• Fracture of the joint’s rim that leads to instability. Generally require surgery.
  • Appearance is similar to Colle or Smith fracture, but has intra-articular involvement.
  • Can cause either volar or dorsal displacement.

Reduction Goals

  1. Length: <5mm of shortening
  2. Volar/Palmar Tilt: <5° dorsal angulation or within 20° of the other wrist
  3. Step off: <2mm
  4. Radial Inclination: <5° change

Normal wrist anatomy:

  • 11° of volar tilt
  • 23° of radial inclination
  • 13mm radial height


  • Salter-Harris II: Up to 15° of angulation and 1 cm of shortening will generally remodel. Remodeling has been estimated to be 10° of angulation per year of remaining growth.

Pediatric patients can be placed in a bivalved cast (long arm or short arm) if expertise is available.

Reduction Tips:
Apply longitudinal traction and then "recreate" the injury by accentuating the deformity before applying dorsal or volar pressure to reduce the fracture.