Yes, the Tibia Contains Growth Plates
Yes, the tibia has growth plates (physes) located at both its proximal (upper) and distal (lower) ends, which are responsible for longitudinal bone growth in children and adolescents. 1, 2
Anatomical Location and Function
The tibia contains two distinct growth plates:
- Proximal tibial growth plate: Located near the knee joint, just below the tibial tuberosity 1, 2
- Distal tibial growth plate: Located near the ankle joint 3, 2
These growth plates are cartilaginous structures that enable longitudinal bone growth during childhood and adolescence. 1, 4
Growth Contribution
The proximal tibial growth plate contributes approximately 57% of the total tibial growth, with the distal growth plate contributing the remaining 43%. 5 This unequal distribution is clinically important when considering growth disturbances or surgical interventions near these regions.
Clinical Significance
Growth Plate Vulnerability
Growth plates are particularly vulnerable to injury in children and adolescents:
- Fractures involving growth plates represent approximately one-third of all pediatric fractures 4
- The distal tibial growth plate fuses in a mediolateral direction during adolescence, leaving portions vulnerable to injury for extended periods 3
- Intra-osseous access procedures (such as emergency vascular access) require careful attention to avoid the epiphyseal growth plate in children, with the recommended tibial insertion site being 2 cm distal to the tibial tuberosity and 1 cm medial to the tibial plateau 1
Growth Plate Closure
Growth plates remain active until skeletal maturity:
- Growth potential is exhausted when growth velocity drops below 2 cm per year and/or when epiphyseal growth plate closure is evident on radiography 6
- The distal tibial growth plate typically closes during late adolescence, though timing varies by individual 3
Pathological Conditions
Growth plates can be affected by various disease processes:
- X-linked hypophosphataemia (XLH) causes characteristic widening and irregularity of the proximal tibial growth plates, visible on radiographs 1
- Late-onset tibia vara (Blount's disease) involves severe growth plate changes that can be visualized on MRI, showing widening of the entire proximal tibial growth plate 7
- Growth plate injuries can result in premature ossification forming "bony bars" that lead to angular deformities or complete growth arrest 4
Imaging Characteristics
Growth plates can be visualized and measured using various imaging modalities:
- MRI studies show that tibial growth plate area varies from 736 mm² to 3,026 mm², and volume ranges from 1.9 cm³ to 13.2 cm³, both increasing linearly with age until reaching a plateau in adolescence 2
- Radiographs are typically sufficient to diagnose growth plate abnormalities, though MRI provides superior detail of cartilaginous structures 1, 7