title: Delayed diagnosis and management of injuries involving the distal radioulnar joint and distal ulna in the pediatric population: recognition and conduct.
abstract: BACKGROUND
  Distal radius fractures associated with ligament or distal epiphyseal injuries of the ulna occur less frequently in skeletally immature patients. The underestimation of the mechanisms of injury leads to conservative management of this type of fracture, resulting in unsatisfactory reductions and loss of range of motion.
  
  
  METHODS
  Between January 2000 and March 2008, ten cases that were referred to our institution from other centers were studied. Treatment was joint reconstruction. The mean age was 11.9 years. Mechanisms of the fracture, as well as the delay of diagnosis, definitive reduction, and the number of surgeries previously performed, were analyzed.
  
  
  RESULTS
  The mean follow-up until the skeletal maturity of the patients was 3.4 years. The mean number of surgeries before the definitive treatment was given was 2.1, varying from attempts of closed reductions under anesthesia to percutaneous pinning in most of the cases. Eighty-seven percent of the patients improved their range of motion after the definitive surgery in the last follow-up, and there has been no evidence of growth disorders.
  
  
  CONCLUSIONS
  The presented fracture pattern is generally undervalued when evaluating management in children; the reduction of this type of injury should be surgical in order to achieve an adequate alignment. Parents should be informed about the treatment, its evolution, and possible subsequent surgeries to reestablish the joint axes and the adequate length of the wrist bones.
authors.affiliation: J.P. Garrahan Hospital Nacional de Pediatria, Buenos Aires, Argentina.
authors.forename: Bibiana
authors.initials: B
authors.lastname: Dello Russo
authors.forename: Horacio F
authors.initials: HF
authors.lastname: Miscione