Early in my career, baseball players who came to see me and needed elbow surgery were usually talented college or professional athletes with UCL injuries. Then something changed, I began seeing more MRIs on high school pitchers with elbow pain, and more and more of them were sustaining full-thickness UCL tears. It was not uncommon on any given end of the week OR day to have a professional, one or two collegiate, and two high school pitchers all undergo Tommy John Surgery.

Over the past few years, a new and shocking group of kids are finding their way into my office as a result of pain or an injury usually reserved for older athletes. These young competitors are sustaining a unique throwing injury, a fracture of the growth plate in their elbow.

On average, boys continue to grow until age 16. The part of their bones that is responsible for growth is referred to as the growth plate. The UCL attaches to the humerus bone adjacent to the growth plate. Figure 1 shows the UCL attaching to the humerus bone and the adjacent growth plate. In athletes who are still growing, throwing forces on the UCL are transferred to the growth plate. In these young athletes, the growth plate is weaker than the UCL.

Some developing athletes experience a jump in their velocity while they are still growing—typically, around the age of 15 or 16. This jump in force can lead to a growth plate fracture. Once fractured, the bone moves out of normal position as shown in Figure 2. With the bone in this position, the UCL no longer functions properly, and the elbow becomes unstable. Upon close review, I recommend surgery to put the fracture back into normal position, and affix it with a screw, to maximize the healing.

Epicondyle growth plate fractures are different from UCL injuries in that surgery, when necessary, needs to be performed within a few weeks of the injury for optimal results. If surgery is delayed, the bone fragment tends to reabsorb, scar tissue develops, and the healing potential decreases.

With growing athletes throwing harder than ever, these injuries are occurring with alarming frequency. This means it is more important than ever before to monitor the progress of young athletes, and to learn about UCL injury prevention early and apply what you learn often.