Physeal arrest of the distal radius

Physeal arrest of the distal radius
Physeal arrest of the distal radius
Management of Physeal arrest of the distal radius
Evaluation of Physeal arrest of the distal radius

 Physeal arrest of the distal radius

Physeal closure : 17 Y-O


Neutral ulnar variance : 80% of wrist stress -> distal radius

Positive ulnar variance : Distal ulnar stress↑ -> impaction to lunate, triquetrum, TFCC


Etiology

Physeal fracture 

Vascular ischemia : compartment SD… etc

Infection

Management

Conservative : Minimal growth remain (<2mm, Paley multiplier)


Physeal bar resection : Demanding surgical procedure, attempt to young age

Epiphysiodesis : Prevent angular deformity, arrest remaining growth, combined with radial or ulnar osteotomy

Ulnar shortening osteotomy : Combined with distal ulnar epiphysiodesis, for ulnar impaction syndrome

Radial osteotomy : Angular deformity correction, with or without acute radial lengthening

Distraction osteogensis : Circular Ex-fix, for large LLD, fine tuning

Surgical decision

Ulnar variance restoration

Radial inclination restoration

Palmar tilt restoration

Consideration of remaining forearm growth


Mild angular deformityRemaining forearm growth (about 40mm)


Evaluation

CBC, ESR, CRP

MRI, bone scan, CT


DDx benign or malignant neoplasm


Biopsy or IntraOP biopsy, culture study


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