The therapeutic attitude in distal radial Salter and Harris type Ⅰ and Ⅱ fractures in children

Introduction: Salter Harris Fractures type, especially type Ⅰ and Ⅱ are treated by orthopedic reduction in the emergency room or operating room, under general anesthesia, followed by plaster immobilization. Neglected or incorrectly treated fractures, leading to malunion and radiocarpal subluxations which require surgical procedure. Purpose: This paper proposes to evaluate the correctly applied orthopedic treatment and the expose of an original surgical technique in case of neglected and incorrectly treated fractures, leading to mal– unions and impediments in the radiocarpal mobility and aesthetics. Material and Method: we studied a group of 238 children with Salter Harris fractures type Ⅰ and Ⅱ, treated in ‘M.S. Curie’ Emergency Hospital for Children, Bucharest. Out of the studied group, 200 children were treated by orthopedic reduction and immobilization in a plaster device. Malunions present within 38 children due to neglected or mistreated fractures, underwent open reduction with internal osteosynthesis by a technique that avoids violating the growth cartilage. This technique involves making an internal fixation with the radial joint surface in a normal position. Results: Children receiving proper orthopedic reduction and immobilization in plaster device, 200 patients, were cured after 30–45 days of immobilization, depending on age and joint mobility which were within normal range. The 38 children with malunions underwent surgery to rectify the position of the radial joint surface. Postoperative results were good, proper position of the radiocarpal joint were made during the surgical procedure. The internal fixation is ensured by a transepiphyseal wire and after 30 days of immobilization in a plaster device the patients started the recovery treatment. Radiocarpal joint mobility returned to normal after a variable period of 3 to 6 months, depending on the patient's age. Conclusions: Salter Harris Ⅰ and Ⅱ fractures are absolute indication for orthopedic treatment, in a matter of emergency, preferably in the operating room under general anesthesia. Verification is necessary between the 7(th) and 14(th) day after orthopedic reduction, to avoid malunions. Malunited fractures require surgical intervention after a special technique, avoiding damage to the growth cartilage and radial epiphysis.