A growth plate fracture is a break through the soft, growing layer of cartilage near the end of a child’s bone.
In the hand and wrist, the most common sites are the lower end of the radius just above the wrist and the base of the finger bones.
Most heal well in a cast or splint in three to four weeks and grow normally afterward.
A smaller number, especially fractures that cross into the joint or crush the growth plate, can affect how the bone grows. Those need follow-up X-rays over the following months.
Why children break growth plates instead of spraining
- Growth plates are weaker than the ligaments around them. A fall that would sprain an adult’s wrist or finger often fractures a child’s growth plate instead
- They’re most vulnerable during growth spurts, in the early teens
- They close as the skeleton matures, usually in the mid to late teens, so the growth risk falls with age
In a child, “it’s just a sprain” is a diagnosis to make carefully. The growth plate is often the weak link.
The main types, simply
- Straight through the growth plate: the bone end slips. May look normal on X-ray. Usually heals well
- Through the growth plate and up into the bone shaft: the most common type. Usually heals well
- Through the growth plate and down into the joint: the joint surface is involved, so alignment matters more
- Through both the joint and the shaft: often needs surgery to line up precisely
- A crush of the growth plate: uncommon, easy to miss, and the most likely to affect growth
Doctors describe these with the Salter-Harris system, types I to V, in the same order as above.
Common hand and wrist growth plate fractures
- Lower end of the radius after a fall on an outstretched hand. Not to be confused with a buckle fracture, which sits just above the growth plate
- Base of the little finger bent sideways, often from catching a ball or a fall
- Base of the fingertip bone in a crushed finger, sometimes an open injury with the nail lifted. See child’s finger crushed in a door
- Thumb base after a fall or a ball strike
Treatment and recovery
- Undisplaced: cast or splint, usually three to four weeks
- Displaced: gently straightened, ideally early, then a cast. Repeated attempts after the first week or so are usually avoided, because they can harm the growth plate
- Into the joint and out of line: surgery, often with small pins. See K-wires
- After the cast: children usually regain movement quickly through play
Follow-up and growth
Some growth plate fractures are followed with X-rays for several months to a year, to confirm the bone is growing evenly.
Warning signs of a growth problem are a wrist or finger that develops an angle, one side of the wrist looking longer, or new pain months after healing.
Repetitive stress, rather than a single fall, can also injure the wrist growth plate.
- See gymnast’s wrist.
- For the elbow version in young throwers, see little league elbow.
Get it checked if
- A child has wrist or finger pain and swelling after a fall, even if they can move it
- A finger looks bent or crosses another when making a fist
- Pain returns months after healing
- The wrist or finger starts to look different from the other side
For older teens and adults, see broken finger and wrist fracture recovery.
Most growth plate fractures heal and grow normally. The follow-up X-ray is how you know yours did.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.