What is the treatment for Salter Harris fractures?

Treatment of Salter-Harris Fractures

The treatment of Salter-Harris fractures primarily depends on the fracture type, displacement, and patient factors, with non-displaced Salter-Harris type I and II fractures typically managed with rigid cast immobilization for 4-6 weeks, while displaced fractures (>2mm) generally require closed or open reduction with internal fixation. 1

Assessment and Classification

• Evaluate fracture displacement carefully:

  • <2mm displacement: Generally suitable for non-operative management

  • 2mm displacement: Consider reduction and possible surgical intervention

  • 2-3mm step-off or >1-4mm displacement: Surgical intervention often required 1

• Additional factors influencing treatment decisions:

  • Patient age and skeletal maturity
  • Fracture stability
  • Integrity of the extensor mechanism
  • Presence of articular surface disruption

Treatment Algorithm by Fracture Type

Non-Displaced Fractures (<2mm displacement)

1. Conservative management:

   • Rigid cast immobilization for 4-6 weeks 1
   • Appropriate analgesics (NSAIDs if not contraindicated)
   • Activity modification
   • Regular radiographic follow-up at 2-week intervals initially 1

2. Key points for non-operative management:

   • Ensure the extensor mechanism is intact
   • Confirm no significant articular surface disruption
   • Verify patient is appropriate for non-operative approach (consider age, activity level)

Displaced Fractures (>2mm displacement)

1. Initial approach:

   • Attempt closed reduction as first-line treatment, preferably under general anesthesia 2
   • If reduction achieves <2mm displacement, immobilize with rigid cast 1

2. If closed reduction fails or displacement remains >2mm:

   • Open reduction and internal fixation (ORIF) indicated 1
   • For Salter-Harris type I and II, use techniques that avoid violating the growth cartilage 2
   • Internal fixation options include cannulated screws, K-wires, or other appropriate hardware based on fracture pattern

Rehabilitation Protocol

1. Early phase (0-4 weeks):

   • Protected motion
   • Pain control
   • Pendulum exercises if appropriate 1

2. Intermediate phase (4+ weeks):

   • Begin gentle passive range of motion exercises after radiographic evidence of healing
   • Progress to active-assisted range of motion as tolerated 1

3. Advanced phase:

   • Strengthening exercises after fracture healing is evident
   • Return to activities gradually based on clinical and radiographic progress

Follow-Up and Monitoring

• Clinical and radiographic follow-up at 2-week intervals initially 1

• Monitor for:

  • Pain levels
  • Range of motion progress
  • Fracture healing
  • Functional improvement
  • Potential complications (especially premature physeal closure)

• Continue regular follow-up for at least 6 months to:

  • Monitor return to pre-injury function and mobility
  • Detect potential complications such as premature physeal closure 1
  • Studies show premature physeal closure can occur in up to 43% of distal tibia Salter-Harris II fractures despite appropriate treatment 3

Special Considerations

• Displaced fractures have higher complication rates:

  • Up to 17% complication rate in displaced fractures vs. 2% overall 4
  • Premature physeal closure risk increases with greater displacement

• Surgical vs. non-surgical for borderline cases (2-4mm displacement):

  • Research shows similar premature physeal closure rates between surgical (46%) and non-surgical (33%) treatment for fractures with 2-4mm displacement 3
  • Surgical fixation with anatomic reduction may improve joint alignment but does not necessarily reduce premature physeal closure incidence 3

• Warning signs requiring urgent reassessment:

  • Increasing pain
  • Loss of reduction
  • Signs of compartment syndrome
  • Neurovascular compromise

Prevention of Subsequent Fractures

• For patients over 50 years with fragility fractures:
  • Evaluate for risk of subsequent fractures
  • Consider calcium (1000-1200 mg/day) and vitamin D (800 IU/day) supplementation
  • Implement fall prevention strategies 1