk” during routine newborn checkups
• different leg lengths
• asymmetry in the fat folds of the thigh around the groin or buttocks
• after 3 months, asymmetry in the motion of the hip and obvious shortening of the affected leg
• in older kids, an exaggeration in the spinal curvature that may develop to compensate for the abnormally developed hip
• limping in older children

Diagnosis

A doctor can determine whether a hip is dislocated or likely to become dislocated by gently pushing and pulling on the child’s thighbones to see if they are loose in their sockets. In one commonly used diagnostic test, a child lies on a flat surface and his or her thighs are spread out to check the hips’ range of motion.

A second test brings the knees together and attempts to push the femoral head out of the socket. It is during these tests that the doctor will hear a “click,” which may indicate a dislocation. These maneuvers are done at routine checkups until babies are walking normally.

Sometimes a doctor will recommend an X-ray or ultrasound to get a better view of a dislocated hip. X-rays (which only take pictures of bones) are done with older kids, while ultrasounds (which take pictures of bones and soft tissues) are better for babies younger than 3 months old because their hip tissue has not yet hardened into bone.

Treatment

Treatment for DDH depends on the child’s age and the severity of the condition. Mild cases may correct themselves in the first few weeks of life. In many cases, however, the pediatrician will refer the child to see a bone specialist (orthopedic surgeon) for treatment.

If baby has an unstable hip that does not get better, a brace called a Pavlik harness will be used to hold the hip in position. This device keeps the femoral head in its socket by holding the knee up toward the child’s head. A shoulder harness attaches to foot stirrups to keep the leg elevated. The goal is to keep the femoral head in the hip socket. As a baby grows, this helps the hip joint to develop normally. Treatment with the Pavlik harness lasts about 6 to 12 weeks, and continues until the hip is stable and ultrasound exams are normal.

Pavlik harnesses do not work in children over 6 months old. Kids who are older and continue to have DDH may need one of two types of surgery:

1. A closed reduction, in which the surgeons gently put the hip back into place after the child is put under anesthesia. Then they put a cast on the body for 3-4 months to hold the bone in position. Doctors prefer this treatment in children under 18 months.
   or
2. An open reduction, in which the surgeons realign the hip and place the thighbone back into the hip socket. During the procedure, doctors loosen the tight muscles and tissues around the hip joint and then later tighten them once the hip is back in place. This is the best procedure for kids older than 18 months, or in cases when closed reduction doesn’t work.

After reaching age 2 or 3, a child might need surgery on the pelvis to deepen the hip socket (if it’s too shallow) or to shorten the thighbone or realign it. After surgery, kids need to wear a hip spica cast (a type of body cast that keeps the hips from moving). The cast usually is needed for several months, depending on the child’s condition.

Outlook

When DDH is recognized early and treated appropriately, most children develop normally and have no related problems.

DDH does not cause pain initially, but it may cause problems down the line, so it’s important to treat it. Kids with untreated DDH end up having legs of uneven length in adulthood, and this can cause a limp or waddling gait, back and hip pain, and overall decreased agility.

There’s been a lot of discussion over the years about the proper way to refer to someone with dwarfism. Many people who have the condition prefer the term “little person” or “person of short stature.” For some, “dwarf” is acceptable. For most, “midget” definitely is not.

But here’s an idea everyone can agree on: Why not simply call a person with dwarfism by his or her name?

Being of short stature is only one of the characteristics that make a little person who he or she is. If you’re the parent or loved one of a little person, you know this to be true.

Dwarfism Facts

Here are some facts that other people may not realize about dwarfism and those who have it.

Dwarfism:

• is characterized by short stature. Technically, that means an adult height of 4 feet 10 inches or under, according to the advocacy group Little People of America (LPA).
• can be caused by any one of more than 300 conditions, most of which are genetic. The most common type is called achondroplasia.
• can and most often does happen in families where both parents are of average height. In fact, 4 out of 5 of children with achondroplasia are born to average-size parents.

Dwarfism isn’t:

• an intellectual disability. A person who has dwarfism is typically of normal intelligence.
• a disease that requires a “cure.” Most people with one of these conditions live long, fulfilling lives.
• a reason to assume someone is incapable. Little people go to school, go to work, drive cars, marry, and raise children, just like their average-size peers.

What Causes Short Stature?

More than 300 well-described conditions are known to cause short stature in a child. Most are caused by a spontaneous genetic change (mutation) in the egg or sperm cells prior to conception. Others are caused by genetic changes inherited from one or both parents.

