Corrective Osteotomy and Bone Distraction Using External Fixation in Patients With Delayed Deformity of Distal Radius Growth Arrest
Authors: Vasquez Eduardo Farias , Faria Rodrigo Tiago Berlink , Monteiro Anderson Vieira , Adolphsson Fernando , Feal Rafael Aquino 
Published: September 2016

Objective: Posttraumatic growth arrest is rare despite the high incidence of distal radius physeal fractures in children and adolescents; its management is dependent on the severity of deformity and remaining growth potential of the patient. This article presents the use of bone distraction technique with external fixation following open distal radius corrective osteotomy in a case series of patients with delayed presentation of distal radius growth arrest in an attempt to improve cosmetic and function of the hand. Materials and Methods: A case series of 5 patients with delayed presentation of distal radius growth arrest associated with cosmetic and functional impairment was studied. All the patients underwent the following surgical treatment: distal radius osteotomy that results in correction of deformity in the sagittal plane, following by application of monolateral external fixation for gradual correction with radial bone distraction. Frontal plane deformity was gradually corrected during bone distraction using a micrometric swiveling clamp in distally, with correction capability up to 50° of angulation. External fixation was removed after full bone regeneration observed in follow-up radiographs. Collected data include the following: age at initial trauma, age at osteotomy, gender, affected side, dominant side, affected side preoperative and postoperative radiographic parameters (total radius length, relative distal radius length, ulnar variance, distal radius ulnar inclination and volar tilt, deformity of distal ulna, preoperative computed tomography (CT), total time of external fixation, and complications—fail of correction, reoperation, infection, nonunion, and neurovascular compromise). Data were submitted to descriptive and analytical statistics by Student t test with P < .05. Results: Mean age at osteotomy was 16.4 years old while mean age at initial trauma was 8.4 years old, all the patients were male with 60% of them with right wrist injured and 100% with right dominant side. Radiographs parameters were the following: preoperative affected side (mean total radius length = 218.1mm, mean total ulna length = 257.4 mm, mean relative distal radius length = −9.8 mm, mean ulnar variance = 6.1 mm, mean distal radius ulnar inclination = −19.3°, volar tilt = −7.50, 60% of deformity in distal ulna); preoperative normal side (mean total radius length = 256.5 mm, mean total ulna length = 269.5 mm, mean relative distal radius length = 9.3 mm, mean ulnar variance = 3.5 mm, mean distal radius ulnar inclination = 19.6°, volar tilt = 3.5°); and post operative affected side (mean total radius length = 231 mm, mean total ulna length = 262.4 mm, mean relative distal radius length = 4.6 mm, mean ulnar variance = 2.8 mm, mean distal radius ulnar inclination = 10°, volar tilt = −1.8°). Mean external fixation total time was 14,6 weeks. There was significant improvement in relative distal radius length and distal radius ulnar inclination (p < 0.01), and in general all radiographs parameters were improved. One of the patients presented complication with severe cutaneous dermatitis (20%). Conclusions: Corrective osteotomy and radial bone distraction using monolateral external fixation is a suitable procedure for major deformities in patients with distal radial growth arrest with little or no growth potential, improving radiographic parameters.