OPERATIVE VERSUS NONOPERATIVE MANAGEMENT OF SALTER-HARRIS TYPE II DISTAL RADIUS FRACTURES IN CHILDREN: A RETROSPECTIVE COHORT STUDY.

BACKGROUND

Salter-Harris type II distal radius fractures are the most common physeal injuries in children. Although closed reduction and cast immobilisation are widely used, concerns about loss of reduction have led to increasing use of Kirschner wire fixation. The relative benefit of routine wire fixation following intraoperative reduction remains uncertain.

METHODS

We performed a retrospective cohort study of 57 children aged 5-16 years treated for Salter-Harris type II distal radius fractures at a single centre between 2019 and 2024. All underwent manipulation under anaesthesia and were managed with either Kirschner wire fixation and cast immobilisation (n=30) or plaster of Paris immobilisation alone (n=27). Radiographic outcomes (radial inclination and volar tilt) were measured before surgery and at final follow-up. Within-group changes were analysed using paired t-tests and between-group differences using Welch's t-tests.

RESULTS

Radiographic alignment improved significantly across the cohort. Volar tilt increased by a mean of +13.7° (95% CI 9.8-17.5, p<0.001) and radial inclination by +5.1° (95% CI 3.6-6.6, p<0.001). Both groups demonstrated significant within-group improvement, but between-group differences were small and not statistically significant (radial inclination Δ diff +1.5°, p=0.32; volar tilt Δ diff +1.9°, p=0.63). No complications, including pin-site infection or physeal arrest, were recorded.

CONCLUSION

Both Kirschner wire fixation and cast immobilisation following manipulation under anaesthesia produced satisfactory early radiographic outcomes in children with Salter-Harris type II distal radius fractures. Routine wire fixation is not required in every case and should be reserved for older children or fractures judged unstable at the time of reduction.