Depending on the type of condition causing the short stature, it is possible for two average-size parents to have a child with short stature, and is also possible for parents who are little people to have an average-size child.

What prompts a gene to mutate is not yet clearly understood. The change is seemingly random and unpreventable, and can happen in any pregnancy. If parents have some form of dwarfism themselves, the odds are likely that their children will also be little people. A genetic counselor can help determine the likelihood of passing on the condition in these cases.

Dwarfism has other causes, including metabolic or hormonal disorders in infancy or childhood. Chromosomal abnormalities, pituitary gland disorders (which influence growth and metabolism), absorptive problems (when the body can’t absorb nutrients adequately), and kidney disease can all lead to short stature if a child fails to grow at a normal rate.

Types of Short Stature

Most types of dwarfism are known as skeletal dysplasia, which are conditions of abnormal bone growth. They’re divided into two types: short-trunk and short-limb dwarfism. People with short-trunk dwarfism have a shortened trunk with more average-sized limbs, whereas those with short-limb dwarfism have an average-sized trunk but shortened arms and legs.

By far, the most common skeletal dysplasia is achondroplasia, a short-limb dwarfism that happens in about 1 of every 15,000 to 40,000 babies born of all races and ethnicities. It can be caused by a spontaneous mutation in a gene called FGFR3, or a child can inherit a change in this gene from a parent who also has achondroplasia.

People with achondroplasia have a relatively long trunk and shortened upper parts of their arms and legs. They may share other features as well, such as a larger head with a prominent forehead, a flattened bridge of the nose, shortened hands and fingers, and reduced muscle tone. The average adult height for someone with achondroplasia is a little over 4 feet.

Diastrophic dysplasia is a different form of short-limb dwarfism. It happens in about 1 in 100,000 births, and is also sometimes associated with cleft palate, clubfeet, and ears with a cauliflower-like appearance. People who have this diagnosis tend to have shortened forearms and calves (this is known as mesomelic shortening).

Spondyloepiphyseal dysplasias (SED) refers to a group of various short-trunk skeletal conditions. Along with achondroplasia and diastrophic dysplasia, it is one of the more common types of dwarfism. In one type of SED, the lack of growth in the trunk area may not become apparent until the child is school age; other forms are apparent at birth. Kids with this disorder also might have clubfeet, cleft palate, and vision and/or hearing issues.

In general, dwarfism caused by skeletal dysplasias results in what is known as disproportionate short stature — meaning the limbs and the trunk are not of the same proportion as those of typically-statured people.

Metabolic or hormonal disorders typically cause proportionate dwarfism, meaning a person’s arms, legs, and trunk are all shortened but remain in proportion to overall body size.

Diagnosis

Some types of dwarfism can be identified through prenatal testing if a doctor suspects a particular condition and tests for it.

But most cases are not identified until after the child is born. In those instances, the doctor makes a diagnosis based on the baby’s appearance, growth pattern, and X-rays of the bones. Depending on the type of dwarfism the child has, diagnosis often can be made almost immediately after birth.

Once a diagnosis is made, there is no “treatment” for most of the conditions that lead to short stature. Hormonal or metabolic problems may be treated with hormone injections or special diets to increase a child’s growth, but skeletal dysplasias cannot be “cured.”

People with skeletal dysplasias can, however, get medical care for some of the health complications associated with their short stature.

Some forms of dwarfism also involve issues in other body systems — such as vision or hearing — and require careful monitoring.

Possible Complications and Treatments

Short stature is the one quality all people with dwarfism have in common. After that, each of the many conditions that cause dwarfism has its own set of characteristics and possible complications.

Fortunately, many of these complications are treatable, so that people of short stature can lead healthy, active lives.

For example, a small percentage of babies with achondroplasia may have hydrocephalus (excess fluid around the brain). They may also have a greater risk of developing apnea (a temporary stop in breathing during sleep). This can be due to abnormally small bone anatomy or because of airway obstruction by the adenoids or the tonsils. Occasionally, a part of the brain or spinal cord is compressed. With close monitoring by doctors, however, these potentially serious problems can be detected early and surgically corrected.

