Addressing Bilateral Post-traumatic Distal Radius Growth Arrest with Positive Ulnar Variance with Acute Ulnar Shortening Osteotomy and Distal Radioulnar Joint Fixation in a 13-Year-Old Child: A Case Report.

Introduction: Pediatric forearm fractures are very common. The distal radius growth physis contributes the majority of the radial length and nearly half of the entire upper extremity. Although growth arrest associated with physeal fractures is rare but the sequelae can be very detrimental and challenging. Partial or complete distal radius physis arrest can lead to radial shortening, alteration of radial tilt or inclination, distal radioulnar joint (DRUJ) incongruity, ulnocarpal abutment syndrome, and injury to the triangular fibrocartilage complex. Post-traumatic distal radius physis arrest is a serious complication that can lead to several disabilities. These disabilities could be devastating as it is related to the functional status of the wrist. In the literature, there are few studies reported post-traumatic distal radius growth arrest. Our case is bilateral post-traumatic distal radius growth arrest with positive ulnar variance that is limiting the patient's wrist function. Case Report: A 13-year-old boy presented to the outpatient department with bilateral wrists pain and deformities, 6 years after sustaining bilateral distal radius fractures, which was managed conservatively at that time. On examination, the patient had obvious bilateral wrists deformities and limitation of range of motion (ROM). Radiographic investigations showed: Bilateral central distal radius physeal osseous bar in the background of positive ulnar variance and dorsal subluxation of the DRUJ. After discussing treatment options with his parents, the patient was treated surgically, starting with the left side by ulnar shortening osteotomy and temporary DRUJ fixation. After 8 weeks from the surgical operation, the patient was referred for physiotherapy for gradual supervised sessions to regain full ROM and strength. One year follow-up, the patient showed near normal wrists activity with satisfactory outcome for him and his family, so the same surgical operation was done to the right side. Conclusion: The treatment of these types of injuries is highly controversial. Options could vary from case to case. We do believe that ulnar shortening osteotomy with temporary DRUJ fixation should be considered in treating late presenting distal radius physeal injury in adolescent patients, aiming for an absolute great outcome.