Management of Salter-Harris II Distal Radius Fractures in Children

Treatment Principles

• The American Academy of Orthopaedic Surgeons recommends that finger motion should not be restricted at any point during treatment, as this increases stiffness risk without improving fracture stability 1
• The American Academy of Orthopaedic Surgeons suggests that surgical fixation should be considered if post-reduction radial shortening is greater than 3 mm, dorsal tilt is greater than 10°, or persistent displacement occurs 2, 3, 4, 5

Cast Management

• A well-molded cast with excellent three-point molding and a cast index less than 0.8 at the fracture site is crucial to prevent loss of reduction, and the cast must never obstruct full finger range of motion 1
• Active finger motion exercises should be initiated immediately to prevent stiffness, as finger motion does not adversely affect adequately stabilized fractures 1

Follow-Up and Monitoring

• Radiographs should be obtained at approximately 1 week post-reduction to detect early loss of reduction, and continue radiographic monitoring at 3 weeks and at cast removal 1