Treatment of Salter Harris 2 Fracture of the Wrist
The treatment for a Salter Harris type 2 fracture of the wrist primarily involves closed reduction and immobilization in a cast with the wrist in a flexed position to prevent displacement. 1
Initial Management
- Radiography is always indicated as the initial imaging for suspected wrist trauma, with a standard 3-view examination (posteroanterior, lateral, and 45° semipronated oblique view) 2
- For minimally displaced fractures (<2-3mm displacement), closed reduction followed by immobilization in a cast is the standard treatment 1, 3
- Immobilization should be performed in a way that counteracts angulation forces - for apex-volar deformities, the wrist should be immobilized in >45° of flexion to reliably prevent secondary displacement 1
Immobilization Technique
- A short arm cast is typically used for initial immobilization 2
- For apex-dorsal fractures, palmar flexion of 45° allows for reliable reduction and prevention of displacement 1
- Active finger motion exercises should be performed following diagnosis to prevent stiffness, which is one of the most functionally disabling adverse effects 2, 4
- Finger motion does not adversely affect adequately stabilized fractures in terms of reduction or healing 2
Follow-up Care
- Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization cessation to confirm adequate healing 4
- Duration of immobilization is typically 3-6 weeks, depending on the stability of the fracture and signs of healing 1
- If there is clinical concern about premature physeal closure, further imaging may be warranted 5
Surgical Management
- For significantly displaced fractures (>3-4mm) or those that cannot be adequately reduced by closed means, surgical intervention with open reduction and internal fixation may be necessary 3, 6
- Surgical fixation with anatomic reduction and removal of interposed tissue may be necessary to improve joint alignment in severely displaced fractures 5
Potential Complications
- Premature physeal closure is a potential complication that should be monitored during follow-up 5, 6
- Stiffness of the fingers can result from prolonged immobilization, pain, swelling, or apprehension 2
- Secondary displacement can occur if the fracture is not properly immobilized in the appropriate position 1
Special Considerations
- The degree of wrist flexion in the cast is critical - studies show that >45° of flexion for apex-volar deformities provides reliable protection against secondary displacement 1
- Patients with initial displacement ≥4mm have significantly higher odds of developing premature physeal closure 6
- A home exercise program for finger motion should be implemented during the immobilization period 2