Adult 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.
  • 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.