Simultaneous correction of radius and ulna for secondary ulnar impaction syndrome with radial physeal arrest in adolescent: A case report and review of literatures.

Introduction: Distal radius physeal fractures are common in pediatric patients. Although most of these fractures heal without complication, some result in significant physeal arrest. If significant physeal arrest occurs, the various treatment methods can be applied depending on the severity of deformity and remaining growth of the patient.

Presentation Of Case: We present a 16-year old female with distal radial physeal arrest who presented four years after initial injury. Radiologically, forearm bone length discrepancy was 7 mm. But, she had a secondary ulnar impaction syndrome. She underwent open wedge corrective osteotomy of distal radius on volar side and ulnar shortening osteotomy, simultaneously. Early mobilization and rehabilitation were started soon after the surgery. At 18 months postoperatively, the ROM was assessed to be almost identical as the unaffected side and the patient presented with no significant symptoms.

Discussion: Distal radial fracture is one of the most common fractures in pediatric population. And distal radial physis is often involved in these fracture, which can lead to physeal arrest. However, even if forearm bone length discrepancy occurs, if the difference is within 1 cm, it is often asymptomatic. In this case, the forearm bone length discrepancy was mild, but due to symptom, we performed surgical treatment.

Conclusion: Distal radial physeal arrest due to distal radial fracture is relatively common in children, and long-term follow-up is needed. Moreover, relatively mild deformity caused by physeal arrest may also cause symptoms, so careful observation is needed.