Impact of Plate Fixation on Growth in Adolescent Forearm Fractures

Q: Impact of Plate Fixation on Growth in Adolescent Forearm Fractures

Hello： Generally, in adolescents with radial and ulnar fractures, fixation with plates and screws avoids the growth plates and does not affect skeletal growth. <br>The plates and screws are typically removed after about a year and a half, depending on the healing condition. <br>I

Postoperative Care for Adolescent Radial and Ulnar Fractures

Hello, I would like to ask about a 13-year-old adolescent who had an open fracture of the right radius and ulna on April 11 of this year.
Surgery was performed on the same day to fix the fracture with a plate and screws.
The patient was discharged on April 16, had the stitches removed on April 25, and in mid-July, the doctor indicated that follow-up visits were no longer necessary and suggested waiting about a year and a half to remove the plate.
I would like to inquire: 1.
Since adolescents are in a growth phase, will having the plate fixed to the bone for a year and a half affect skeletal growth? 2.
When would be the most appropriate time to remove the plate? Thank you!

Indi, 40~49 year old female. Ask Date: 2022/10/31

Dr. Li Wenhong reply Orthopedics

Hello: Generally, in adolescents with radial and ulnar fractures, fixation with plates and screws avoids the growth plates and does not affect skeletal growth.
The plates and screws are typically removed after about a year and a half, depending on the healing condition.
It is recommended to follow up with X-rays every six months to a year.
Thank you! Changhua Hospital, Orthopedics, Dr.
Li Wen-Hong.

Reply Date: 2022/10/31

More Info

The impact of plate fixation on growth in adolescent forearm fractures is a significant concern for both patients and their families. In your case, a 13-year-old adolescent with an open fracture of the radius and ulna underwent surgical fixation with plates and screws. It's essential to understand how this intervention might affect growth and development, especially during this critical period of skeletal maturation.

1. Impact of Plate Fixation on Growth: The primary concern with the use of plates and screws in growing adolescents is the potential impact on the growth plates (epiphyseal plates) located at the ends of long bones. These growth plates are responsible for the longitudinal growth of bones, and any injury or surgical intervention in their vicinity can potentially affect their function. However, if the fracture and subsequent fixation are managed appropriately, the risk of significant growth disturbances is relatively low.
In general, the presence of a plate does not directly inhibit growth unless it interferes with the growth plate itself. If the plate is placed away from the growth plate and does not cause any damage to it, the growth should proceed normally. It is crucial to monitor the growth of the affected limb and compare it with the non-injured limb to ensure that there are no discrepancies developing over time.

2. Timing for Plate Removal: The timing for the removal of the plate is typically determined by several factors, including the healing of the fracture, the patient's age, activity level, and the presence of any complications. In your case, the recommendation to wait approximately 1.5 years before removing the plate is common practice. This duration allows for adequate healing and ensures that the bone has regained sufficient strength to withstand normal activities without the support of the plate.

It is also essential to consider the patient's growth patterns. If the patient is still growing, the surgeon may want to monitor the growth plates closely during follow-up visits. If there are any concerns about growth discrepancies or complications arising from the plate, the surgeon may decide to remove it earlier.

Additional Considerations:
- Follow-Up Care: Regular follow-up appointments with an orthopedic specialist are crucial. These visits allow for monitoring of the healing process and the growth of the bones. The doctor may perform X-rays to assess the condition of the fracture and the growth plates.

- Physical Activity: After the initial healing phase, it is essential to gradually reintroduce physical activity. Engaging in appropriate rehabilitation exercises can help restore strength and mobility to the affected limb.

- Nutrition: Adequate nutrition plays a vital role in bone healing and growth. Ensure that the adolescent is consuming a balanced diet rich in calcium and vitamin D, which are essential for bone health.

- Potential Complications: While most adolescents recover well from such injuries, it is essential to be aware of potential complications, such as growth disturbances or malunion of the fracture. If there are any concerns about the limb's appearance or function, it is crucial to consult the orthopedic surgeon promptly.

In conclusion, while the fixation of a fracture with plates and screws can raise concerns about growth in adolescents, careful management and monitoring can mitigate these risks. Regular follow-ups and appropriate care will help ensure that the adolescent continues to grow and develop normally. If you have any further questions or concerns, do not hesitate to reach out to your healthcare provider for personalized advice and guidance.

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