Evaluation and Management of Transitional Fractures of the Distal Radius

TL;DR

This study examines rare transitional fractures in adolescents' distal radius, describing their patterns and treatment outcomes.

Contribution

The study presents the largest series of transitional fractures of the distal radial physis and introduces a novel treatment approach.

Findings

Transitional fractures of the distal radius typically show an ulnar-sided Salter-Harris III fracture on AP radiographs and SH-II on lateral radiographs.

One patient was successfully treated with closed reduction and percutaneous pinning, a first in reported cases.

All fractures healed without complications, except one case with partial growth arrest requiring surgical intervention.

Abstract

Introduction: Transitional fractures about a closing physeal plate in adolescents are most common at the distal tibia physis but have been reported in other anatomical locations, including the distal radius. Only 10 prior cases of transitional fractures of the distal radius have been reported in the prior literature. This study aims to report the findings and outcomes from the largest series to date of these rare injuries.

Methods: Data were collected on six cases of these fractures in patients less than 18 years of age. Demographic, injury, radiographic, and outcome data were collected via retrospective chart review.

Results: The patients' ages ranged from 13 to 18 years. Four patients were male and two were female. Four of six patients presented after low-energy falls during sporting events. None were open injuries, and there was no or minimal displacement in all cases. The typical radiographic pattern in both this series and prior reports was an ulnar-sided Salter-Harris (SH) III fracture on the anterior-posterior (AP) radiograph and an SH-II fracture on the lateral radiograph. Two injuries had an isolated SH-III component on the AP radiograph, which had only been reported once prior. Five patients were treated with closed reduction and casting. One patient was treated with closed reduction and percutaneous pinning (CRPP) due to loss of reduction after splinting and involvement of the distal radio-ulnar joint (DRUJ). To the best of our knowledge, this is the first reported case to be managed in this fashion. All injuries had routine healing without complications, other than one case that developed partial growth arrest and required physeal bar excision with < 1 cm limb length discrepancy and no functional deficit at 18 months after physeal bar excision.

Conclusions: This is the largest series of transitional fractures of the distal radial physis presented to date and broadens the resources available for the evaluation and management of these rare injuries. This series additionally demonstrates fracture patterns similar to the Tillaux fracture of the distal tibia, with an isolated SH-III fracture component in the coronal plane, and demonstrates successful treatment with CRPP, both of which can help guide diagnosis and treatment in the future.

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