From the Research
The initial management for a mildly displaced Salter-Harris II humeral head fracture in a child typically involves closed reduction followed by immobilization in a sling and swathe or shoulder immobilizer for 3-4 weeks. The reduction should be performed under appropriate analgesia or sedation, with gentle manipulation to align the fracture fragments. After reduction, radiographs should be obtained to confirm adequate alignment. Children generally require less rigid immobilization than adults due to their greater healing potential and remodeling capacity. Pain management includes acetaminophen (15 mg/kg every 4-6 hours) and/or ibuprofen (10 mg/kg every 6-8 hours) for the first few days. Close follow-up is essential, with radiographs at 1-2 weeks to ensure the fracture position is maintained. Physical therapy is typically initiated after immobilization to restore range of motion and strength. This approach is effective because children's bones heal quickly and have significant remodeling potential, especially near growth plates. The Salter-Harris classification specifically addresses fractures involving the growth plate, and type II involves the growth plate and metaphysis, which generally has a good prognosis with appropriate management 1. However, the most recent study available is from 2023, but it is focused on veterinary medicine and not directly applicable to human medicine 2. Therefore, the recommendation is based on the highest quality study available that is relevant to human medicine, which is from 2012 1. Some other studies have reported good outcomes with different management approaches, but they are either older or less relevant to the specific case of a mildly displaced Salter-Harris II humeral head fracture in a child 3, 4, 5. In general, the key to successful management of this type of fracture is to achieve and maintain adequate alignment, promote healing, and restore range of motion and strength. The specific details of the management approach may vary depending on the individual case, but the overall goal is to minimize morbidity, mortality, and impact on quality of life. Some important considerations in the management of this type of fracture include:
- The use of appropriate analgesia and sedation to minimize pain and discomfort
- The importance of close follow-up to ensure that the fracture position is maintained and to detect any potential complications
- The need for physical therapy to restore range of motion and strength after immobilization
- The potential for remodeling and healing in children, which can affect the management approach and outcomes.