Pearls
Adult reduction goals:
- Length: <5mm of shortening
- Volar/Palmar Tilt: <5° dorsal angulation or within 20° of the other wrist
- Step off: <2mm
- Radial Inclination: <5° change
Normal wrist anatomy:
- 11° of volar tilt
- 23° of radial inclination
- 13mm radial height
Pediatrics:
- 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.
- Salter-Harris III and IV: Risk of growth arrest if not reduced to anatomic alignment.
- Metaphysis Fractures, acceptable angulation by age:
- 4–9 yo Sagittal 15–20°, Coronal 15°
- 9–11 yo Sagittal 10–15°, Coronal 5°
- 11–13 yo Sagittal 10°, Coronal 0°
- >13yo Sagittal 0–5°, Coronal 0°
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 volar pressure to reduce the fracture.