Growth plate injury of the hand and wrist in renal osteodystrophy

We present two cases of growth plate injury of the hand and wrist in young patients with renal rickets and osteodystrophy but no history of antecedent trauma. The postulated mechanism of injury is subclinical biomechanical stress on the involved extremity superimposed on the already weakened metaphysis and growth plate. Thus, the findings may be viewed as an insufficiency injury to the metaphysis and growth plate. Physicians should be aware that, in the absence of unusual athletic activity, epiphysiolysis of the upper extremity is uncommon and requires a search for underlying metabolic bone disease.