Tomori Yuji, Nanno Mitsuhiko, Takai Shinro
Department of Orthopaedic Surgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa.
Department of Orthopaedic Surgery, Ukima Central Hospital.
Medicine (Baltimore). 2020 Jul 31;99(31):e21515. doi: 10.1097/MD.0000000000021515.
The distal radius is the region of the body with the highest incidence of physeal injury. However, it is uncommon for the distal radius to undergo growth arrest without a history of trauma. We present a case of premature closure of the distal radial physis without evident history of trauma in a girl.
A 14-year-old girl presented with chronic progressive deformity and painful functional limitation of her right forearm. The right wrist pain had begun when the patient was 5 years old. There was no evident history of trauma. The deformity and persistent right wrist pain had prevented her from performing sports activities and activities of daily living.
Radiography and computed tomography showed a volarly angulated distal radius and dorsally protruding distal ulna with a length discrepancy between the distal radius and ulna due to premature physeal closure of the right distal radius.
To eliminate the deformity and achieve painless functional recovery of the wrist, an opening wedge osteotomy of the distal radius with an iliac bone graft was performed, followed by a shortening osteotomy of the distal ulna.
Radiography at final follow-up 1 year and 9 months postoperatively showed good alignment of the distal radioulnar joint without length discrepancy between the two forearm bones. The range of motion of the left wrist had reached 100% of the contralateral wrist without any pain, and the right grasp strength was 18 kg, which was 82% compared with the dominant left wrist.
Premature closure of the distal radial physis impairs the growth potential of the physis and leads to wrist dysfunction due to deformities. In the present case, a satisfactory outcome was achieved via corrective osteotomy of the distal radius with an iliac bone graft combined with ulnar shortening osteotomy.
桡骨远端是骨骺损伤发生率最高的身体部位。然而，桡骨远端在没有创伤史的情况下发生生长停滞并不常见。我们报告一例女童桡骨远端骨骺过早闭合且无明显创伤史的病例。
一名14岁女孩因右前臂慢性进行性畸形和疼痛性功能受限前来就诊。患者5岁时开始出现右腕疼痛。无明显创伤史。畸形和持续的右腕疼痛使她无法进行体育活动和日常生活活动。
X线摄影和计算机断层扫描显示桡骨远端掌侧成角，尺骨远端背侧突出，由于右桡骨远端骨骺过早闭合，桡骨和尺骨远端存在长度差异。
为消除畸形并实现腕部无痛功能恢复，对桡骨远端进行了开角截骨并植骨，随后对尺骨远端进行了缩短截骨。
术后1年9个月的最终随访X线摄影显示桡尺远侧关节对线良好，两根前臂骨之间无长度差异。右腕关节活动范围达到对侧腕关节的100%，无任何疼痛，右手握力为18kg，与优势侧左手相比为82%。
桡骨远端骨骺过早闭合会损害骨骺的生长潜力，并因畸形导致腕关节功能障碍。在本病例中，通过桡骨远端截骨并植骨结合尺骨缩短截骨术取得了满意的效果。