As a child with dwarfism grows, other issues also may become apparent, including:

• development of some motor skills, such as sitting up and walking happening at older ages than an average-sized child
• a greater susceptibility to ear infections and hearing loss
• breathing problems caused by small chests
• weight problems
• curvature of the spine (scoliosis, kyphosis, and/or lordosis)
• bowed legs
• trouble with joint flexibility and early arthritis
• lower back pain or leg numbness
• crowding of teeth

Not every type of dwarfism has all of these problems associated with it, and proper medical care can help with many of them. Surgery also can be used to improve some of the leg, hip, and spine problems people with dwarfism sometimes face.

Nonsurgical options can help, too — for instance, excessive weight can worsen many orthopedic problems, so a dietitian might help develop a healthy plan for shedding extra pounds. And doctors or physical therapists can recommend ways to increase physical activity without putting extra stress on the bones and joints.

Helping Your Child

Although types of dwarfism, and their severity and complications, vary from person to person, in general a child’s life span is not affected by dwarfism. Although the Americans with Disabilities Act protects the rights of people with dwarfism, many members of the short-statured community don’t feel that they have a disability.

You can help your child with dwarfism lead the best life possible by building his or her sense of independence and self-esteem right from the start.

Here are some general tips to keep in mind:

• Treat your child according to his or her age and developmental level, and not size. For example, a 2-year-old should not still be using a bottle, even if he or she is the size of a 1-year-old. And, if you expect a 6-year-old to clean up his or her room, don’t make an exception simply because your child is small.
• Adapt to your child’s limitations. Something as simple as a light switch extender and a well-placed step stool can give a short-statured child a sense of independence around the house.
• Present your child’s condition — both to your child and to others — as a difference rather than a hindrance. Your attitude and expectations can have a significant influence on your child’s self-esteem.
• Learn to outwardly deal with people’s reactions, whether it’s simple curiosity or outright ignorance, without anger. Address questions or comments as directly as possible, then take a moment to point out something special about your child. If your child is with you, this approach shows that you notice all the other qualities that make him or her unique and, importantly, that his or her dwarfism doesn’t cause you any anger. It also helps prepare your child for dealing with these situations when you’re not there.
• If your child is teased at school, don’t overlook it. Talk to teachers and administrators to make sure your child is getting the support he or she needs.
• Encourage your child to find a hobby or activity to enjoy. If sports aren’t going to be your child’s thing, then maybe music, art, computers, writing, or photography will be.
• Finally, get involved with support associations like the Little People of America. Getting to know other people with dwarfism — both as peers and mentors — can show your child just how much he or she can achieve.

There’s a lot of disagreement among doctors when it comes to fibromyalgia. Theories differ as to what causes it and how best to treat it. There’s even disagreement about what to call it — some call it a syndrome, others a disorder, still others a chronic condition.

Whatever you label it, and whatever its origins, fibromyalgia presents a very real challenge to those coping with its symptoms each day.

Fibromyalgia is a common chronic pain condition — it affects millions of people in the United States. It’s far more common in females than males and can start when kids are in their teen years or even younger, although it’s most common in women between the ages of 20 and 50.

About Fibromyalgia

Fibromyalgia (fy-bro-my-AL-ja) is a long-term, or chronic, syndrome that causes widespread pain in the muscles, joints, and other soft tissues of the body. The term “fibromyalgia” comes from the Latin word “fibro” for fibrous tissue, and the Greek “myo” for muscle, and “algos” meaning pain. In kids, it is sometimes referred to as juvenile primary fibromyalgia syndrome.

The pain of fibromyalgia is often accompanied by isolated tender or sore areas, fatigue, poor sleep, headaches, and other symptoms. Fibromyalgia is often considered a syndrome rather than a disease because it’s a collection of symptoms that seem to be related but, unlike a disease, there’s no cause that can be identified.

Although fibromyalgia is a chronic condition, its symptoms typically come and go. They can be mild at times, then so severe at others that they interfere with normal activities. Many kids with fibromyalgia can attend school regularly, but their abilities vary depending upon the severity of their symptoms.

Treatment for fibromyalgia focuses on managing the pain and other symptoms. This often involves a combination of medicines and lifestyle changes, such as exercise, relaxation, and stress-management techniques. There is no cure for fibromyalgia, but treatment has been shown to improve the quality of life for those who have it.

Symptoms

Most kids with fibromyalgia complain of widespread muscle pain, usually a dull or burning kind, but sometimes more of a shooting or throbbing pain. Widespread means the pain happens on both sides of the body, above and below the waist; it can range from mild to severe.

Usually, someone with fibromyalgia also has a number of tender spots — places where he or she feels pain if the spot is pressed. Common tender spots include the back of the head, between the shoulder blades, shoulders, chest, neck, hips, knees, and elbows.

