Physeal Arrest of the Distal Radius

Abstract

Fractures of the distal radius are among the most common pediatric fractures. Although most of these fractures heal without complication, some result in partial or complete physeal arrest. The risk of physeal arrest can be reduced by avoiding known risk factors during fracture management, including multiple attempts at fracture reduction. Athletes may place substantial compressive and shear forces across the distal radial physes, making them prone to growth arrest. Timely recognition of physeal arrest can allow for more predictable procedures to be performed, such as distal ulnar epiphysiodesis. In cases of partial arrest, physeal bar excision with interposition grafting can be performed. Once ulnar abutment is present, more invasive procedures may be required, including ulnar shortening osteotomy or radial lengthening.

Premature Physeal Closure of an Extraphyseal Distal Radius Fracture Secondary to Smooth Kirschner Wire Fixation: A Case Report

“…This has been reported in the literature between 1 and 7% [1]. Salter-Harris type II patterns are reported as having the highest risk for physeal closure [3].…”

“…Disruption is usually secondary to wrist trauma [1][2][3][4][5]. Closure of the radial growth plate occurs most commonly after Salter fractures which involve the physis.…”

“…Patients can undergo a lengthening osteotomy of the radius, a shortening osteotomy of the ulna (typically with closure of the ulnar physis), or a combination of the two [1,10,11]. Due to the gross three dimensional deformity present in our patient with reversal of the normal radial inclination, we chose to realign the wrist and forearm by correcting the radius alone.…”

“…Distal radius fractures are common in the pediatric population [1]. The majority are physeal Salter-Harris type I or II patterns [2].…”

“…Salter-Harris type II patterns are reported as having the highest risk for physeal closure [3]. Risk factors include multiple attempts at closed reduction and reduction performed greater than [7][8][9][10] days from the injury [1,3]. Metaphyseal distal radius fractures that are extraphyseal can be associated with premature physeal closure.…”