Distraction osteogenesis for correction of distal radius deformity after physeal arrest.

PURPOSE

To present intermediate-term follow-up for pediatric patients following correction of forearm deformity with the use of distraction osteogenesis after distal radius physeal arrest in the setting of trauma.

METHODS

Retrospective review of a single surgeon's experience using a circular external fixator to correct forearm deformity in four patients whose average age at time of application was 13.8 years. All patients were evaluated clinically with radiographs, physical examination, and functional outcome assessments including the Short-Form 12, Disabilities of the Arm, Shoulder and Hand, and Mayo Wrist score.

RESULTS

At the time of intermediate-term follow-up, at a mean of 112 months, all patients were nearly pain free (average visual analog scale of 1). All were willing to undergo the same treatment again. Wrist flexion increased 11 degrees , extension decreased 2 degrees , radial deviation decreased 14 degrees , ulnar deviation increased 7 degrees , and pronation and supination both decreased 5 degrees on average. The radius was lengthened an average of 7 mm, with an average preoperative ulnar variance of +7 mm and an average postoperative ulnar variance of +1 mm. Mean outcome scores were as follows: Short-Form 12 was 82, Disabilities of the Arm, Shoulder and Hand was 11, and Mayo Wrist was 76. Three of four patients experienced treatment-related complications, whereas two of four required unplanned returns to the operating room.

CONCLUSIONS

The use of distraction osteogenesis is a reasonable alternative to osteotomy, bone grafting, and internal fixation in pediatric patients with severe forearm deformity and dysfunction after physeal arrest in the setting of trauma. This procedure is burdened with complications and requires a committed patient and surgeon. It provides good correction of deformity and relief of pain, and maintains functional range of motion while avoiding the use of permanent orthopedic implants.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.