Rockwood Children CH8

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SECTION TWO • Upper Extremity

Figure 8-54.  A: AP radiograph of growth arrest with open ulnar physis. B: MRI scan of large area of growth arrest that was not deemed respectable by mapping. Note is made of impaction of the distal ulna against the triquetrum and a secondary peripheral TFCC tear. C: Radiograph after ulnar shortening osteotomy, restoring neutral ulnar variance. A, B C

A complete arrest of the distal radial physis in a skeletally immature patient can be a serious problem. The continued growth of the ulna with cessation of radial growth can lead to incongruity of the DRUJ, ulnocarpal impaction, and development of a TFCC tear (Fig. 8-55). 12,204 The radial deviation deformity at the wrist can be severe enough to cause limitation of wrist and forearmmotion. Pain and clicking can develop at the ulnocarpal or radioulnar joints, indicative of ulnocarpal impaction or a TFCC tear. The

deformity will progress until the end of growth. Pain and limited motion and function will be present until forearm length is rebal- anced, until the radiocarpal, ulnocarpal, and radioulnar joints are restored, and until the TFCC tear and areas of chondromalacia are repaired or debrided. 12,152,192 Ideally, physeal arrest of the distal radius will be discovered early before the consequences of unbalanced growth develop. Radiographic screening 6 to 12 months after injury can identify

Figure 8-55.  A: AP radiograph of radial growth arrest and ulnar overgrowth after physeal fracture. Patient complained of ulnar-sided wrist pain and clicking. B: Clinical photograph of ulnar over- growth and radial deviation deformity. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

A

B