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Topic:

Ulna Fracture

Issue:

Wrist

Category:

Trauma

Title:

Physeal Fractures of the Distal Ulna: Incidence and Risk Factors for Premature Growth Arrest

Author:

Lee, Julianna BA; Värk, Pille-Riin MD; Mendenhall, Shaun D. MD; Chang, Benjamin MD; Buttrick, Eliza BA; Shah, Apurva S. MD, MBA

Journal:

Journal of Pediatric Orthopaedics

Date:

March 2024

Reference:

44(3): p 151-156, DOI: 10.1097/BPO.0000000000002585

Level Of Evidence:

IV

# of Patients:

56

Study Type:

Retrospective review

Location:

Single children's hospital in the United States

Summary:

This study investigates the incidence of premature growth arrest following distal ulnar physeal fractures and identifies risk factors for this complication.

Methods:

Retrospective review of patients with distal ulnar physeal fractures at a children's hospital. Follow-up period: minimum of 6 months. Fractures classified by the Salter-Harris system (SH I-IV). Follow-up radiographs assessed for ulnar variance and signs of premature physeal arrest.

Exclusions:

Patients without 6-month follow-up were excluded.

Results:

Fracture Patterns: SH II: 52.7%, SH I: 29.1%, SH III: 9.1%, SH IV: 9.1%. Displaced fractures: 41.1% (mean translation 40.2%, mean angulation 24.8 degrees). Growth Disturbance: 19.6% had radiographic signs of growth disturbance: 5.4% had growth disturbance but continued growth. 14.3% had complete growth arrest. Risk Factors for Growth Disturbance: Displaced fractures and SH III/IV fractures were more likely to result in growth disturbance. 34.8% of SH III fractures vs. 3.2% for non-SH III fractures (P=0.003). 50% of SH IV fractures vs. 11.1% of non-SH IV fractures (P=0.012). Children with <2 years of skeletal growth remaining had a higher risk of growth disturbance (46.2% vs. 9.5%, P=0.007). Surgical Interventions: 3 patients required surgery, including ulnar lengthening, epiphysiodesis, and corrective osteotomy.

Conclusions:

Distal ulnar physeal fractures, particularly SH III and IV fractures, have a 20% risk of growth disturbance or growth arrest. Displaced fractures, intra-articular fractures, fractures needing open reduction, and older children are at greater risk for premature growth arrest and should be followed more closely.

Relevance:

Limitations:

Perspective:

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