What type of splint is recommended for a distal femur Salter-Harris fracture?

Splinting for Distal Femur Salter-Harris Fractures

For distal femur Salter-Harris fractures, immobilization with a long leg splint in the position found is the recommended first aid approach, though definitive treatment typically requires surgical intervention due to the high risk of complications and growth disturbance. 1

Initial Management

• Distal femur Salter-Harris fractures should be treated as medical emergencies, similar to knee dislocations 2
• Initial assessment should include:
  • Evaluation for signs of poor perfusion (blue, purple, or pale extremity) which requires immediate emergency response 1
  • Assessment for open wounds with severe bleeding, which should be managed according to severe bleeding protocols 1

Splinting Recommendations

• According to the 2024 American Heart Association guidelines, splinting of a fractured extremity is useful to:

  • Reduce pain
  • Reduce risk for further injury
  • Facilitate transport to a medical facility 1

• The fracture should be treated in the position found unless straightening is necessary for safe transport 1

• Any open wounds should be covered with clean dressings to reduce contamination and infection risk 1

Important Considerations

• Distal femur Salter-Harris fractures are often more severe than they appear on plain radiographs:

  • Plain X-rays significantly underestimate displacement compared to MRI or CT scans 3
  • Advanced imaging (MRI or CT) is strongly recommended for all Salter-Harris III fractures of the distal femur 3

• These fractures have high complication rates:

  • 70% of patients with Salter-Harris type 2 distal femur fractures develop complications including epiphysiodesis (growth arrest) 4
  • Vascular assessment is critical as these injuries can compromise blood supply 2

Definitive Treatment

• External immobilization alone (casts or splints) has a high failure rate in maintaining anatomic alignment 5
• Most displaced fractures require:
  • Reduction under general anesthesia
  • Internal fixation (typically percutaneous pinning) 5
  • Close monitoring for growth disturbances

Common Pitfalls to Avoid

1. Underestimating the injury: These fractures often appear less severe on plain radiographs than they actually are 3
2. Failing to assess vascular status: Always check distal pulses and perfusion 2
3. Attempting reduction without proper analgesia: Reduction requires intravenous analgesia and gentle traction along the axis of the limb 5
4. Relying solely on external immobilization: Most displaced fractures require surgical fixation 5
5. Inadequate follow-up: These fractures need close monitoring for growth disturbances 4

For initial splinting before definitive care, a long leg posterior splint with the knee in slight flexion (10-20 degrees) is typically used, though the exact position should be based on the position that provides the most stability while maintaining comfort and vascular status.