Fatigue (tiredness) is another common complaint of kids with fibromyalgia. Because of this, fibromyalgia can mimic the symptoms of a similar condition called chronic fatigue syndrome. Sometimes, a person can have both conditions, but they are separate syndromes.

Fibromyalgia also usually causes sleeping problems that make getting a good night’s sleep difficult. Some kids may have other sleep disorders like restless legs syndrome and sleep apnea. Poor sleep can also lead to waking up with body aches and stiffness that may improve during the day, then get worse at night.

Additional symptoms of fibromyalgia can include:

• gastrointestinal problems like irritable bowel syndrome
• problems with memory or concentration
• headaches
• irritability
• anxiety
• depression

People with fibromyalgia often notice a variety of external factors that can make their symptoms worse, from emotional stress to cold, damp weather.

Causes

Doctors aren’t really sure what causes fibromyalgia, but most agree that the brains of people who have it sense pain differently. They might feel pain in response to things (like stress) that aren’t normally painful.

Some cases of fibromyalgia seem to be triggered by an event — like an infection or illness, physical injury, or emotional upset. Genetic factors also might play a role. Fibromyalgia tends to run in families, so it’s possible that having a genetic mutation may increase someone’s risk of developing the condition.

Diagnosis

If your child seems to be suffering from one or more of fibromyalgia’s major symptoms — such as chronic muscle pain, fatigue, or disrupted sleep — contact a doctor. While there’s no specific test to diagnose fibromyalgia, a doctor can run tests to rule out other possible causes, such as thyroid disorders, infectious diseases, or rheumatic diseases (like juvenile idiopathic arthritis).

Since fibromyalgia can’t be confirmed by any laboratory tests and has few, if any, visible signs, it can be difficult for doctors to diagnose the condition. This can be frustrating for someone who has it. Some estimates claim that it takes an average of 5 years for someone with fibromyalgia to get an accurate diagnosis, and some doctors are not as familiar with the condition as others.

Doctors diagnose fibromyalgia in someone based on medical history, the person’s description of symptoms, and a physical exam, including a check of 18 usual tender spots. Most kids with fibromyalgia will have pain when pressure is applied to at least five of the tender spots, and will have widespread musculoskeletal aches lasting for at least 3 months, with no other medical problem causing the pain.

Treatment

There’s no cure for fibromyalgia, but treatment can help manage symptoms, ease pain, and improve a child’s overall health and quality of life. Treatments for fibromyalgia include both lifestyle changes, behavioral therapy, and medicines.

Before giving medicines, doctors usually will try other treatments, such as:

• Regular exercise. This may increase pain at first, but exercise can help ease symptoms when done gradually and regularly. Some kids benefit from working with a physical therapist. Others can show improvement from stretching and relaxation exercises.
• Stress-relief methods. This can include yoga, t’ai chi, and other disciplines, as well as light massage, breathing exercises, and acupuncture.
• Proper sleep. Getting enough sleep is one of the most effective ways to treat fibromyalgia, so children with fibromyalgia should be encouraged to avoid caffeine and sugary beverages and snacks right before bedtime. They also should go to bed and get up at the same time each day and limit napping during the daytime.
• Healthy lifestyle choices. This includes eating a healthy diet and finding activities that help distract from the symptoms of fibromyalgia.

Some kids also find that changing the way they think about their condition helps improve their symptoms. Cognitive-behavioral therapy (CBT), a therapy used by mental health professionals, can help kids learn to filter out negative thoughts, recognize what makes symptoms worse, and set limits to keep symptoms in check.

If these steps aren’t enough to manage fibromyalgia symptoms, the doctor may prescribe medications. Some of the more common ones prescribed to treat fibromyalgia are:

• Pain relievers. Over-the-counter medicines, such as acetaminophen, ibuprofen, and naproxen sodium, can help ease the pain and stiffness caused by fibromyalgia. Doctors also may use prescription pain relievers, such as tramadol.
• Antidepressants. A number of prescription antidepressants are used to ease pain and fatigue and help promote better sleep.
• Anti-seizure medications. A handful of drugs used to treat epilepsy are also useful in treating fibromyalgia symptoms.

In addition to helping your child manage the symptoms of fibromyalgia, it’s also important to provide the necessary emotional support. Talking about the condition and coming up with coping strategies together can help.

Many young people also find that support groups, as well as counseling from a trained psychologist, can help them learn to manage their symptoms, feel better, and have a more positive outlook on life.

