Possible Growth Plate Break of an Arm, Shoulder, or Hand (Child)

Your child may have a crack or break (fracture) in the growth plate of a bone in his or her shoulder, arm, or hand. A growth plate is an area near each end of the long bones that 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 in the growth plate is known as a physeal, Salter, or Salter-Harris fracture. Doctors sort growth plate breaks in many ways. The Salter-Harris system is the most common. It grades the break from I to V. The higher the number, the more serious the break.

A normal growth plate can’t be seen on an X-ray. So a break in the growth plate can’t be seen on an X-ray unless the nearby bone is pushed out of place (displaced). Your child may need follow-up X-rays. After this time, if a break is there, new bone growth may be seen on X-ray.

If the second X-ray doesn’t show any sign of a break and your child isn’t in pain, he or she probably won’t need any treatment. If your child is in pain or the second X-ray shows that a break is there, a splint or cast may be put on the arm or hand. This will hold the bones in place while they heal. The arm may also be put into a sling to elevate it and hold it still.

Home care

Your child’s healthcare provider may prescribe medicines for pain. Follow the provider’s instructions for giving these medicines to your child. Don’t give your child aspirin unless the provider tells you to. If pain medicine was not prescribed, ask the provider what medicine to give your child for pain or discomfort.

General care

  • Follow the healthcare provider’s instructions about how much your child should use the affected arm during the time between X-rays and after an injury is confirmed or ruled out.

  • If the arm is swollen or painful, keep it elevated. As often as possible, lay your baby down and put pillows under the arm until the injured area is raised above the level of the heart. In older children, have the child sit or lie down. Put pillows under the child’s arm until the hand is raised above the level of the heart. For babies and younger children, watch that the pillows don't slip and move near the face.

  • Put a cold pack on the injured area to help control 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. 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. 

  • 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 is given a splint or cast, care for it as you’ve been instructed. 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 or cast completely dry at all times. The splint or cast should be covered with a plastic bag and kept out of the water when your child bathes. Close the top end of the bag with tape or rubber bands.

  • Encourage your child to wiggle or exercise his or her fingers on the affected arm often.

Follow-up care

Follow up with your child’s healthcare provider, or as advised. Growth plate fractures usually heal well with no problems as long as you maintain regular follow up with your healthcare provider as instructed.  But your child may need to be seen by a specialist. If you were referred to a specialist, make that appointment as soon as you can.

Special note to parents

Healthcare providers are trained to recognize injuries like this one in young children as a sign of possible abuse. Several healthcare providers may ask questions about how your child was injured. Healthcare providers are required by law to ask you these questions. This is done for protection of the child. Please try to be patient and not take offense.

Call 911

Call 911 if any of these occur:

  • Trouble breathing

  • Confusion

  • Very drowsy or trouble awakening

  • Fainting or loss of consciousness

  • Rapid heart rate

  • Seizure

  • Stiff neck

When to seek medical advice

Call your child's healthcare provider right away if any of these occur:

  • Symptoms like swelling or pain get much worse

  • Fever (see Fever and children, below)

  • Chills

  • Fingers of the hand on the injured arm are cold, blue, numb, burning, or tingly.  If the splint is on, loosen it before going for help. It may be too tight.

  • Swelling or pain gets worse after a cast or splint is put on the arm. Babies too young to talk may show pain with crying that can't be soothed. If the splint is on, loosen it before going for help.

  • Cast or splint gets wet or soft

  • You have any problems with the splint or cast

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For babies and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Baby under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.

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