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. Because the bone has not yet fully formed in this area in babies and toddlers, 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 healthcare provider 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 it 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 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 do so. If pain medicine was not prescribed, ask the provider what medicine you should give your child for pain or discomfort.

General care

  • Older children: If your child has been given crutches, he or she should use them to walk. Your child should not walk or put weight on the injured leg or foot until the healthcare provider says it’s OK.

  • Babies and toddlers: 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. 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 has a boot, open it to apply cold, unless told otherwise.

  • 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 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. 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.

Follow-up care

Follow up with your child’s healthcare provider within 1 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

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 occurs:

  • Wet or soft splint or cast

  • Splint or cast is too tight. If the splint is on, loosen it before going for help. It may be on too tight.

  • 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.

  • Child can’t move the toes on the foot of the injured leg

  • Fever (See Fever in children, below) or chills

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until he or she is at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell him or her which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher in a child of any age

  • Fever of 100.4 or higher in baby younger than 3 months

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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