Kids who need a cast often have plenty of questions. Here are answers to some frequent inquiries about casts.

What are the different kinds of casts?

A cast, which keeps a bone from moving so it can heal, is essentially a big bandage that has two layers — a soft cotton layer that rests against the skin and a hard outer layer that prevents the broken bone from moving.

These days, casts are made of either:

• plaster of paris: a heavy white powder that forms a thick paste that hardens quickly when mixed with water. Plaster of paris casts are heavier than fiberglass casts and don’t hold up well in water.
• synthetic (fiberglass) material: made out of fiberglass, a kind of moldable plastic, these casts come in many bright colors and are lighter. The covering (fiberglass) on synthetic casts is water-resistant, but the padding underneath is not. You can, however, get a waterproof liner. The doctor putting on the cast will decide whether a fiberglass cast with a waterproof lining is appropriate.

How is a cast put on?

First, several layers of soft cotton are wrapped around the injured area. Next, the plaster or fiberglass outer layer is soaked in water. The doctor wraps the plaster or fiberglass around the soft first layer. The outer layer is wet but will dry to a hard, protective covering. Doctors sometimes make tiny cuts in the sides of a cast to allow room for swelling.

Can plaster of paris casts get wet?

Absolutely not! A wet cast may not hold the bone in place because the cast could start to dissolve in the water and could irritate the skin underneath it, possibly leading to infection. So your child shouldn’t swim and should use a plastic bag or special sleeve (available online or sometimes at pharmacies) to protect the cast from water. And instead of a shower, your child may need to take a sponge bath.

Can synthetic (fiberglass) casts get wet?

Although the fiberglass itself is waterproof, the padding inside a fiberglass cast is not. So it’s still important to try to keep a fiberglass cast from getting wet. If this is a problem, talk to the doctor about getting a waterproof liner. Fiberglass casts with waterproof liners let kids continue bathing or even go swimming during the healing process. Although the liner allows for evaporation of water and sweat, it’s still fragile. Also, only certain types of breaks can be treated with this type of cast. Your doctor will determine if the fracture may be safely treated with a waterproof cast.

Is it OK to have people sign and draw on my child’s cast?

Definitely! That often makes the whole broken bone experience more bearable for kids. Permanent markers usually work best; washable ones can smear. Feel free to encourage siblings, family members, and classmates to sign it, draw pictures on it, or decorate it with stickers. The doctor might even let your child keep the adorned cast as a souvenir.

What if my child has an itch in the cast?

Try blowing some air in the cast with a hair dryer — be sure to use the cool setting, though. And you should never pour baby powder or oils in the cast to try to relieve itching or try to reach the itch with long, pointed object such as a pencil or hanger — these could scratch or irritate your child’s skin and can lead to an infection.

What if the cast gets a crack?

This can happen if the cast is hit or crushed, has a weak spot, or if the injured area begins to swell underneath. Call your doctor as soon as you notice a crack. In most cases, a simple repair can be done to the cast without needing to remove it or change it.

What if the cast causes my child’s fingers or toes to turn white, purple, or blue, or if the skin around the edges of the cast gets red or raw?

If your child’s fingers or toes are changing color, the cast may be too tight and you should call the doctor right away.

Redness and rawness are typically signs that the cast is wet inside, from sweat or water. Sometimes, kids pick at or remove the padding from the edges of fiberglass casts. They shouldn’t do this, though, because the fiberglass edges can rub on the skin and cause irritation. Call your doctor to have the problem fixed right away.

Why aren’t some types of broken bones put in casts right away?

Some kinds of fractures are put into a splint at first, then later switched to a cast. If there is concern about swelling, the doctor may do this so a cast doesn’t get too tight.

Do all broken bones need casts?

No. Some fractures, such as a rib or collarbone, are not casted. Even displaced collarbones (in which pieces on either side of the break are out of line) heal well with a sling or special strap called a “figure-of-eight clavicle strap,” which the child wears like a vest. Some non-displaced finger and toe fractures (in which the pieces on either side of the break line up) that don’t involve the joint or the growing part of a child’s bone (called the growth plate) may heal well with a splint or buddy taping (taping the injured digit to the adjacent unaffected finger or toe).

Certain fractures of larger long bones, such as the femur (thighbone), are hard to keep straight in a cast. Although doctors used to put many of these kinds of fractures in traction (a way of gently pulling the bone straight), these days, surgery is often used instead.

Will my child feel pain when the broken bone is in a cast?

