Dome osteotomy and ulnar shortening for neglected distal radius epiphyseal injury with ulnar impaction syndrome: a 6-year follow-up

Distal radial epiphyseal injury are common in children, generally with good outcomes. However, 15% of patients injured involving the distal radius physis, which results in growth arrest, reported incidence from 1% to 7%. The ulnar positive variance can cause secondary wrist deformity, pain at ulnar side and deteriorated function, etc. We share a case of adolescent with neglected distal radius epiphyseal injury with ulnar impaction syndrome treated with dome osteotomy and ulnar shortening.

A 13-year-old boy suffered from non-displaced left distal radius physeal fracture due to slipping injury. The injury was neglected at the first place without conservative treatment. He came to our clinic a few weeks later. He complained wrist deformity, ulnar side wrist pain as well as limited range of motion. Radiograph showed malunion of left distal radial fracture with ulnar variance 8.9mm and radial inclination 5.3 degree. CT also showed bony physeal bar. Surgical plan includes inverted dome osteotomy to correct angulation with ulnar shortening and radial shaft lengthening. The bony bar was excised as well.

The post operative radiograph in 1 month showed ulnar variance 0mm and radial inclination 17.6 degree. After 6 years and 5 months showed ulnar variance 7.1 mm and radial inclination 20 degree. At the last visit, his left wrist VAS score 0, extension 90°, flexion 90°, and a full range of supination and pronation. Grip strength of the left hand 62lbs, 78% compared with the dominant right hand. 

In patients with growth potential, it is important to monitor till skeletal maturity to identify any evolving growth-related complications. Our study was the first case reported in English literature to establish a longitudinal follow-up to 6.5 years Although no discomfort or limited ROM of injured wrist, recurrent positive ulnar variance needs to be addressed to avoid other complications

Keywords: Dome osteotomy, ulnar shortening, distal radius epiphyseal injury, ulnar impaction syndrome