From the Guidelines
For a Salter-Harris type II nondisplaced distal fibula fracture in a 7-year-old child, a short leg posterior splint is the recommended immobilization method. This recommendation is based on the principle of simple immobilization being appropriate for small, nonarticular, or minimally displaced fracture fragments, as suggested by the American College of Foot and Ankle Surgeons 1. The splint should extend from below the knee to the toes, with the ankle positioned at 90 degrees (neutral position), and should be well-padded, particularly around bony prominences, and secured with an elastic bandage. Key considerations for the management of this type of fracture include:
- Immobilization to prevent further injury and allow healing
- Non-weight bearing status to reduce stress on the fracture site
- Regular follow-up with X-rays to monitor the healing process
- Management of pain with appropriate doses of acetaminophen or ibuprofen as needed The choice of a posterior splint for this injury is preferred because it provides adequate stabilization while allowing for potential swelling in the first few days post-injury. It is crucial for the family to be aware of the signs of complications, such as increasing pain, numbness, color changes in the toes, or a loose and uncomfortable splint, and to seek immediate medical attention if these occur. Given the involvement of the growth plate and metaphysis in Salter-Harris II fractures, proper immobilization is key to ensuring a good prognosis, especially in nondisplaced fractures.
From the Research
Treatment Options for Salter Harris II Nondisplaced Distal Fibula Fracture
- Nondisplaced physeal fractures of the distal tibia and fibula can be safely treated nonoperatively 2
- The treatment approach may depend on the fracture pattern, with some patterns being more likely to result in premature physeal closure (PPC) and angular deformity 3
- In cases where closed reduction is unsuccessful, open reduction may be necessary to remove interposed tissue and achieve reduction 4
Splint Type
- There is no specific information in the provided studies regarding the recommended splint type for a Salter Harris II nondisplaced distal fibula fracture in a 7-year-old
- However, it is generally important to immobilize the affected area to allow for proper healing and to minimize the risk of complications
Considerations
- The unique anatomy of the skeletally immature ankle and the mechanism of injury should be taken into account when treating these injuries 2
- The fracture pattern can affect the risk of PPC and angular deformity, with pronation-external rotation (PER) injuries being more likely to result in these complications 3