Physeal Growth Arrest in Distal Radius Fracture: A Case Report.

ABSTRACT

Introduction: Distal radius fractures account for nearly one-third of all pediatric fractures, making it among the most common of all pediatric fractures. Studies report that distal radius physeal arrest rates following trauma to the distal radius seem to occur in only about 5% of patients. Significant ulnar variance can develop leading to notable pain and limitations in function. Case Report We present a case of a 17-year-old right-hand dominant adolescent Caucasian male with persistent ulnar wrist pain. The patient presented to our outpatient clinic for evaluation of his left wrist following 6-8 months of persistent ulnar-sided pain. Ten months prior, the patient had fallen off a shed and was treated in the emergency room and referred to the outpatient clinic for follow-up. The patient initially sustained a Salter-Harris Type 2 distal radius fracture treated with closed reduction and short arm cast application in the emergency room. The short arm cast was removed at 8 weeks, and then, the patient was placed in a brace. The patient was lost to follow-up before returning to the clinic 16 months after the original injury when he noticed worsening pain in the left wrist, localized to the distal radioulnar joint with increased hand usage at a new job. Radiographs at that time showed a worsening positive ulnar variance as well as a partially open distal ulnar physis. After 6 months of occupational therapy and over-the-counter pain management, the ulnar-sided pain had not resolved. The radiograph showed a positive Ulna variance of 2.5 mm, which was corrected with a 5 mm excision osteotomy of the distal ulna. The patient reported significant pain relief and a 42-point improvement in his patient-rated wrist evaluation score. Conclusion: Distal radius growth arrest, while uncommon, can present with ulnar-sided pain and positive ulnar variance that is safely treatable with ulnar shortening osteotomy.