Deformity correction by Ilizarov distraction osteogenesis after distal radius physeal arrest

Objective: The aim of this study was to evaluate the results of osteotomy and distraction osteo¬genesis using Ilizarov circular external fixator to treat radial shortening and severe wrist defor¬mity due to neglected post-traumatic distal radius physeal arrest. Methods: The study retrospectively reviewed 4 patients (4 males; average age: 16 years; range: 14 to 19 years) who underwent osteotomy and distraction osteogenesis to treat radial shortening and severe wrist deformity due to neglected distal radius physeal arrest. Mean interval between trauma and surgical intervention was 8 (range: 4 to 12) years and mean follow-up time was 83 (range: 40 to 126) months. Patients were evaluated with radiographic measurements (shortening and length¬ening ratio, radioulnar joint leveling, distal radioulnar joint congruency), objective functional meas¬urements (grip and pinch strength, range of motion measurements [ROM]) and subjective function¬al measurements (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire and Mayo wrist score). Statistical analysis was made using the Mann-Whitney U non-parametric test. Results: Radiographic measurements were obtained preoperatively and at the final follow-up. The mean shortening ratio of the radius was 14.6% (range: 9.3% to 18.7%) and mean lengthen¬ing ratio was 15.9% (range: 13.2% to 18.3%). Normal distal radioulnar joint leveling and distal radioulnar congruency resembling a joint was established in all but one patient with four mil¬limeters of ulna plus deformity. According to the Mann-Whitney U non-parametric test, there was no statistical difference in grip and pinch power, ROM on flexion/extension, and ulnar/radi- al deviation axis between the operated and non-operated sides. There was statistically significant pronation/supination restriction between the operated and non-operated sides (p<0.04). Mean DASH score was 2.07 (range: 0.0 to 8.3) and the mean Mayo wrist score was 89 (range: 75 to 100) points. According to the Mayo wrist score, results were excellent in one patient, good in two patients, and satisfactory in one patient. Conclusion: The use of distal metaphyseal osteotomy and Ilizarov distraction osteogenesis is a viable treatment method for neglected physeal fractures of the distal radius as it establishes acceptable deformity correction and a functional wrist joint.