Journal of Musculoskeletal Trauma

Epiphyseal Fractures of the Distal Radius in the Children: Hui Taek Kim, Myung Soo Youn, Jong Seo Lee, Young Jun Choi, Yoon Jae Seong; J Korean Fract Soc 2008;21(3):225-231. Published online July 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.3.225

PURPOSE
To evaluate the long-term results of treatment of epiphyseal fractures of the distal radius in children.
MATERIALS AND METHODS
23 cases of distal radial epiphyseal fracture, treated by two methods: group 1, closed reduction (CR) plus cast (6 cases); group 2, CR and K-wire fixation (under anesthesia due to marked translation of the distal fragment and swelling) plus cast (17 cases), were selected for this study. All patients were followed up for more than 1 year (average: 3.2 years). Postoperatively, epiphyseal displacement and epiphyseal angulation were measured on anteroposterior and lateral radiographs. At follow-up, the affected and normal sides were compared. Final results were classified by radiologic (radial inclination, volar tilting and radial shortening) and clinical (limitation of ROM, wrist pain, grip strength and wrist deformity) criteria.
RESULTS
Group 1 had 5 good, 1 fair result; group 2 had 14 good, 2 fair and 1 poor - there was no statistically significant difference between two groups. All cases where the epiphyseal displacement was less than 30% had good results. A poor case showed a radial shortening, wrist deformity and pain due to premature epiphyseal closure. Premature epiphyseal closure was treated by bar resection and free fat, along with corrective osteotomy when necessary and lengthening of radius with or without epiphysiodesis of the ulna.
CONCLUSION
Remodeling can be expected in epiphyseal fractures of the distal radius. Repeated forceful attempts to achieve accurate reduction should be avoided to prevent secondary physeal injury.

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How long does it to achieve sagittal realignment of the displaced epiphysis in Salter-Harris type II distal radial fracture when treated by manual reduction?
Seung Hoo Lee, Hyun Dae Shin, Eun-Seok Choi, Soo Min Cha
Journal of Plastic Surgery and Hand Surgery.2023; 57(1-6): 346. CrossRef

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Treatment of Distal Tibial Epiphyseal fracture Salter-Harris Type I & II: Sung Ho Hahn, Bo Kyu Yang, Seung Rim Yi, Sung Hwan Yoo; J Korean Soc Fract 1999;12(4):1065-1070. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1065

Abstract PDF

It is known that the Salter-Harris type I and II fractures of the distal tibial epiphysis usually can be treated by conservative method. But according to Spiegel, unpredictable group(type II) fractures might have more complications than expected when treated by conservative method without accurate reduction. Eleven cases in type I or II fractures were treated at the National Police Hospital between March 1992 and March 1997. If more than 2mm displacement was present compared to contralateral side after closed reduction, open reduction and internal fixation method was done and in those all cases, periosteal interposition was found on the operative field that might interrupt anatomical reduction and cause late complications such as angular deformity.

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Interposition of Periosteum in Distal Tibial Physeal Fractures of Children
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Jae Woo Cho
Journal of the Korean Fracture Society.2011; 24(1): 73. CrossRef

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Analsis of the Distal Tibial Physeal and Epiphyseal Injury: In Ho Choi, Choon Ki Lee, Duk Yong Lee, Se Il Suk, Song Choi, Yong Hoon Kim, Suk Kee Tae, Seong Il Kim; J Korean Soc Fract 1989;2(2):164-173. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.164

Abstract PDF: We have reviewed 21 cases of physeal and epiphyseal fracture of the distal tibia including one case of juvenile Tillaux fracture and four cases of triplane fracture. The patterns of fracture were correlated with the mechanism of injury using the modified Lauge-Hansen method and sysemic classification of the triplane frature was proposed. Treatment included closed reduction and cast(9 cases), closed reduction and percutaneous pin fixation(4 cases), and open reduction(8 cases). Two of the nine patients treated by means of closed reduction and cast had ankle joint incongruity or progressive varus deformity requiring corrective ost eotomy. These two patients had either Salter-Harris Type III ro Type IV fracture after supination-inversion injury. In one patient, who had 100 per cent displacement of the distal tibial epiphysis and degloving injury of the ankle, premature physeal arrest developed after open reduction and internal fixaion for Salter-Harris Type Tyre I fracture. If there are triagular metaphseal ledge along with the juvenile Tillaux fracture-like vertical epiphyseal fracture line on the antero-posterior view and Salter-Harris Type II or Type IV frature on the lateral view, a certain type of triplane fracture is strongly suggested. Plain radiographs, however, could not accurately demontrate the detailed configuration of the triplane fracture, instead computerized axial tomography was very helpful us to analyse the true dimensions of the triplane fracture. We agree that displace Salter-Harri Type III or Type IV and transitional fractures with a fracture gap of more than two millimeters in the weight-bearing portion of the epiphysis regure open reduction.

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