title: A complex injury of the distal ulnar physis: a case report and brief review of the literature.
abstract: Physeal fractures of the distal forearm are common injuries in children and adolescents. However, Salter-Harris type III and type IV fractures of the distal ulnar epiphysis are often high-energy injuries that require open reduction for restoration of anatomical alignment. These injuries are uncommon and there are few descriptions of them in the contemporary literature. Here we report the case of a 13-year-old boy with a type IV distal ulna fracture not diagnosed with standard radiography. After closed manipulation, an incompletely reduced physis was suspected on the basis of fluoroscopic imaging and comparison radiographs of the contralateral wrist. Computed tomography showed a large, displaced physeal fragment. The patient underwent open reduction and internal fixation. Thorough radiographic assessment should be conducted when there is a high suspicion for these fracture patterns. Appropriate diagnosis can lead to expedient reduction and expectant management of sequelae associated with these injuries.
authors.affiliation: University of Chicago Medical Center, Chicago, Illinois, USA. thomasohagan1@gmail.com
authors.forename: Thomas
authors.initials: T
authors.lastname: O'Hagan
authors.forename: Deepak
authors.initials: D
authors.lastname: Reddy
authors.forename: Waqas M
authors.initials: WM
authors.lastname: Hussain
authors.forename: Jimmi
authors.initials: J
authors.lastname: Mangla
authors.forename: Alfred
authors.initials: A
authors.lastname: Atanda
authors.forename: Robert
authors.initials: R
authors.lastname: Bielski
mesh_terms: D000293:Adolescent; D003951:Diagnostic Errors; D004838:Epiphyses / Q000293:injuries / Q000473:pathology*; D005592:Fracture Fixation / Q000379:methods*; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D005596:Fractures, Closed / Q000628:therapy*; D005599:Fractures, Ununited / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D026201:Musculoskeletal Manipulations / Q000379:methods; D017063:Outcome Assessment, Health Care; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014457:Ulna / Q000000981:diagnostic imaging / Q000473:pathology*; D014458:Ulna Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging