What is the treatment for a non-displaced distal fibula Salter Harris type 2 fracture?

Treatment of Non-Displaced Distal Fibula Salter Harris Type 2 Fracture

Non-displaced distal fibula Salter-Harris type 2 fractures should be treated with cast immobilization without the need for reduction, as these fractures have excellent outcomes with conservative management. 1

Initial Management

• For non-displaced fractures (displacement <3mm):
  • Apply a short leg cast
  • No reduction is necessary
  • Weight-bearing status should be non-weight bearing initially

Cast Selection and Duration

• Short leg cast is sufficient and offers advantages over long leg cast:
  • Similar rates of loss of reduction (no statistically significant difference in displacement rates) 2
  • Shorter total casting time (statistically significant) 2
  • Quicker return to activities 2
  • Better functional outcomes during recovery

Follow-up Protocol

• Radiographic follow-up at:
  • 1-2 weeks after initial casting to ensure no displacement has occurred
  • 3-4 weeks for assessment of healing
  • Final follow-up at cast removal (typically 4-6 weeks total)

Monitoring for Complications

• Monitor for premature physeal closure (PPC), which is the most common complication:
  • Overall complication rate for non-displaced fractures is very low (approximately 2%) 1
  • If clinical concern for growth disturbance develops (angular deformity, limb length discrepancy), obtain CT imaging to assess for bony bar formation

When to Consider Surgical Management

• Surgery is indicated only if:
  • Displacement is ≥3mm 1, 3
  • Closed reduction fails to achieve <2mm displacement 4
  • Loss of reduction occurs during follow-up

Key Considerations and Pitfalls

1. Avoid unnecessary reduction attempts for truly non-displaced fractures, as manipulation of the physis can increase risk of growth disturbance

2. Differentiate from distal tibia fractures, which have higher complication rates:

   • Distal tibia SH-II fractures have much higher rates of premature physeal closure (29-55%) 4, 3
   • Fibula fractures generally have better prognosis than similar fractures of the distal tibia

3. Recognize risk factors for complications:

   • Displacement >3mm
   • Multiple reduction attempts
   • Delayed treatment
   • High-energy mechanism of injury

4. Ensure adequate follow-up for at least 4-6 months to monitor for any growth disturbances, even though these are rare in non-displaced fibular fractures

The excellent prognosis of non-displaced distal fibula Salter-Harris type 2 fractures supports a conservative approach with cast immobilization as the definitive treatment, with surgical intervention reserved only for significantly displaced fractures.