Does a 10-year-old male (YOM) with a non-displaced Salter-Harris type 2 fracture of the distal humerus require orthopedic evaluation beyond casting?

From the Guidelines

A 10-year-old male with a non-displaced Salter-Harris type II fracture of the distal humerus should be evaluated by an orthopedic specialist, even if casting is already planned, as the fracture involves the growth plate and has potential for growth disturbance or malunion if not properly managed 1.

Key Considerations

• The orthopedic specialist will determine the optimal immobilization method, such as a posterior splint or cast, which has been shown to provide better pain relief in the first 2 weeks after injury compared to a collar and cuff immobilization 1.
• The duration of immobilization is typically 3-4 weeks, and the specialist will establish an appropriate follow-up schedule to monitor healing and ensure proper alignment is maintained.
• Growth plate fractures in children require specialized monitoring to detect early signs of complications, such as premature growth arrest, angular deformity, or joint incongruity.
• The distal humerus is particularly important for elbow function, and proper management is essential to preserve normal growth and function of the elbow joint as the child develops.

Management

• The orthopedic specialist will assess for any subtle displacement that might require closed reduction or, rarely, surgical intervention.
• They will also consider the potential risks and benefits of different treatment options, including the risk of limb-threatening ischemia associated with casting the arm in hyperflexion 1.
• A meta-analysis has shown that closed reduction and percutaneous Kirschner wire pinning is the preferred treatment for most displaced supracondylar fractures of the humerus, with more favorable outcomes for cubitus varus and Flynn’s elbow criteria 1.

From the Research

Non-Displaced Salter 2 Fracture of Distal Humerus

• The provided studies do not directly address the management of non-displaced Salter 2 fractures of the distal humerus in a 10-year-old patient.
• However, the studies suggest that orthopedic consultation is often necessary for Salter-Harris type II fractures, especially if there are concerns about fracture stability or displacement 2, 3.
• The use of closed reduction and percutaneous fixation with Kirschner wires has been reported to be effective in treating Salter-Harris type II proximal humerus epiphyseal injuries, with excellent results and no major complications 2.
• External fixators have also been used to treat Salter-Harris type II proximal humerus injuries, providing good stability and healing with early rehabilitation 3.
• In complex cases, such as those involving posterior sternoclavicular joint displacement, the use of locking compression plates has been reported to be effective in achieving good outcomes 4.

Orthopedic Consultation

• Given the potential complexity of Salter-Harris type II fractures, orthopedic consultation is likely necessary to determine the best course of treatment for a non-displaced Salter 2 fracture of the distal humerus in a 10-year-old patient.
• Orthopedic specialists can assess the fracture and provide guidance on the need for surgical intervention, casting, or other treatment options 2, 3, 4.
• A survey of the Pediatric Orthopaedic Society of North America membership may provide additional insights into the current state of practice for managing Salter-Harris II fractures, although the specific details of this survey are not provided in the available evidence 5.