At what age does the growth plate (physeal) close in adolescents?

Growth Plate Closure Age in Adolescents

Growth plates typically close around age 14 in girls and age 16 in boys, though complete skeletal maturity may extend to ages 15-18 in females and 17-19 in males depending on the specific bone location. 1, 2

Age-Specific Closure Timeline

General Population

• Females: Growth plate closure occurs between ages 14-18 years, with most plates closing by age 16-17 1, 2, 3
• Males: Growth plate closure occurs between ages 16-19 years, with most plates closing by age 17-18 1, 2, 3

Site-Specific Variations

Upper Extremity 3:

• Proximal humerus: 17-18 years
• Glenoid: 16-18 years
• Clavicle: 18-20 years (latest to close)
• Distal radius: 15-18 years in females 4

Lower Extremity 5, 6:

• Complete fusion occurs in 75%, 85%, 97%, 98%, 98% of radius, femur, proximal tibia, distal tibia, and calcaneus respectively in 17-year-old females 5
• In males, 90%, 97%, 95%, 97%, 98% fusion rates occur by age 19 years 5
• Distal tibia and fibula: Complete fusion as early as age 12 in females (all by age 16), and age 14 in males (all by age 19) 6

Key Clinical Considerations

Sex Differences 5, 7:

• Girls complete growth plate closure approximately 2 years earlier than boys across all skeletal sites 5
• This sex-based difference is consistent and clinically significant for surgical planning 1, 2

Factors Influencing Closure 5:

• Pubertal development: Strong correlation with growth plate fusion (ρ = 0.514-0.598) 5
• BMI: Positive correlation with earlier closure; obese/overweight adolescents show increased odds ratio (2.65-8.71 in females, 1.71-4.03 in males) for earlier fusion 5
• Physical activity: Does NOT significantly influence closure timing 5

Surgical Planning Implications

Guided Growth Techniques 1, 2:

• Must be performed at least 2-3 years before skeletal maturity to be effective 1, 2
• This means intervention should occur by age 12 in girls and age 14 in boys at the latest 1, 2

Osteotomy Timing 1, 2:

• Complications are reduced when surgery is performed later in childhood or after skeletal maturity 1, 2
• Delaying corrective osteotomies until growth plate closure is often prudent to minimize recurrence rates 1

Important Caveats

Continued Growth Beyond Expected Closure 8:

• Some adolescents continue statural growth beyond radiographic bone age of 15 years (females) or 17 years (males) 8
• This is particularly common in inflammatory bowel disease (80% of patients) but can occur in healthy individuals 8
• Clinical implication: Height monitoring should continue even after expected closure age, especially during transition to adult care 8

Rapid Closure Process 4:

• Once physeal closure begins, the process completes within less than one year 4
• This explains why transitional fractures near growth plates are relatively rare 4

Assessment Method 5:

• MRI is highly accurate for assessing growth plate status with excellent inter-observer agreement (Κ = 0.87-0.94) 5
• Growth plate fusion occurs in an ascending order: foot → knee → wrist 5