From the Guidelines
For an undisplaced Salter-Harris type I fracture of the distal fibula with a vertical component, treatment typically involves immobilization with a cast or walking boot for 4-6 weeks, with gradual weight bearing and alphabet movements advised to prevent stiffness and maintain joint mobility. The goal of treatment is to promote fracture healing while minimizing the risk of complications, such as growth disturbances or ligamentous injuries. According to the evidence, functional support is preferred over immobilization, especially the use of a brace 1.
Key Considerations
- Gradual weight bearing is generally advised, starting with non-weight bearing for 1-2 weeks, then progressing to partial weight bearing as pain allows, and finally to full weight bearing.
- Alphabet movements (ankle range of motion exercises where the patient "writes" the alphabet with their foot) are beneficial once the acute pain subsides, usually after 1-2 weeks, to prevent stiffness and maintain joint mobility.
- Physical therapy may be recommended after immobilization to restore strength and function.
- Regular follow-up with radiographs is important to ensure proper healing and to monitor for growth disturbances, which can occur with physeal injuries.
Evidence-Based Recommendations
The evidence suggests that exercise therapy should be started as soon as possible to recover joint functionality 1. Additionally, functional support is effective in preventing recurrent ankle sprains, and exercise therapy has only shown a significant preventive effect for recurrent ankle sprains 1.
Treatment Approach
The treatment approach should prioritize functional support, exercise therapy, and gradual weight bearing to promote fracture healing and prevent complications. Immobilization should not be used in the treatment of a lateral ankle sprain, and surgery should be reserved for patients with lateral ligament ruptures or those who require quick recovery 1.
Conclusion is not allowed, so the answer will be ended here.
From the Research
Treatment of Salter-Harris Fracture
The treatment of Salter-Harris fracture depends on the type and severity of the fracture. According to the studies, treatment options include:
- Medical management for type I to III fractures 2
- Surgical intervention for type IV and V fractures, or for complicated cases such as those with osteomyelitis or avascular necrosis 2, 3
- Operative treatment for displaced Salter-Harris type I distal fibula fractures 3
- Rehabilitation programs that incorporate therapeutic alliance concepts for elite pediatric athletes with complicated recoveries 4
Gradual Weight Bearing and Alphabet Movements
There is no direct evidence in the provided studies to support or advise against gradual weight bearing and alphabet movements for the treatment of Salter-Harris fracture. However, the studies suggest that rehabilitation programs should be tailored to the individual patient's needs and goals, and may include exercises to improve range of motion, strength, and function 4, 5.
Key Considerations
When treating Salter-Harris fractures, it is essential to consider the following:
- The type and severity of the fracture
- The patient's age and overall health
- The presence of any complications, such as osteomyelitis or avascular necrosis
- The need for surgical intervention or medical management
- The importance of rehabilitation programs that incorporate therapeutic alliance concepts to facilitate successful recovery and return to activity 2, 3, 4, 5, 6