Artikel
Treatment of length discrepancy after posttraumatic radial growth arrest
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Autoren
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Florian Goehtz
- Klinik für Handchirurgie, Bad Neustadt, Germany
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Hermann Krimmer
- Zentrum für Handchirurgie, Ravensburg, Germany
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Jörg Van Schoonhoven
- Klinik für Handchirurgie, Bad Neustadt, Germany
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Wiebke Hülsemann
- Wilhelmstift Hamburg, Hamburg, Germany
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Posttraumatic growth disturbances after radial physeal fractures occur in about 4%.
Depending on the children's age a partial or complete growth arrest of the distal radial physis leads to progressive shortening of the radius with radioulnar length discrepancy and / or deformation of the distal radius with functional limitation, disturbance of the DRUJ, pain and cosmetic impairment.
A variety of different procedures are performed for correction: callus distraction of the radius, osteotomy of the radius with or without bone graft, ulna shortening osteotomy, ulnar physiodesis.
Factors influencing treatment and results are children's age at trauma, amount of radius shortening/radioulnar length discrepancy, uniplanar or two-dimensional deformity of the distal radius, and remaining growth potential.
It is not proven which correction at which age ends up with the best functional results.
Methods: Retrospectively we analysed the demographic data and x-rays of 13 cases treated in 3 hand centers with distraction of the radius for:
- age at trauma (mean age at trauma 9,3 yrs; range 4-14 yrs.)
- age at 1st operative correction of length discrepancy (mean age at 1st operative correction 14,5 yrs, range 9-18 yrs.)
- amount of radius shortening at the 1st operative intervention (mean 19,3 mm, range 9-30 mm)
- performed operative technique: callus distraction radius 5, distraction radius with secondary internal plate fixation: without bone graft 4 - with iliac bone graft 4
- additional correction of the ulna: in no case an additional intervention of the ulna was performed at the 1st operative correction.
- recurrence of length discrepancy with need of second intervention: 2 cases (1 treated with callus distraction, 1 case with ulna-shortening).
- secondary operative intervention due to complications: 3 cases (2 non-unions in the group with plating with iliac bone graft, 1 pin-site-infection of the distraction fixator)
Results and Conclusions: Collected data show different approaches of adjusting the radioulnar length discrepancy by lengthening the radius. In younger patients the remaining growth potential of the distal ulna may lead to recurrence of length discrepancy after correction. Therefore an additional physiodesis of the distal ulna may be advisable in the growing child.
A comparing further study at the end of growth is planned to compare functional results, final forearm length and radioulnar position and satisfaction of patients to decide about the best treatment age and technique.
