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
- 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.
Apply longitudinal traction and then "recreate" the injury by accentuating the deformity before applying volar pressure to reduce the fracture.