DonJoy Brace for Salter-Harris II Fracture of Dorsal Distal Radius
A DonJoy dorsal nighttime orthosis (removable splint) is NOT suitable as the primary immobilization device for a Salter-Harris II fracture of the distal radius, regardless of displacement status. These fractures require more substantial immobilization than a nighttime-only brace can provide.
Primary Treatment Approach
For non-displaced or minimally displaced (<3mm) Salter-Harris II fractures:
- Immediate closed reduction under general anesthesia in the operating room or emergency department with conscious sedation is the standard approach 1
- Full-time immobilization with a cast or rigid splint (not a nighttime-only brace) for 30-45 days depending on patient age 1
- The immobilization device must allow full finger range of motion but provide continuous wrist stabilization 2, 3
For displaced fractures (≥3mm displacement):
- Closed reduction followed by cast immobilization is indicated 4
- If closed reduction fails to achieve <3mm residual displacement, open reduction with internal fixation is required 1, 4
- Surgical technique must avoid violating the growth cartilage 1
Why DonJoy Brace is Inadequate
A DonJoy dorsal nighttime orthosis provides only intermittent immobilization during sleep hours, which is fundamentally incompatible with the treatment requirements for physeal fractures:
- Salter-Harris II fractures require continuous immobilization for 30-45 days to prevent malunion 1
- Even initially non-displaced fractures can displace during healing, requiring full-time stabilization 2
- Nighttime-only bracing would allow uncontrolled wrist motion during waking hours, risking loss of reduction and growth plate damage 1
Critical Management Points
Mandatory radiographic follow-up:
- Verification radiographs between days 7-14 after reduction to detect early malunion 1
- Follow-up at approximately 3 weeks to confirm maintenance of alignment 2, 3
- Repeat imaging at time of immobilization removal 2, 3
Immediate finger mobilization:
- Begin active finger motion exercises immediately after immobilization to prevent stiffness 2, 5, 3
- The splint must never obstruct full finger range of motion 2, 5
- Finger motion does not adversely affect adequately stabilized radius fractures 3
Common Pitfalls to Avoid
- Never use inadequate immobilization devices like nighttime-only braces for acute fracture management, as this leads to malunion requiring surgical correction 1
- Do not delay radiographic verification beyond 14 days, as undetected displacement necessitates more complex surgical intervention 1
- Avoid prolonged immobilization beyond what is necessary for healing (typically 30-45 days), as extended immobilization increases stiffness risk 2, 5
- Monitor for unremitting pain during follow-up, which may indicate complications requiring reevaluation 6, 5
When Surgical Intervention Becomes Necessary
Surgical fixation is indicated when:
- Post-reduction displacement exceeds 3mm 2, 3, 4
- Closed reduction fails to achieve adequate alignment 1, 4
- Malunion develops from neglected or inadequately treated fractures 1
The surgical technique must use transepiphyseal fixation that avoids damaging the growth cartilage, followed by 30 days of cast immobilization and 3-6 months of rehabilitation 1.