Management of Nondisplaced Salter-Harris 2 Fracture of the 2nd PIP Joint
A nondisplaced Salter-Harris 2 fracture of the 2nd proximal interphalangeal (PIP) joint should be managed with closed reduction (if any displacement exists) followed by immobilization with buddy taping or a short splint for 3-4 weeks, with early follow-up radiographs at 7-14 days to confirm maintained alignment.
Initial Management Approach
Immobilization Strategy
Nondisplaced Salter-Harris fractures are absolute indications for conservative orthopedic treatment, preferably performed urgently to prevent displacement 1.
For nondisplaced fractures of the digits, immobilization can be achieved through:
- Buddy taping to the adjacent finger (3rd digit) to provide support while allowing some controlled motion
- Short aluminum splint maintaining the PIP joint in slight flexion (15-20 degrees) for comfort and stability
- Duration of immobilization: 3-4 weeks depending on clinical healing and patient age 1
Critical Early Follow-Up
Mandatory radiographic verification between days 7-14 post-reduction is essential to detect any loss of reduction or displacement 1.
This early follow-up is crucial because neglected or incorrectly treated Salter-Harris fractures can lead to malunion, requiring subsequent surgical intervention 1.
Key Management Principles
Why Conservative Treatment Works
Salter-Harris type I and II fractures have excellent healing potential when properly immobilized, with most achieving normal joint mobility within 30-45 days 1.
The metaphyseal fragment in SH2 fractures provides inherent stability compared to pure physeal injuries, making these fractures amenable to conservative management when nondisplaced.
Monitoring for Complications
Watch for premature physeal closure, though this is less common in finger fractures compared to weight-bearing bones like the distal tibia (where PPC rates can reach 29-55%) 2, 3.
Signs requiring urgent reassessment include:
- Increasing pain or swelling
- Loss of finger alignment
- Inability to achieve gentle active motion after immobilization period
Treatment Algorithm
- Confirm nondisplaced status on AP and lateral radiographs
- Apply buddy taping or short splint with PIP in slight flexion
- Schedule follow-up at 7-10 days with repeat radiographs to confirm maintained alignment 1
- Continue immobilization for 3-4 weeks total if alignment maintained
- Begin gentle range-of-motion exercises after immobilization period
- Expect full recovery of joint mobility within 3-6 months depending on patient age 1
Common Pitfalls to Avoid
Failure to obtain early follow-up radiographs (7-14 days) is the most common error leading to missed displacement and subsequent malunion 1.
Over-immobilization beyond 4 weeks can lead to unnecessary stiffness in the PIP joint, which is prone to contracture.
Inadequate initial immobilization allowing micromotion can convert a nondisplaced fracture to a displaced one requiring surgical intervention.
When Surgery Becomes Necessary
If displacement occurs despite proper immobilization, open reduction with internal fixation using techniques that avoid violating the growth cartilage may be required 1.
Malunited fractures that present late require surgical correction to restore radiocarpal (or in this case, digital) joint alignment and prevent long-term functional impairment 1.