Traumatic Physeal Arrests at the Wrist

Abstract

Fractures involving the physes of the distal forearm are exceedingly common in children, representing upwards of 1/3 of all pediatric fractures. These injuries are often amenable to closed treatment, but physeal injury can lead to premature arrest and significant related long-term sequela. Common practice guidelines have not been established amongst the pediatric orthopaedic community for radiographic monitoring, need for 3-dimensional imaging, and treatment algorithms in these injuries. This review seeks to outline the literature and share the perspective and methods of a panel of leading pediatric upper extremity experts in hopes of providing a framework for better understanding these injuries and treating their growth-related sequelae.

Variant Salter-Harris Type III Distal Ulna “T” Fracture in the Setting of Galeazzi Equivalent Wrist Injury

“…The distal ulna ossification center forms between the ages of 5 and 7 years, and along with the distal radial ossification center accounts for 70% to 80% of longitudinal bone growth in the forearm before epiphyseal fusion by age 19 and 17 years, respectively. [17][18][19] With fractures of the distal ulna, the incidence of growth arrest has been reported as high as 55% 14 . The most dominant factor in the prevention of growth arrest is adequate anatomical reduction of the distal ulna 14 .…”

“…In GE fractures, involvement of the distal ulna ossification center with disruption of the DRUJ is highly predictive of future growth disturbance. 17,23 After fracture healing, follow-up with radiographs of the injured wrist should occur in 3- to 6-month intervals until Park-Harris lines reveal normal growth or pathologic changes are seen. 4,19 In the event interval change in ulnar variance is appreciated on follow up imaging, radiographs of the contralateral wrist may be obtained to assess for symmetric growth.…”

“…4,19 In the event interval change in ulnar variance is appreciated on follow up imaging, radiographs of the contralateral wrist may be obtained to assess for symmetric growth. 17 If concern for growth arrest persists, further workup should begin with MRI to evaluate for physeal bar formation. 24 When present, physeal bar excision may be performed in children with more than 2 years of growth remaining and the presence of growth plate tethering.…”