Unusual distal radial epiphyseal injury in a child

Abstract

An eleven-year old boy presented to the accident and emergency department after falling o€ a roof from a height of about 10 feet. His only signi®cant injury was to the left wrist. Physical examination revealed a swollen dorsally angulated left wrist. He initially had no neurovascular de®cit in the hand and radiographs showed a double Salter Harris type II fracture [1] of the distal radial and ulnar metaphyses (Fig. 1). Two hours after admission he developed signs of median nerve compression and manipulative reduction and POP application under a general anaesthetic was undertaken. After manipulation median nerve function returned. Further X-rays showed a large volar metaphyseal fragment, which was rotated through 908 (Fig. 2). This, was not reducible by closed manipulation and surgical exploration was therefore undertaken. This revealed a large metaphyseal fragment which presented it's cancellous surface volarly and was compressing the median nerve. When this fragment was reduced a stable reduction was achieved and a forearm cast was only required (Fig. 3). The fracture subsequently went on to unite satisfactorily. At 6/52 follow-up the growth plate showed no signs of damage. Injury, Int. J. Care Injured 30 (1999) 149±150