Possible Salter (Growth Plate) Fracture of the Lower Extremity (Child)

Your child may have a crack or break (fracture) in the growth plate of a bone in his or her hip, leg, or foot. 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 fracture in the growth plate is known as a physeal or Salter (or Salter-Harris) fracture. There are different ways to classify a growth plate fracture. The Salter-Harris system is the most common. It grades fractures from 1 (I) to 5 (V) increasing in severity with every grade.

A normal growth plate can’t be seen on an X-ray. So a fracture of the growth plate can’t be seen on an X-ray unless the nearby bone is pushed out of place (displaced). If the healthcare provider thinks that your child has a fracture despite a normal X-ray, they may treat it like a fracture. Your child will need a follow-up appointment and possibly more X-rays. The provider may order an X-ray of the opposite, uninjured side to compare the X-rays. This will help decide if a fracture is there. Over time, if a fracture is there, new bone growth may be seen on X-ray.

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. 

General care

  • Follow the doctor’s instructions about how much your child should use the affected leg during the time between X-rays and after an injury is confirmed or ruled out. If your child has been given crutches, he or she should use them to walk. Your child shouldn't walk without crutches or put weight on the injured leg or foot until the provider says it’s OK.

  • If the leg is swollen or painful, keep it raised (elevated).  Keep the affected leg or foot raised to reduce pain and swelling. This is most important during the first 2 days (48 hours) after the injury. As often as possible, have your child sit or lie down. Put pillows under your child’s leg until the injured area is raised above the level of the heart. For infants and younger children, watch that the pillows don't slip and move near the face.

  • Put an ice pack on the injured area to help control swelling. To make an ice pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. 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 ice 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 ice pack on the injured area for up to 20 minutes every 1 to 2 hours the first day. Keep using the ice pack 3 to 4 times a day for the next 2 days, then as needed. You can place the ice pack directly on the splint or cast. If your child has a boot, open it to apply cold, unless told otherwise.

  • 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. Covering the cast or splint with a plastic bag will not make it completely waterproof. Don't let water run directly over the area. Don't place the covered cast in water.

  • Encourage your child to wiggle or exercise the toes on the foot of the injured leg often.

Follow-up care

Follow up with your child’s healthcare provider, or as advised. Growth plate fractures often heal well with no problems. 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 your child's protection. Please try to be patient and not take offense.

Call 911

Call 911 if your child has any of these:

  • Trouble breathing

  • Confusion

  • Very drowsy or trouble awakening

  • Fainting or loss of consciousness

  • Fast heart rate

  • Seizure

  • Stiff neck

When to get medical advice

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

  • Symptoms such as swelling or pain that get worse

  • Toes of the foot on the injured leg are cold, blue, numb, burning, or tingly

  • Swelling or pain gets worse after a cast or splint is put on the leg or foot. 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.

  • A cast or splint gets wet or soft.

  • Any problems with the cast or splint.

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

Also call your child’s provider right away if your child has a fever (see "Fever and 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°F (38°C) 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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