Paeds Trauma iSAWE 11

Question

An 11 year old girl falls from a trampoline onto her outstretched hand.

Paeds Trauma iSAWE 11, lateral radiograph of the distal forearm
Lateral radiograph of the distal forearm. Image by Nevit Dilmen (talk), Wikimedia Commons, CC BY-SA 3.0.
  1. Describe the radiograph and classify the injury.
  2. How would you treat it and what are the limits of manipulation?
  3. What follow up is needed?

Answer

Radiograph

  • Dorsally displaced fracture through the distal radial physis
  • Salter-Harris type II, with a metaphyseal fragment
  • The most common physeal injury

Salter-Harris

TypeFracture line
IThrough the physis
IIPhysis and metaphysis
IIIPhysis and epiphysis
IVMetaphysis, physis and epiphysis
VCrush of the physis

Treatment

  • Closed reduction under sedation or anaesthesia within 7 days
  • Avoid repeated or late manipulation (after about 7 to 10 days), it injures the physis
  • Above elbow cast for 3 to 4 weeks
  • Percutaneous K-wire if unstable or with swelling
  • Accept residual angulation, remodelling is good near the wrist
  • Median nerve symptoms need urgent reduction and possible carpal tunnel release

Follow up

  • Radiographs at 6 to 12 months to detect growth arrest
  • Growth arrest in about 4 to 5%
  • Ulnar positive variance and ulnocarpal impaction if the radius stops growing
  • Epiphysiodesis of the ulna or radial lengthening for arrest

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.