What is the management of Salter-Harris type 1 (fracture of the growth plate) fracture of the wrist?

From the Guidelines

Management of a Salter-Harris type 1 fracture of the wrist typically involves simple immobilization, as surgery is not usually required for this type of fracture, especially when fracture fragments are small, nonarticular, or minimally displaced, as noted in 1. The initial treatment should include ice application for the first 48-72 hours to reduce swelling, elevation of the wrist above heart level, and pain management with acetaminophen or ibuprofen.

• Immobilization with a well-padded short arm cast for 3-4 weeks is recommended to allow proper healing.
• The cast should be kept dry and clean, and the patient should be monitored for signs of compartment syndrome such as increasing pain, pallor, paresthesia, or paralysis.
• Follow-up radiographs are recommended at 1-2 weeks to ensure proper alignment and at 3-4 weeks to confirm healing before cast removal.
• After cast removal, gentle range of motion exercises should be initiated, gradually increasing in intensity over 2-3 weeks, as most Salter-Harris type 1 fractures have excellent outcomes with minimal risk of growth disturbance since the growth plate remains intact, as implied by the general principles of fracture management in 1. Key considerations in the management of Salter-Harris type 1 fractures of the wrist include:
• Monitoring for complications such as premature growth arrest or malunion, especially if the patient experiences persistent pain, swelling, or limited motion after cast removal.
• Ensuring proper alignment and healing through regular follow-up radiographs, as suggested by the principles outlined in 1.

From the Research

Management of Salter Harris 1 Fracture of the Wrist

• The management of Salter Harris 1 fracture of the wrist typically involves orthopedic reduction in the emergency room or operating room, under general anesthesia, followed by plaster immobilization 2.
• Neglected or incorrectly treated fractures can lead to malunion and radiocarpal subluxations, which may require surgical procedure 2.
• In cases of malunion, surgical intervention with a special technique that avoids damaging the growth cartilage and radial epiphysis may be necessary 2.
• The use of internal fixation with a transepiphyseal wire and immobilization in a plaster device for 30 days can help ensure proper healing and return of radiocarpal joint mobility 2.
• Verification of the fracture reduction is necessary between the 7th and 14th day after orthopedic reduction to avoid malunions 2.

Complications and Special Considerations

• Salter Harris 1 fractures can be complicated by osteomyelitis, particularly in patients with sickle cell disease, and may require surgical intervention 3.
• In cases of concomitant injuries, such as anterior cruciate ligament (ACL) tears, non-surgical rehabilitation strategies may be necessary to promote healing of the growth plate and facilitate a safe return to sport 4.
• A multidisciplinary approach, including physical therapy rehabilitation, may be essential for managing complex knee injuries in young athletes 4.

Treatment Outcomes

• Proper orthopedic reduction and immobilization can result in cure after 30-45 days of immobilization, depending on age and joint mobility 2.
• Surgical intervention for malunions can result in good postoperative outcomes, with proper position of the radiocarpal joint and return of joint mobility after a variable period of 3 to 6 months 2.