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Infrequent physeal wrist injury of the ulna and radius: a case report.

Carbonell PG, Rey EF, Vicente-Franqueira JR, Trigueros AP - Strategies Trauma Limb Reconstr (2008)

Bottom Line: All these injuries were checked intraoperatively during open reduction.We believe that this clinical case illustrates the importance of carefully assessing physeal wrist injuries when they occur, especially in those cases involving the ulna and the radius.Diagnostic methods such as CT and MRI scans are indispensable for through evaluation and treatment of the injury.

View Article: PubMed Central - PubMed

Affiliation: Unit of Pediatric Traumatology and Orthopedics Pediatric Surgery, Hospital General Universitario de Alicante (Alicante University Hospital), Alicante, Spain, gutierrez_ped@gva.es.

ABSTRACT
We describe the case of a 13-year-old patient with a left wrist physeal fracture of the ulna and radius. X-Ray showed a Salter-Harris type II injury of the radius, and CT and MRI identified the following: type II epiphysiolysis of the radius with a metaphyseal wedge and type IV fracture of the ulna, with interposition in the focus of the fracture of the extensor carpi ulnaris tendon, as well as a tear in the central area of the triangular fibrocartilage complex. All these injuries were checked intraoperatively during open reduction. We believe that this clinical case illustrates the importance of carefully assessing physeal wrist injuries when they occur, especially in those cases involving the ulna and the radius. Diagnostic methods such as CT and MRI scans are indispensable for through evaluation and treatment of the injury.

No MeSH data available.


Related in: MedlinePlus

Anteroposterior (a) and lateral (b) X-rays showing radius fracture and displacement of the physeal fracture of the ulna
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Fig1: Anteroposterior (a) and lateral (b) X-rays showing radius fracture and displacement of the physeal fracture of the ulna

Mentions: This is a 13-year-old boy with trauma to his left arm due to hyperpronation after landing on his outstretched hand when he fell off of his bicycle. Upon examination, symptoms included pain, swollen and wrist deformity with normal neurovascular tests. X-rays revealed physeal fracture of the ulna and radius, more specifically, a Salter–Harris type II fracture of the radius and a type II or IV fracture of the ulna (Fig. 1 a, b). Emergency closed reduction failed. Ct imaging confirmed a metaphyseal fracture of the radius and a type IV Salter–Harris epiphyseal fracture of the ulna. MRI also confirmed: (a) injury of the radius with metaphyseal involvement not visible on the conventional X-ray, (b) a Salter type IV, Peterson type V fracture in ulna, (c) interposition of the extensor carpi ulnaris (ECU) at the point of ulnar fracture and (d) a Palmer type I B peripheral tear of the TFCC complex of the wrist (Fig. 2 a, b) [1, 5, 10]. Based on these findings, we performed an open reduction and fixed the fracture with K-wires. A long-arm cast was then put on with the forearm in the neutral position. During the procedure, all injuries were examined; reduction of the physeal fracture of the ulna was affected by the interposition of the ECU. The TFCC injury was sutured and reinforced with a retinaculum from the ECU [10]. Bone union was achieved with satisfactory alignment without pain (the patient plays the drums), but loss 10º of pronation and supination range of movement (ROM). At last review (2 years follow-up) there was 0.8 cm of ulna minus configuration by ulna physeal arrest, but without distal bowing of the radius.Fig. 1


Infrequent physeal wrist injury of the ulna and radius: a case report.

Carbonell PG, Rey EF, Vicente-Franqueira JR, Trigueros AP - Strategies Trauma Limb Reconstr (2008)

Anteroposterior (a) and lateral (b) X-rays showing radius fracture and displacement of the physeal fracture of the ulna
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2599799&req=5

Fig1: Anteroposterior (a) and lateral (b) X-rays showing radius fracture and displacement of the physeal fracture of the ulna
Mentions: This is a 13-year-old boy with trauma to his left arm due to hyperpronation after landing on his outstretched hand when he fell off of his bicycle. Upon examination, symptoms included pain, swollen and wrist deformity with normal neurovascular tests. X-rays revealed physeal fracture of the ulna and radius, more specifically, a Salter–Harris type II fracture of the radius and a type II or IV fracture of the ulna (Fig. 1 a, b). Emergency closed reduction failed. Ct imaging confirmed a metaphyseal fracture of the radius and a type IV Salter–Harris epiphyseal fracture of the ulna. MRI also confirmed: (a) injury of the radius with metaphyseal involvement not visible on the conventional X-ray, (b) a Salter type IV, Peterson type V fracture in ulna, (c) interposition of the extensor carpi ulnaris (ECU) at the point of ulnar fracture and (d) a Palmer type I B peripheral tear of the TFCC complex of the wrist (Fig. 2 a, b) [1, 5, 10]. Based on these findings, we performed an open reduction and fixed the fracture with K-wires. A long-arm cast was then put on with the forearm in the neutral position. During the procedure, all injuries were examined; reduction of the physeal fracture of the ulna was affected by the interposition of the ECU. The TFCC injury was sutured and reinforced with a retinaculum from the ECU [10]. Bone union was achieved with satisfactory alignment without pain (the patient plays the drums), but loss 10º of pronation and supination range of movement (ROM). At last review (2 years follow-up) there was 0.8 cm of ulna minus configuration by ulna physeal arrest, but without distal bowing of the radius.Fig. 1

Bottom Line: All these injuries were checked intraoperatively during open reduction.We believe that this clinical case illustrates the importance of carefully assessing physeal wrist injuries when they occur, especially in those cases involving the ulna and the radius.Diagnostic methods such as CT and MRI scans are indispensable for through evaluation and treatment of the injury.

View Article: PubMed Central - PubMed

Affiliation: Unit of Pediatric Traumatology and Orthopedics Pediatric Surgery, Hospital General Universitario de Alicante (Alicante University Hospital), Alicante, Spain, gutierrez_ped@gva.es.

ABSTRACT
We describe the case of a 13-year-old patient with a left wrist physeal fracture of the ulna and radius. X-Ray showed a Salter-Harris type II injury of the radius, and CT and MRI identified the following: type II epiphysiolysis of the radius with a metaphyseal wedge and type IV fracture of the ulna, with interposition in the focus of the fracture of the extensor carpi ulnaris tendon, as well as a tear in the central area of the triangular fibrocartilage complex. All these injuries were checked intraoperatively during open reduction. We believe that this clinical case illustrates the importance of carefully assessing physeal wrist injuries when they occur, especially in those cases involving the ulna and the radius. Diagnostic methods such as CT and MRI scans are indispensable for through evaluation and treatment of the injury.

No MeSH data available.


Related in: MedlinePlus