Some pain is expected for the first few days, but it’s usually not severe. The doctor may recommend acetaminophen or ibuprofen to ease pain.

How are casts taken off?

The doctor will use a small electrical saw to remove the cast. Although it may look and sound scary to your child, the process is actually quick and painless. The saw’s blade isn’t sharp — it has a dull, round blade that vibrates from side to side. The vibration is strong enough to break apart the fiberglass or plaster, but shouldn’t hurt your child’s skin and may even tickle.

What will the injured area look and feel like when the cast is removed?

Once the cast is off, the injured area will probably look and feel pretty weird to your child: The skin will be pale, dry, or flaky; hair will look darker; and the area (muscles especially) will look smaller or weaker. Don’t worry, though — this is all temporary. And depending on the type and location of the fracture, the doctor may also give your child special exercises to do to get the muscles around the broken bone back in working order.

Growth plates are the areas of growing tissue near the ends of the long bones in the legs and arms in kids and adolescents. Also called a physis or epiphyseal plate, a growth plate produces new bone tissue.

An injured growth plate might not do its job properly, which can lead to crooked or misshapen bones, limbs that are too short, or even arthritis. Fortunately, this is rare. With recognition and the right treatment, most growth plate injuries are successfully treated without long-term problems.

About Growth Plates

All long bones have an area called the epiphysis, which is the rounded end of the bone. The long, middle part (or shaft) of the bone is the diaphysis; the area where the bone gets wider at its end is the metaphysis.

In growing kids, growth plates sit between the metaphysis and the epiphysis. Growth plates are at the end of long bones, and grow in length. They’re made up of cartilage, a rubbery, flexible material (the nose, for instance, is made of cartilage).

When a child’s bones are done growing (called reaching skeletal maturity), the growth plates ossify (harden) and the epiphysis fuses with the metaphysis, forming one complete bone.

Girls tend to reach skeletal maturity earlier than boys. Their growth plates usually close around ages 13 to 15, while boys’ growth plates close later, at around ages 15 to 17. Before growth is complete, the growth plates are at risk for fractures (breaks). An adult whose bones have finished growing might simply pull a muscle or a tendon after a fall. But in a child, that same fall could injure the growth plate.

Causes of Growth Plate Injuries

Most of the time, growth plate injuries happen from falling or twisting. Contact sports, like football or basketball, or fast-moving activities like skiing, skateboarding, sledding, or biking, are common causes. Injuries can also happen from activities that require repetitive training, like gymnastics, track and field, or pitching a baseball.

Less common causes of injury include:

• exposure to extreme cold
• medical conditions that affect bone growth
• medicines that can affect bone growth, like treatments for arthritis or cancer

Signs and Symptoms

Signs and symptoms of a growth plate injury are the same as those for a broken bone, and include:

• inability to put weight or pressure on the limb
• pain or discomfort
• inability to move the limb

If you suspect your child has a bone injury, get immediate care with your primary care provider, an orthopedic surgeon, or at an emergency room or urgent care facility.

Diagnosis

In the emergency room or doctor’s office, doctors will ask how the injury happened and may do some physical tests, like applying pressure to the bone or joint to see if it’s unstable.

Because growth plates are cartilage, they may not show up on X-rays. X-rays show just the hard, calcium-containing parts of bones. But doctors can still tell a lot from an X-ray, including whether there’s swelling near the growth plates or a widening of the growth plates that might indicate a fracture.

Treatment

Treatment for growth plate injuries first involves resting and not bearing weight on the affected limb. Often, this means wearing a cast, splint, or brace over the area to prevent movement. Many growth plate injuries are minor, and this may be the only treatment necessary.

Other times, if bones are out of place, they may have to be put back into place through a gentle procedure called a reduction. If needed, a reduction will usually be done in the emergency room or operating room, after the child has been given medicine to lessen the pain. Afterward, the child may wear a cast, splint, or brace to make sure the bones don’t move out of place.

In a complicated injury, surgery might be needed to realign the bones. Surgical plates, screws, or wires might be used to secure the area so that the bone heals normally. After surgery, some kids will wear a cast or splint during recovery.

After the fracture has healed, some kids might need physical therapy to help strengthen the area around the injury, restore normal movement if a joint (like the elbow) was affected, and make sure bones and joints are working normally.

Outlook

Most kids who are treated for growth plate injuries do not have any long-term complications. However, follow-up care is important to make sure bones are healing and continuing to grow normally.