What is the management for a non-displaced Salter-Harris type 2 fracture?

Management of Non-Displaced Salter-Harris Type II Fractures

Non-displaced Salter-Harris type II fractures should be managed with conservative treatment consisting of immobilization with an appropriate splint or cast, followed by early protected motion therapy to prevent stiffness and optimize functional outcomes. 1

Initial Management

• Apply appropriate immobilization based on fracture location:

  • Buddy taping, aluminum/thermoplastic splint, or custom-molded splint 1
  • For distal tibia fractures, a non-weight-bearing long-leg cast is recommended for fractures with <2mm displacement 2
  • Immobilization period typically lasts 30-45 days, depending on patient age 3

• Verify reduction between 7-14 days after initial immobilization to ensure proper alignment and avoid malunions 3

Key Decision Points

1. Displacement assessment is crucial:

   • <2mm displacement: Conservative management with cast/splint 2
   • 2-4mm displacement: Consider closed reduction under anesthesia 4

   • 4mm displacement: May require surgical intervention 2

2. Monitoring for complications:

   • Regular radiographic follow-up at 2-week intervals initially 1
   • Monitor for premature physeal closure, which occurs in approximately 29-33% of cases even with proper management 2

Rehabilitation Protocol

• Early protected motion is critical once the fracture is stable 1
• Progress through rehabilitation phases:
  1. Protected motion and pain control (0-4 weeks)
  2. Gentle passive range of motion exercises (around 4 weeks)
  3. Active-assisted range of motion as tolerated
  4. Strengthening exercises after radiographic evidence of healing 1

Prevention of Complications

• The most significant complication is premature physeal closure (PPC), occurring in up to 43% of cases overall 2
• For patients over 50 years with fragility fractures, consider:
  • Calcium (1000-1200 mg/day) and vitamin D (800 IU/day) supplementation
  • Fall prevention strategies
  • Bone health assessment 5, 1

Special Considerations

• Surgical intervention is indicated when:

  • Closed reduction fails to achieve <3mm displacement
  • Fracture is unstable after reduction
  • There is evidence of neurovascular compromise or compartment syndrome 6

• Caution: Even with surgical fixation and anatomic reduction, the risk of premature physeal closure remains high and is not significantly reduced compared to conservative management 2

Follow-up Protocol

• Clinical and radiographic follow-up for at least 6 months 1
• Monitor for:
  • Return to pre-injury function and mobility
  • Signs of premature physeal closure
  • Growth disturbances
  • Need for subsequent procedures (epiphysiodesis, osteotomy) 2

Common Pitfalls to Avoid

• Failing to verify reduction within 7-14 days, which can lead to malunions requiring surgical correction 3
• Neglecting early motion therapy, which can result in joint stiffness and poor functional outcomes 1
• Inadequate monitoring for premature physeal closure, which can lead to growth disturbances 2