From the Guidelines
Surgical fixation is recommended for Salter-Harris type 2 wrist fractures with significant displacement, such as postreduction radial shortening >3 mm, dorsal tilt >10°, or intra-articular displacement. Management of a Salter-Harris type 2 wrist fracture typically involves immobilization with a cast for 4-6 weeks, but surgical intervention may be necessary in cases with significant displacement, as suggested by the study published in The Journal of the American Academy of Orthopaedic Surgeons 1. Initial treatment should begin with pain control using acetaminophen or ibuprofen. The fracture should be immobilized in a long-arm cast for the first 3-4 weeks, followed by a short-arm cast for the remaining period if healing progresses well. Key considerations include:
- Immobilization in a cast for 4-6 weeks
- Pain control using acetaminophen or ibuprofen
- Weekly radiographs for the first 2-3 weeks to ensure proper alignment
- Positioning the wrist in slight flexion and ulnar deviation
- Progressive rehabilitation program after cast removal, starting with gentle range of motion exercises and gradually advancing to strengthening exercises over 4-6 weeks. It is essential to monitor for potential complications such as growth arrest, which can lead to deformity or limb length discrepancy, with close follow-up for 6-12 months, as the growth plate often remains intact on one side, preserving growth potential, but significant displacement may require surgical intervention, as recommended by the study 1.
From the Research
Management of Salter-Harris Type 2 Fractures
The management of Salter-Harris type 2 fractures, particularly in the context of a wrist fracture, involves several key considerations.
- Orthopedic reduction in the emergency room or operating room under general anesthesia, followed by plaster immobilization, is a common approach for treating Salter-Harris type 1 and 2 fractures 2.
- For neglected or incorrectly treated fractures leading to malunion and radiocarpal subluxations, surgical procedure may be necessary 2.
- The position of wrist immobilization after reduction of pediatric distal radial fractures, including Salter-Harris type 2 injuries, can vary, but immobilization in dorsiflexion or a neutral position is often recommended for volar displacement, and palmar flexion or a neutral position for dorsal displacement 3.
- Closed reduction followed by casting is a treatment option for minimally displaced Salter-Harris type 2 fractures of the distal tibia, while open reduction and internal fixation may be necessary for more displaced fractures or those with significant residual displacement after closed reduction 4, 5.
- Surgical management does not necessarily reduce the risk of premature physeal closure in displaced Salter-Harris type 2 fractures of the distal tibia, and the decision for surgical intervention should be based on individual case characteristics 5.
- Conservative treatment is often recommended for Salter-Harris type 1 and 2 distal tibial epiphyseal fractures, while surgery may be indicated for type 3 and 4 fractures to reduce the incidence of premature physeal closure 6.
Key Considerations
- The goal of treatment is to achieve anatomical reduction and maintain it until healing, while minimizing the risk of complications such as premature physeal closure.
- The choice of treatment, whether conservative or surgical, depends on the severity of the fracture, the amount of displacement, and the presence of any associated injuries or complications.
- Close follow-up and monitoring are essential to ensure proper healing and to address any potential complications early on.