J Korean Fract Soc.  2008 Jul;21(3):225-231. 10.12671/jkfs.2008.21.3.225.

Epiphyseal Fractures of the Distal Radius in the Children

• Kim HT
• Youn MS
• Lee JS
• Choi YJ
• Seong YJ

• KMID: 2015446
• DOI: http://doi.org/10.12671/jkfs.2008.21.3.225

Abstract

PURPOSE: To evaluate the long-term results of treatment of epiphyseal fractures of the distal radius in children.
MATERIALS AND METHODS
23 cases of distal radial epiphyseal fracture, treated by two methods: group 1, closed reduction (CR) plus cast (6 cases); group 2, CR and K-wire fixation (under anesthesia due to marked translation of the distal fragment and swelling) plus cast (17 cases), were selected for this study. All patients were followed up for more than 1 year (average: 3.2 years). Postoperatively, epiphyseal displacement and epiphyseal angulation were measured on anteroposterior and lateral radiographs. At follow-up, the affected and normal sides were compared. Final results were classified by radiologic (radial inclination, volar tilting and radial shortening) and clinical (limitation of ROM, wrist pain, grip strength and wrist deformity) criteria.
RESULTS
Group 1 had 5 good, 1 fair result; group 2 had 14 good, 2 fair and 1 poor - there was no statistically significant difference between two groups. All cases where the epiphyseal displacement was less than 30% had good results. A poor case showed a radial shortening, wrist deformity and pain due to premature epiphyseal closure. Premature epiphyseal closure was treated by bar resection and free fat, along with corrective osteotomy when necessary and lengthening of radius with or without epiphysiodesis of the ulna.
CONCLUSION
Remodeling can be expected in epiphyseal fractures of the distal radius. Repeated forceful attempts to achieve accurate reduction should be avoided to prevent secondary physeal injury.

Keyword

Epiphyseal fracture of distal radius

MeSH Terms

Anesthesia
Child
Congenital Abnormalities
Displacement (Psychology)
Follow-Up Studies
Hand Strength
Humans
Osteotomy
Radius
Wrist

Figure

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  Fig. 1 Measurement of the epiphyseal angle and displacement of the growth plate of the distal radius on A-P and lateral radiographs.

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  Fig. 2 (A) A-P and lateral radiographs of an 8-year-old boy who sustained a Salter-Harris type II growth plate injury in the distal radius. (B) Closed reduction was achieved at the first attempt and a long arm cast was applied. Postoperatively, the epiphyseal angle was 12° and the displacement was 30%. (C) Radiographs taken 5 years and 5 months after trauma show satisfactory results. This patient showed no clinical complications at the last follow up.

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  Fig. 3 (A) Radiographs of an 11-year-old boy who sustained a Salter-Harris type II growth plate injury in the distal radius. (B) Closed reduction was attempted 4 to 5 times and K-wires were used to maintain reduction. (C) Two years after injury, radiographs show 5 mm of radial shortening and a wrist deformity involving 15° of radial inclination and 15° of volar tilting, due to central bar formation of the distal radial physis. This patient complained of poor grip strength. (D) Resection of the physeal bar, fat graft and corrective osteotomy of the distal radius were performed (A-P radiographs following surgery). (E) 2 years and 6 months after surgery, the radius again observed to be 5 mm shorter than the ulna. (F) Ulnar shortening through the growth plate was performed, with simultaneous epiphysiodesis of the ulna. (G) Final follow-up radiographs showed a satisfactory result.

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