Remodeling of Salter Harris Type II Epiphyseal Plate Injury of the Distal Radius

Author(s): Houshian S, Holst A K, Larsen M S, Torfing T

Source:  J Pediatr Orthop 24:472-476, 2004

Summary:

Salter-Harris II distal radius fractures are common in children.  This study evaluated 85 patients after such a fracture at a single institution. There were 55 boys and 30 girls.  The median age at the time of fracture was 11 years.  Twenty-two patients did not require closed reduction.  The remaining patients underwent closed reduction for considerable angulation and/or displacement.  Eighty-one patients had residual dorsal angulation and four patients had residual volar angulation after immobilization.  Three patients had residual radial deviation between 12 and 15 degrees. Twenty patients had axial displacement of the fracture at the time of injury, and 53 patients had ipsilateral fractures of the distal ulna and/or carpal bones.

Premature closure of the growth plate was not observed in any children.  At follow-up, 73 (86%) of the patients were anatomically remodeled.  The remaining 12 patients had some abnormal volar and/or radial inclination of the distal radius.  Complete remodeling was seen in almost all children up to ten years of age.  Children older than ten years of age had increased chance of residual angulation.  Many of these children, however, still had open growth plates, which may allow future remodeling.  Mobility of the wrist and forearm was normal in all patients.  Grip strength was also normal.  Four patients complained of mild pain after work or sports-related activity.

This article makes many interesting points regarding Salter-Harris II fractures of the distal radius.  While many of these injuries are sheering by mechanism, damage to the epiphyseal plate growth cells is extremely rare.  The authors limited closed reduction to two attempts, which may prevent any iatrogenic injury to the growth plate.  Remarkably, remodeling was noted in almost all children up to the age of ten years.  Even older children with incomplete remodeling still demonstrated full range of motion and had minimal complaints.  The information from this article can be used with that of prior studies suggesting remodeling potential of approximately 1 degree per month or 10 degrees per year in the plane of motion in children under 10 years of age (Friberg KSI:  Acta Orthop Scand 1979).  It cannot, however, be extrapolated to intra-articular Salter-Harris III fractures of the distal radius. 

 

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