Rockwood Children CH8

294

SECTION TWO • Upper Extremity

A

B

D Figure 8-59.  A: The appearance of the distal ulna in the patient seen in Figure 8-44, 3 years after injury, demonstrating premature fusion of the distal ulnar physis with 3.2 cm of shortening. The distal radius is secondarily deformed, with tilting and translocation toward the ulna. B: In the patient in Figure 8-44 with distal ulnar physeal arrest, a lengthening of the distal ulna was performed using a small unipolar distract- ing device. The ulna was slightly overlengthened to compensate for some subsequent growth of the distal radius. C: Six months after the lengthening osteotomy, there is some deformity of the distal ulna, but good restoration of length has been achieved. The distal radial epiphyseal tilt has corrected somewhat, and the patient has asymptomatic supination and pronation to 75 degrees. D: Similar case to A–C, but with more progressive distal radial deformity treated with corrective osteotomy and epiphysiodesis of the distal radius.

C