Abstract

DELLO RUSSO, Bibiana; DOGLIOTTI, Pedrio  and  MISCIONE, Horacio. Delayed diagnosis and management of injuries involving the distal radioulnar joint and distal ulna in pediatric population: recognition and approach. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2009, vol.74, n.3, pp.220-229. ISSN 1852-7434.

Background: Distal radius fractures associated with ulnar ligament or distal epiphysial injuries are less frequent in skeletally immature patients. Underestimation of injury mechanisms leads to conservative treatment for this type of fracture which results in unsatisfactory reductions and loss of range of motion. Methods: Between January 2000 and March 2008 ten cases were studied whose treatment involved joint reconstruction. Mean age was 11.9 years. We analyzed the fracture mechanisms, time to diagnosis, definitive reduction treatment, and the number of previous surgical operations. Results: Mean follow-up until patients' skeletal maturity was 3.4 years. Mean surgeries prior to definitive treatment was 2.1; varying from attempts at closed reductions under anesthesia to percutaneous pinning in most of the cases. 87% of the patients improved their range of motion after the definitive surgery, as noted in the latest follow-up. Conclusions: This fracture pattern is generally underestimated when evaluating the treatment to be employed in children; in this type of injuries reduction should be surgical in order to achieve an adequate alignment. Parents should know this method, its evolution and the possible subsequent surgeries to reestablish the joint axes and the adequate length of the wrist bones.

Keywords : Fractures; Radius; Children; Galeazzi equivalent injuries; Open reduction; Ligament injuries; Distal ulnar epiphysis.

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