Tang Chris W, Kay Robert M, Skaggs David L
Department of Orthopaedic Surgery, Children's Hospital of Los Angeles, University of Southem California School of Medicine, 90027, USA.
J Pediatr Orthop B. 2002 Jan;11(1):89-92. doi: 10.1097/00009957-200201000-00015.
We report a 12-year-old girl who developed growth arrest of the distal radius physis 9 months after sustaining a complete fracture of the distal radial and ulnar metaphysis with no involvement of the physis evident at time of injury. The girl sustained a fracture of the metaphysis of her right distal radius and ulna after a fall. Anterior-posterior, lateral and oblique radiographs at injury, and during subsequent healing show no evidence of the fracture involving the physis. She was treated with closed reduction and casting for 6 weeks and healed uneventfully. She returned 4 month later concerned about distal ulnar prominence. Radiographs revealed a loss of radial tilt and with suspicion of a physeal bar. Magnetic resonance imaging confirmed a physeal bar located in the dorsal radial region. A literature search of the Medline database was used to obtain prior case reports for review purpose. The patient underwent an epiphysiodesis of the distal radius and ulna along with an opening wedge osteotomy and bone grafting of the distal radius to restore radial height and inclination. She healed without complication and with restoration of the normal relationship of the distal radius and ulna. A review of the literature reveals five reported case of distal radial metaphyseal fractures not invloving the physis leading to growth arrest. By comparison, there are 31 reported cases of distal radius physeal arrest following fractures involving the physis. The physician should be aware that common distal radius metaphyseal fractures may rarely lead to growth arrest.
我们报告了一名12岁女孩，她在桡骨远端和尺骨远端干骺端完全骨折9个月后出现桡骨远端骨骺生长停滞，受伤时骨骺未见明显损伤。该女孩跌倒后发生右桡骨远端和尺骨干骺端骨折。受伤时及随后愈合过程中的前后位、侧位和斜位X线片均显示骨折未累及骨骺。她接受了闭合复位和石膏固定6周，愈合顺利。4个月后她因尺骨远端突出前来复诊。X线片显示桡骨倾斜度丧失，怀疑有骨骺桥形成。磁共振成像证实了位于桡骨背侧区域的骨骺桥。通过检索医学文献数据库（Medline）获取既往病例报告以供综述。患者接受了桡骨远端和尺骨远端骨骺阻滞术，同时进行了桡骨远端开放楔形截骨和植骨，以恢复桡骨高度和倾斜度。她愈合良好，未出现并发症，桡骨远端和尺骨的正常关系得以恢复。文献综述显示，有5例报告的桡骨远端干骺端骨折未累及骨骺但导致生长停滞。相比之下，有31例报告的桡骨远端骨骺骨折后出现骨骺阻滞。医生应意识到，常见的桡骨远端干骺端骨折可能很少导致生长停滞。
