title: Neglected epiphyseal injuries of the distal end of the radius with ulnar impaction: analysis of distal osteotomy of both bones using a dorsal midline approach.
abstract: BACKGROUND
  To evaluate results of a technique for treating neglected epiphyseal injuries of the distal radius with ulnar impaction.
  
  
  METHODS
  This retrospective study involved six cases (four males; two females), all of whom sustained the primary injury during childhood (range 9-12 years of age). All presented with wrist deformity and ulnar-sided wrist pain. They were managed with osteotomy of the distal radius, osteotomy and shortening of the ulna, harvesting the bone grafts, and distal radioulnar joint (DRUJ) reduction performed simultaneously through a dorsal midline approach. Mean follow-up was 30 months (range 24-36).
  
  
  RESULTS
  Deformity correction and pain relief was observed in all patients. Flexion arc increased from an average of 60° to 102.5°, supination from an average of 31.67° to 67.50°, and pronation from an average of 30.83° to 61.67°. The mean preoperative DASH score was 87.5, which improved to 18.72 postoperatively.
  
  
  CONCLUSIONS
  Neglected epiphyseal injuries of the distal radius are difficult to manage and many variations are described for handing each of the associated problems. Our technique provides an option for managing this injury with an easy surgical approach, single incision, and cost effectiveness. All the four components of the surgery, which include osteotomy of the distal radius, osteotomy of the ulna, harvesting the bone grafts, and DRUJ reduction were done through a single incision and in a single sitting. Level of evidence IV.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Pt B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. paritosh.gogna@gmail.com.
authors.forename: Paritosh
authors.initials: P
authors.lastname: Gogna
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Sahil
authors.initials: S
authors.lastname: Gaba
authors.affiliation: Department of Orthopaedics and Rehabilitation, Pt B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors.forename: Reetadyuti
authors.initials: R
authors.lastname: Mukhopadhyay
authors.affiliation: Department of Orthopaedics and Rehabilitation, Pt B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Rohilla
authors.affiliation: Department of Orthopaedics and Rehabilitation, Pt B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors.forename: Amanpreet
authors.initials: A
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D002648:Child; D004838:Epiphyses / Q000293:injuries; D005260:Female; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D016916:Joint Deformities, Acquired / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D010027:Osteotomy; D011885:Radius Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014457:Ulna / Q000000981:diagnostic imaging / Q000601:surgery*; D014955:Wrist Joint; D055815:Young Adult
keywords: Neglected epiphyseal injury of distal-end radius; Osteotomy; Ulnar impaction