BACKGROUND: Despite the frequent occurrence of these injuries, we know little about the natural history of Salter-Harris II (SH II) distal radius fractures. We conducted a systematic review of studies examining the radiographic and clinical outcomes of nonoperatively managed SH II distal radius fractures. METHODS: Systematic searches of the MEDLINE and Cochrane computerized literature databases and manual searches of bibliographies were performed. We reviewed both descriptive and quantitative data. RESULTS: Seven studies including 434 SH II fractures were reviewed. Two studies reported clinical outcomes based on patient age, but neither study described a statistical correlation between patient age and outcome. Two studies discussed the effect of age on radiographic outcome and reported higher rates of anatomic remodeling in children 10 years or younger. Two studies with long-term (average follow-up greater than 8 years) clinical results reported complication rates of 5%. Long-term follow-up of radiographic outcomes appeared in 4 studies with variable results. Five studies reported the frequency of premature physeal arrest after SH II fractures, with results ranging from 0% to 4.3%. CONCLUSIONS: Based on this review, no recommendations can be made as to what defines an acceptable reduction or which fractures would benefit from surgical intervention. Angular deformity seems to correct to an acceptable alignment in patients less than 10 years of age, but these younger patients seem to be at higher risk for symptomatic shortening if a growth arrest occurs. Redisplacement after reduction is fairly common, and other more severe complications such as pain, loss of motion, and nerve injury can occur.