Physeal arrest of the distal radius with midcarpal instability

Case contributed by Dr Domenico Nicoletti

Presentation

Pain and swelling of the wrist several years after radial and ulnar fractures with fixation of the radial fracture.

Patient Data

Age: 5-11 years
Gender: Male

XR left wrist

Complete radial metaphyseal fracture with displacement. Buckle fracture of the distal ulna.

 

XR left wrist (control postoperatively)

Distal radius treated with percutaneous K-wires.

XR left wrist (control after one month)

The fracture is in anatomic alignment with callus formation.

XR left wrist (six years later)

AP and lateral x-ray show a bony bar across the growth plate of the distal radius exactly where the initial pins were placed, indicating the presence of a growth arrest. Positive ulnar variance (8 mm).

CT left wrist

There is a posteromedial bony bar with reactive sclerosis extending across the growth plate of the distal radius (yellow circle) with dorsal tilt of the radius from prior fracture with resultant similar dorsal tilt of the lunate and dorsal subluxation of the capitate. The radial inclination angle is increased: 39 ° (normal values: 21°-25°); pathological dorsal radial tilt (44.6°). The normal radial volar tilt averages 11° and has a range of 2°-20°.

MRI left wrist

Midcarpal instability with tenosynovitis of the extensor carpi ulnaris tendon and joint effusion. T1-weighted magnetic resonance images show a central bar traversing the distal radial physis.

Case Discussion

Case of distal radius extraphyseal fracture treated with Kirschner wire fixation, complicated by premature physeal closure with a bony bar on the radial side, exactly where the initial pins were placed. K-wire related complications are migration of the pins, superficial infections, and damage to the physeal plates. Physeal arrest of the distal radius may alter, impair, or completely stop the growth of the bone. A physeal bar between the metaphysis and epiphysis in the local region of the growth plate can cause progressive deformities and functional problems of the wrist. It is advisable in adolescents with distal radius fractures treated with pin fixation to be followed up with radiographs of the wrist after approximately one year to document normal growth of the distal radius. CT and MRI are useful for detecting the size and position of the bony bridge and information related to cartilage abnormalities.

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Case information

rID: 78383
Published: 2nd Jun 2020
Last edited: 5th Jun 2020
Inclusion in quiz mode: Included

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