What is the treatment for Salter-Harris II fracture (Salter-Harris type II fracture) in the wrist?

From the Guidelines

The treatment for a Salter-Harris type II fracture in the wrist typically involves immobilization with a cast for 4-6 weeks, as this approach has been shown to be effective in promoting healing and minimizing the risk of growth disturbances 1. When managing a Salter-Harris type II fracture in the wrist, it is essential to consider the potential for growth disturbance and the importance of proper immobilization.

• Initially, a well-padded short arm cast or sugar-tong splint should be applied with the wrist in a neutral or slightly flexed position.
• If the fracture is displaced, closed reduction under sedation or anesthesia is necessary before casting, as indicated by the American College of Radiology 1.
• Pain management includes acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours) for the first few days.
• Weekly X-rays for the first 2-3 weeks are recommended to ensure the fracture remains properly aligned, and follow-up for 6-12 months is still important to monitor for any growth abnormalities. The treatment approach is guided by the principles of restoring radial length, inclination, and tilt, as well as the realignment of the articular fracture fragments, as outlined in the ACR Appropriateness Criteria 1.
• After cast removal, gentle range of motion exercises should be started, gradually increasing activity over 2-4 weeks.
• Physical therapy may be beneficial for regaining strength and mobility, although the evidence for this is not as strong as for immobilization and proper reduction 1.

From the Research

Treatment of Salter Harris II Fractures in the Wrist

• The treatment of Salter Harris II fractures in the wrist is not directly addressed in the provided studies, as they focus on fractures of the distal tibia and radius.
• However, the studies provide information on the treatment of Salter Harris II fractures in general, which may be applicable to wrist fractures.
• According to 2, closed reduction and casting is a common treatment approach for Salter Harris II fractures, but loss of reduction is a potential complication.
• The study 3 found that nonoperative treatment of Salter Harris II distal radius fractures can result in good outcomes, with high rates of anatomic remodeling in children 10 years or younger.
• However, the study 4 notes that displaced fractures have a small risk of growth arrest, and that closed reduction followed by a cast may be indicated for fractures with displacement greater than or equal to 3 mm.

Factors Affecting Treatment Outcomes

• The study 2 found that initial angulation more than 5 degrees on the PA view is a risk factor for loss of reduction.
• The study 5 found that there is considerable variation in the indications for operative and nonoperative management of closed Salter Harris II distal tibia fractures, and that consensus was only reached for nonoperative management in patients with less than 3 mm of translation after closed reduction.
• The study 6 found that surgical fixation with anatomic reduction and removal of interposed tissue may not reduce the incidence of premature physeal closure, and may increase the need for subsequent surgeries.

Complications and Outcomes

• The study 3 found that complication rates for nonoperatively managed Salter Harris II distal radius fractures are generally low, ranging from 0% to 5%.
• The study 4 found that the overall complication rate for Salter Harris II fractures of the distal tibia is 1 out of 51 patients, but that displaced fractures have a higher complication rate of 1 out of 6 patients.
• The study 6 found that premature physeal closure is a common complication of Salter Harris II fractures, with an overall rate of 43%.