Surgical Management of Posttraumatic Distal Radial Growth Arrest in Adolescents

Author(s): Waters PM, Bae DS, Montgomery KD

Source: J Pediatric Orthopaedics 22:717-724, 2002

Summary:

Distal radius fractures are common in children.  Fortunately, posttraumatic distal radial growth arrest is rare.  Considerable radial growth arrest leads to altered kinematics about the wrist.  This report studies 30 adolescents who underwent surgery for progressive deformity following distal radial growth arrest.  The original injury was variable and encompassed the entire gamut of Salter-Harris fractures.  Twenty-four patients reported significant impairment prior to surgical interventions.  Six patients were asymptomatic or referred for early radiographic signs of radial arrest with positive ulnar variance.  The objectives of treatment were to both diminish the symptomatic impairment and to stabilize the radiographic parameters.  The exact procedure chosen was variable, depending on the deformity and the age of the patient.  Management was directed to either the distal ulna, distal radius, TFCC, or distal radioulnar joint.  This combination of treatment regimens clouds the ultimate results.  Ulnar osteotomy was successful in correcting ulnar variance and radial osteotomy was successful for restoration of distal radius parameters.  A decrease in pain was uniform across the patients who were symptomatic.  No asymptomatic patients became symptomatic following the procedures.  Modified wrist scores improved both in symptomatic and asymptomatic patients.  Complications were minimal, except for one patient who had displacement of a radial osteotomy.

The consequences of radial growth arrest in a child or adolescent depend upon the skeletal age of the patient and the severity of the arrest.  Partial arrest may lead to angular deformities of the distal radius, while complete arrest may lead to pure ulnar overgrowth.  In either case, there are altered radial, carpal and ulnocarpal kinematics which may lead to pain, loss of motion and degenerative changes.  The concept of correcting deformities back to their innate alignment is well-founded in the adult literature.  Similarly, recommending treatment prior to the onset of symptoms is warranted in potentially severe deformity.  This study reports considerable improvement in both the clinical and radiographic parameters.  It also indicates that the exact treatment regimen must be individualized and include consideration of patient age, extent of arrest, and expectations.

 
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J Pediatric Orthopaedics