An unusual injury of pediatric both forearm fractures: Distraction epiphysiolysis: A case report

Abstract

Introduction and importance: Pediatric both forearm fractures are one of the common traumas we encounter in clinical practice. We aimed to show a complication not shown in the literature, its possible cause and management of this complication in the surgery of these fractures.

Case presentation: 9 years old girl applied to emergency orthopedics unit after fall. Both forearm fracture was appeared after X-ray. Due to reduction loss in the control X-ray of the first week, closed reduction and intramedullary K wire were planned. The prebent K-wire was tried to be sent as intramedullary. While attempting to advance the K-wire, loss of intramedullary resistance was felt. When controlled with fluoroscopy, type 1 epiphysiolysis was observed in the distal radius. Open anatomical reduction was performed on distal radius epiphysis. Two K wires were placed so that crossed the physis line. In 2-year follow-up, there was no length discrepancy or limitation of movement between the left and right radius.

Clinical discussion: Intramedullary fixation is first choice for surgery in pediatric both forearm fractures. There are 2 opinions for K-wire entering point: proximal and distal of physis. The biggest concern about transphyseal transmission of the K wire is that this conduction may cause physeal damage or arrest. However, physeal damage or arrest could not be shown in the literature. On the other hand, transphyseal application provides convenience in terms of surgical applicability.

Conclusion: In our opinion, it will be more appropriate and safe to send the K wire transphyseal over the styloid for pediatric population have both forearm fractures.