Management options and outcomes for Salter–Harris type 3 and 4 fractures of the proximal phalanx of the hallux in children

Epiphyseal fractures of the proximal phalanx of the hallux are rare in pediatric patients. While various management techniques exist, studies detailing outcomes, complications, and pathogenic mechanisms of Salter–Harris (S-H) 3 and S-H 4 fractures in children are limited. This study evaluates the radiographic, clinical, and functional outcomes of pediatric patients with these injuries and identifies potential risk factors for adverse results. A retrospective review was conducted on 11 pediatric patients diagnosed with S-H 3 and S-H 4 fractures. Demographics, injury mechanisms, and treatment modalities were collected. Radiographic and clinical evaluations assessed fracture healing, range of motion (ROM), and the presence of premature physeal closure (PPC) or other complications over multiple follow-up intervals. The cohort included six S-H 3 and five S-H 4 fractures (mean age: 12.9 years). Mean follow-up was 6.5 ± 3.7 for S-H 4 and 8.5 ± 3.9 years for S-H 3 fractures. Ten cases with displacement less than 2 mm underwent closed reduction and Kirschner (K) wires fixation; one case (>2 mm displacement) required open reduction and a 2.0 mm compression screw. All patients achieved satisfactory radiographic healing without PPC or angular deformity. Clinically, most regained near-normal ROM without major complications such as joint incongruity or infection. Surgical treatment of S-H 3 and S-H 4 hallux fractures using closed reduction and K-wires is safe and effective, ensuring stable fixation and favorable long-term outcomes. PPC rarely results in malalignment because these fractures typically occur when skeletal growth is nearly complete. J Pediatr Orthop B XXX: XXXX–XXXX Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.