Neglected epiphyseal injuries of the distal end of the radius with ulnar impaction: analysis of distal osteotomy of both bones using a dorsal midline approach

Abstract

BackgroundTo evaluate results of a technique for treating neglected epiphyseal injuries of the distal radius with ulnar impaction.Materials and methodsThis retrospective study involved six cases (four males; two females), all of whom sustained the primary injury during childhood (range 9–12 years of age). All presented with wrist deformity and ulnar-sided wrist pain. They were managed with osteotomy of the distal radius, osteotomy and shortening of the ulna, harvesting the bone grafts, and distal radioulnar joint (DRUJ) reduction performed simultaneously through a dorsal midline approach. Mean follow-up was 30 months (range 24–36).ResultsDeformity correction and pain relief was observed in all patients. Flexion arc increased from an average of 60° to 102.5°, supination from an average of 31.67° to 67.50°, and pronation from an average of 30.83° to 61.67°. The mean preoperative DASH score was 87.5, which improved to 18.72 postoperatively.ConclusionNeglected epiphyseal injuries of the distal radius are difficult to manage and many variations are described for handing each of the associated problems. Our technique provides an option for managing this injury with an easy surgical approach, single incision, and cost effectiveness. All the four components of the surgery, which include osteotomy of the distal radius, osteotomy of the ulna, harvesting the bone grafts, and DRUJ reduction were done through a single incision and in a single sitting. Level of evidence IV.

Combined navigated drilling and arthroscopy facilitate minimally invasive surgical treatment of ulnar–radial joint dislocation caused by epiphyseal premature closure

“…[27] The shorter the radius is, the greater load on the ulna will be, which will eventually lead to the symptoms of ulnocarpal impingement. [6] This is the reason of pain in the distal radioulnar joint and restricted range of motion around the wrist in this patient.…”

“…Here, the patient had a history of trauma and a significant growth potential at the age of 11. Gogna et al [6] claimed that growth retardation often occurs after epiphyseal injury of distal radius in children, leading to asynchronous growth of radius and ulna. The earlier epiphyseal closure is, the more obvious the deformity is.…”

“…[5] Normal growth of ulna and arrest of radius can cause the separation of ulnar–radial joints and the deviation of wrist joints to radial side, and they often result in pseudo Madelung deformity, which limits the rotation of wrist joint and forearm. [6] In 1935, Meyerding and Overton [7] first proposed the treatment method of corrective osteotomy. However, corrective osteotomy operation has numerous complications, for example, poor correction, infection, neurovascular injury, osteofascial compartment syndrome, failure of internal fixation, and nonunion after osteotomy.…”

Evaluation of Outcome of Percutaneous K-wires Fixation of Pediatric Both Bone Forearm Fractures

“…Other studies have advocated the insertion of the wire from the metaphysis of the distal radius and proximal ulna to spare the growth plate and epiphysis, but the technique requires a larger bending angle to pass the pins through the medullary canal (21) .…”

Diagnostic Value of Magnetic Resonance Image Feature Analysis under Reconstruction Algorithm for Knee Epiphyseal Injury

“…Epiphysis, located at both ends of the immature bone, is made of cartilage and is particularly vulnerable to damage during childhood growth and development [1][2][3]. erefore, if it is not treated in time after being damaged, it is likely to cause complications such as myositis ossificans, bone nonunion, angular malformation, knee joint adhesion, and infection [4].…”