title: Deformity correction by Ilizarov distraction osteogenesis after distal radius physeal arrest.
abstract: OBJECTIVE
  The aim of this study was to evaluate the results of osteotomy and distraction osteogenesis using Ilizarov circular external fixator to treat radial shortening and severe wrist deformity 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 lengthening ratio, radioulnar joint leveling, distal radioulnar joint congruency), objective functional measurements (grip and pinch strength, range of motion measurements [ROM]) and subjective functional 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 lengthening 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 millimeters 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/radial 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedics and Traumatology, Faculty of Medicine, Maltepe University, İstanbul, Turkey. hakangundes@yahoo.com
authors.forename: Hakan
authors.initials: H
authors.lastname: Gündeş
authors.forename: Levent
authors.initials: L
authors.lastname: Buluç
authors.forename: Mustafa
authors.initials: M
authors.lastname: Sahin
authors.forename: Tuğrul
authors.initials: T
authors.lastname: Alici
mesh_terms: D000293:Adolescent; D006132:Growth Plate / Q000254:growth & development; D006801:Humans; D018889:Ilizarov Technique; D016916:Joint Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D008297:Male; D010027:Osteotomy; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging / Q000601:surgery*; D011885:Radius Fractures / Q000150:complications; D000072042:Salter-Harris Fractures; D014457:Ulna / Q000000981:diagnostic imaging; D014955:Wrist Joint / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult