Distal radial fracture

Case contributed by Dr Jeremy Jones

Presentation

Fall onto left hand. Swollen and tender.

Patient Data

Age: 7 years
Gender: Male
X-ray

Dorsal displacement and angulation of the distal radius at the physis.  There is widening of the palmar aspect of the physis.  There is also fragmentation dorsally which is likely to be from the metaphysis making this a Salter-Harris type II injury with more physeal displacement than is usually seen.

Case Discussion

In children, it is vital to assess the physis and look for small changes in its width. When there is angulation of the epiphysis, displacement of the epiphysis on the metaphysis or widening of the physis, think of a Salter-Harris fracture.

Salter-Harris type II injuries are by far the commonest type of physeal injury. When you suspect a type I injury (epiphyseal slip), look carefully for a metaphyseal fragment which makes it a type II injury.

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