What are the implications of a distal radial epiphyseal (growth) plate displacement of 1 centimeter in a dorsal direction?

From the Guidelines

A distal radial growth plate displaced 1 cm dorsally requires immediate orthopedic consultation for reduction and stabilization. This injury, known as a Salter-Harris fracture, needs prompt treatment to prevent growth disturbances and long-term deformity. The displacement of 1 cm is significant and may be considered as intra-articular displacement, which according to the study by 1, suggests surgical fixation for fractures with intra-articular displacement. Initial management includes immobilization with a well-padded splint in slight flexion and ulnar deviation while awaiting definitive treatment.

• Key considerations for initial management include:
  • Pain control with age-appropriate analgesics such as ibuprofen (10mg/kg every 6 hours) or acetaminophen (15mg/kg every 4-6 hours)
  • Elevation of the extremity above heart level and application of ice for 20 minutes every 2-3 hours to reduce swelling
• Definitive treatment may involve closed reduction under sedation or general anesthesia, followed by cast immobilization for 4-6 weeks. However, given the significant displacement, surgical intervention with pins may be necessary to achieve adequate alignment, as suggested by the study 1.
• Follow-up radiographs are essential at 1 week to ensure maintained reduction and then periodically to monitor growth plate function. This injury requires careful attention because the distal radial growth plate contributes significantly to the radius's longitudinal growth, and disruption can lead to growth arrest or angular deformities.

From the Research

Distal Radial Growth Plate Displacement

• A distal radial growth plate displaced 1 cm dorsally is a significant injury that requires proper treatment to ensure optimal outcomes.
• According to 2, open reduction and internal fixation using plates and screws can be an effective treatment for displaced distal radius fractures in patients over 60 years of age, with satisfactory reduction achieved in all 18 fractures and no instances of loss of fracture reduction during the study period.
• However, the study by 3 found that fixed-angle volar plating can provide rigid fixation and stable recovery of grip and pronosupination strength, but may entail a risk of pronation strength loss and distal radioulnar joint destabilization.
• In pediatric patients, the choice between open reduction and internal fixation (ORIF) and cast placement depends on factors such as fracture severity, patient's age, and specific characteristics of the injury, as suggested by 4.
• The study by 5 found that a persistent articular gap and step-off of ≥1 mm after a distal radial fracture may lead to post-traumatic arthritis of the radiocarpal joint, and that arthroscopic assessment of the reduction in the articular surface can be useful in evaluating the need for further treatment.
• Another study by 6 found that preoperative radiographic criteria can be developed to help determine which distal radius fractures may need arthroscopic evaluation, and that a cutoff value of 5.80 mm for the sum of preoperative displacements determined by lateral radiography and coronal CT scan can be a good indicator for residual articular displacement after internal fixation.

Treatment Options

• Open reduction and internal fixation (ORIF) using plates and screws is a common treatment for displaced distal radius fractures, as seen in 2 and 4.
• Fixed-angle volar plating is another treatment option, as discussed in 3, which can provide rigid fixation and stable recovery of grip and pronosupination strength.
• Cast placement is also a treatment option, particularly for pediatric patients, as suggested by 4.
• Arthroscopic evaluation and treatment may be necessary in some cases, as discussed in 5 and 6, to assess and address residual articular displacement and other complications.

Outcomes and Complications

• The outcomes of treatment for distal radial growth plate displacement can vary depending on the severity of the injury, the treatment approach, and other factors, as seen in 2, 3, and 4.
• Complications such as malunion, nonunion, and device failure can occur, as discussed in 2 and 3.
• Post-traumatic arthritis of the radiocarpal joint is a potential long-term complication, as suggested by 5.
• Other complications such as reflex sympathetic dystrophy syndrome and post-traumatic carpal tunnel syndrome can also occur, as seen in 3.