Follow-up radiographs at 10 days to 2 weeks may also show a periosteal reaction subsequent to fracture healing. Some people advocate radiographic stress views to demonstrate fracture instability when attempting to rule out a physeal fracture. I feel that this strategy only adds injury to injury. If the fracture is, in fact, displaced, the radiograph will show it. Any new information provided by stressing the knee won't affect management, and the stress maneuver may cause further physeal and epiphyseal damage.
Management depends on the type of fracture.
Type I fractures involve only the physis. If there is no displacement with a type I fracture, I apply a cylinder or long leg cast, with use of crutches and protective weight bearing for 4 weeks, followed by rehabilitation to restore motion and strength. Type II fractures involve the metaphysis as well as the physis. If patients have type I or type II fractures with displacement, reduction is required. This can usually be done closed, by manipulation.