Treatment of Salter-Harris Type 1 Distal Radius Fracture in a 13-Year-Old
A DonJoy brace (or any removable splint) is NOT sufficient for a Salter-Harris type 1 distal radius fracture in a 13-year-old—this injury requires closed reduction followed by rigid immobilization in a long-arm cast for 4-6 weeks. 1, 2
Why Removable Bracing is Inadequate
Removable splints are only appropriate for stable, minimally displaced buckle fractures—not physeal injuries. 3, 4 The American Academy of Orthopaedic Surgeons explicitly recommends against using removable splints for fractures requiring rigid stabilization. 4
Salter-Harris type 1 fractures involve separation through the growth plate and are inherently at risk for displacement, even after initial reduction. 5, 2 These fractures require rigid immobilization to maintain alignment during the critical healing period.
In a study of 163 physeal injuries with 25-year follow-up, all Salter-Harris type 1 distal radius fractures were treated with long-arm cast immobilization for 6 weeks, not removable bracing. 6
Proper Treatment Algorithm
Initial Management
All distal radius fractures should undergo closed reduction (if displaced) and initial splinting, followed by post-reduction radiographs to assess alignment. 1
Perform the reduction under general anesthesia in the operating room for optimal pain control and muscle relaxation. 2
Apply a long-arm plaster cast for 6 weeks following reduction. 6, 2
Critical Follow-Up
Radiographic re-evaluation at 7-14 days post-reduction is mandatory to detect loss of reduction. 2 This is when re-displacement most commonly occurs, and early detection allows for timely intervention.
Complete re-displacement can occur even after apparently successful closed reduction due to soft tissue interposition (periosteum, flexor tendons, pronator quadratus). 5
When Closed Reduction Fails
If re-displacement is detected at the 1-week follow-up, open reduction with internal fixation using Kirschner wires is indicated. 5, 2
Avoid repeated forceful manipulation attempts, as these increase the risk of growth arrest, compartment syndrome, and avascular necrosis of the epiphysis. 5
Long-Term Prognosis Considerations
Most uncomplicated Salter-Harris type 1 distal radius fractures have excellent long-term outcomes when properly treated. 6 In a 25-year follow-up study, patients were fully asymptomatic after appropriate cast immobilization.
Growth disturbances of >1 cm occurred in only 4.4% of distal radial physeal injuries, and these were primarily in more complex Ogden subtypes (1C, 2B, 2D), not simple type 1 fractures. 6
Immediate active finger motion exercises should be started at diagnosis to prevent finger stiffness, which does not adversely affect adequately stabilized fractures. 1, 4
Common Pitfalls to Avoid
Do not use a removable brace/splint for physeal fractures—this is only appropriate for stable buckle fractures of the metaphysis. 3, 4
Do not skip the 7-14 day radiographic follow-up—this is when occult soft tissue interposition becomes apparent through loss of reduction. 2
Do not assume initial successful reduction will be maintained—complete re-displacement can occur even with seemingly stable initial reductions. 5