In this section
Distal radial physeal fractures - Emergency Department
Long-term prognosis is based on the type of physeal injury. Salter-Harris III and IV will have longer follow-up (at 6-12 months) to watch for a growth arrest. Table 1 shows the recommended follow-up schedule.
Table 1: Recommended follow-up schedule for distal radial physeal fractures.
Subsequent review appointments
Discharge advice to parents
Type I & II -undisplaced
Within 5 days post-immobilisation with x-ray
At 4 weeks post-immobilisation. X-ray out of backslab or splint
If x-ray findings satisfactory and clinical exam normal, discharge
Parents should be warned to re-present if child develops angular deformity
2-3 months for return to full contact sports
Type I & II - displaced
Within 5 days post-reduction with x-ray
At 2 weeks post-reduction with x-ray
At 4 weeks post-reduction with x-ray out of cast
If x-ray findings satisfactory, discharge
Older children (
<2 years growth remaining) need closer follow-up due to less remodelling potential
Type III & IV - displaced
As per post-operative instructions
Removal of pins usually occurs at 4 weeks
Physeal fractures need a recheck with x-rays approx. 6 months after injury to check for a growth arrest
The cast should be checked at each visit, to ensure that it is moulded properly and fitting well, so not to allow further loss of reduction.
The risk of growth arrest should also be evaluated. Physeal injuries to the distal ulna should be carefully checked as there is a higher risk of growth arrest.
Physeal fractures should not be re-manipulated after five days from injury due to increased risk of further damaging the growth plate. Fractures with angulation up to 20 degrees (as seen on lateral x-ray) should remodel if there is two years or more of growth remaining.
The overall risk of physeal arrest after distal radial physeal fracture is approximately 4%. The higher the Salter-Harris fracture classification number, the greater the chance of growth arrest.
Malunion can occur if the fracture is mal-reduced or reduction is lost without close follow-up.
Indications for a consultant orthopaedic surgeon opinion are:
For Salter-Harris fracture types III and IV, after recheck at 6-12 months showing no growth plate injury or malunion, patients should be discharged.
Bae D. Pediatric distal radius and forearm fractures. J Hand Surgery 2008; 33: 1911-23.
Bae DS, Waters PM. Pediatric distal radius fractures and triangular fibrocartilage complex injuries. Hand Clin 2006; 22: 43-53.
Waters PM, Bae DS. Fractures of the distal radius and ulna. In Rockwood and Wilkins'Fractures in Children, 7th Ed. Beaty JH, Kasser JR (Eds). Lippincott Williams & Wilkins, Philadelphia 2010. p.292-346.