From the Guidelines
The management of a Salter-Harris Type 2 fracture should involve closed reduction followed by immobilization with a cast for 3-6 weeks, depending on the specific bone involved and the patient's age, as this approach prioritizes minimizing morbidity, mortality, and optimizing quality of life. When considering the management of such fractures, it's crucial to prioritize techniques that minimize disruption to the growth plate, given the potential for long-term growth disturbances. For minimally displaced fractures, simple immobilization may be sufficient, as noted in studies discussing the treatment of fractures, including those from the American College of Foot and Ankle Surgeons 1. Key considerations in the management include:
- The use of appropriate analgesia or sedation, especially in children, to facilitate comfortable reduction
- Application of a well-molded cast to maintain proper alignment
- Regular follow-up radiographs to ensure the fracture remains properly aligned
- Weight-bearing restrictions for lower extremity fractures during the healing period
- Potential for physical therapy after cast removal to restore range of motion and strength Surgical intervention is typically reserved for fractures that cannot be adequately reduced closed, have significant displacement, or involve the growth plate of weight-bearing bones, emphasizing the need for careful assessment and decision-making in the management of these fractures.
From the Research
Management of Salter-Harris Type 2 Fractures
The management of Salter-Harris Type 2 fractures typically involves orthopedic reduction and immobilization. Key aspects of management include:
- Orthopedic reduction in the emergency room or operating room, under general anesthesia, followed by plaster immobilization 2
- Immobilization in a weight-bearing long leg cast for 4 weeks, allowing for adequate healing and faster rehabilitation without adverse effects on growth 3
- Closed manipulation and plaster cast immobilization, with regular follow-ups, to prevent deformities and achieve good functional outcomes 4
Surgical Intervention
Surgical intervention may be necessary in cases of malunions or neglected fractures. This can involve:
- Open reduction with internal osteosynthesis, using a technique that avoids violating the growth cartilage 2
- Internal fixation with a transepiphyseal wire, followed by 30 days of immobilization in a plaster device 2
- Anatomical reduction and adequate immobilization to prevent deformities and achieve good functional outcomes 4
Complications and Follow-up
Complications such as epiphysiodesis, femoral over-lengthening, and loss of knee motion can occur, especially in type 2B fractures 5. Regular follow-ups are necessary to monitor for these complications and to ensure proper healing. Frequent monitoring and further testing, such as MRI, may be necessary to better diagnose and manage these injuries 4.