Distal ulna physeal fracture Salter-Harris type IV versus cleft ulnar epiphysis: Two pediatric case report

Forearm fractures in children are among the most common fractures however isolated distal ulnar physeal fractures are rare, especially Salter-Harris type IV fracture involving epiphysis, physis and metaphyseal parts. Growth disturbances are not uncommon in such fractures. Also, certain anatomical variants, including cleft ulna epiphysis, may mimic fracture lines on radiographs, unnecessary operational intervention may result from misinterpretation. We describe 2 cases the first of a 12-year-old child who had sustained a bilateral wrist trauma after falling from a bicycle. A left distal forearm both bones fracture was discovered on the first presentation, an attempted closed reduction failed. Closed reduction percutaneous pinning was conducted using Elastic intramedullary nails to surgically stabilize the fracture. A missed distal ulna Salter-Harris type IV physeal fracture was discovered 5 days later while repeating radiographs of the contralateral wrist. open reduction internal fixation was done and Kirschner wire was used for fixation. Recovery from surgery went smoothly. The patient showed accepted alignment and no clinical deformity at the third month follow-up visit. The second case was a 13-year-old male who was complaining of wrist pain and swelling following a fall onto an outstretched hand. A distal radius nondisplaced Salter-Harris type II fracture and a possible distal ulnar Salter-Harris type IV injury diagnosed on radiographs. Although closed reduction done, evaluation under general anesthesia was necessary due to ongoing radiologic concern. The diagnosis of cleft ulnar epiphysis rather than a trans epiphyseal fracture confirmed by intraoperative fluoroscopic stress testing, which showed a stable distal radioulnar joint without displacement. The patient showed preserved alignment at follow-up and was treated conservatively with immobilization. Careful radiographic evaluation is essential in the setting of bilateral wrist trauma to exclude isolated distal ulnar Salter-Harris type IV, and cleft ulna epiphysis can mimic Salter-Harris type IV on plain radiographs in pediatric trauma. Early reduction and follow up regularly to minimize the risk of growth disturbances and avoidance of misdiagnosis.